North Dakota Nursing Needs Study: Year Four Results and Comparisons Patricia Moulton, Ph.D. Presentation for the North Dakota State Board of Nursing July 21, 2006 C H R Overview of the North Dakota Nursing Needs Study Year Four Data Collection Projects Year Four Products Workplace Characteristics Salary Nursing Supply Pipeline Year Four Conclusions Year Five and Six Data Collection Projects 1
North Dakota Nursing Needs Study Projects 2003-2004 2002-2003 2004-2005 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 Year: 1 2 3 4 5 6 7 8 9 10 Facility Survey Licensed Nurse Survey Licensed Nurse Focus Groups Faculty Survey Faculty Focus Groups Education Technology Assessment Student Survey Student Focus Groups High School Student Survey Supply and Demand Projections Year Four Data Collection Projects Healthcare Facility Survey 200 facilities responded 96% of counties represented Licensed Nurse Survey 1,457 surveys completed on-line 30% of Nurses who renewed on-line High School Student Survey 568 students completed the survey online 19 counties were included 2
Year Four Products Nursing Supply Fact Sheet Nursing Demand Fact Sheet Online reports for the three data collection projects Legislative Testimony Presentations and Posters at the National (3), State (4) and Community (3) level. Data has been incorporated into National Nurse Shortage Designation effort. Conclusions from the study are being considered by the North Dakota Nursing Leadership Council. Workplace Characteristics 3
Statewide Vacancy Trend 14% 12% 10% 8% 6% 4% 2% 0% 2003 2004 2005 2006 LPN RN LPN Vacancy Rate Map Note. Vacancy rates include all responding health care facilities within each county (hospital, long-term care, clinic, home health and public health). Also, there is a difference in the numbers of incomplete responses across years. For example, there were 18 counties in 2005 and 23 in 2006 with incomplete data. 4
RN Vacancy Rate Map Note. Vacancy rates include all responding health care facilities within each county (hospital, long-term care, clinic, home health and public health). There were similar numbers of counties with incomplete data in 2005 and 2006. Statewide Turnover Trend 25% 15% 10% 5% 0% 2003 2004 2005 2006 LPN RN 5
LPN Turnover Map Note. Turnover rates include all responding health care facilities within each county (hospital, long-term care, clinic, home health and public health). Also, there is a difference in the numbers of incomplete responses across years. For example, there were 18 counties in 2005 and 28 in 2006 with incomplete data. RN Turnover Rate Map Note. Turnover rates include all responding health care facilities within each county (hospital, long-term care, clinic, home health and public health). Also, there is a difference in the numbers of incomplete responses across years. For example, there were 11 counties in 2005 and 23 in 2006 with incomplete data. 6
Workplace Changes Observed by LPNs in the Last Three Years Voluntary Overtime Larger Patient Care Load Decreased Quality Care Increased Use of LPNs Organizational Decisionmaking Non-patient Care Duties Increased Floating Mandatory Overtime 5% 5% 11% 12% 12% 12% 15% 22% 24% 28% 30% 18% 14% 17%21% 28% 23% 29% 30% 30% 35% 35% 41% 43% 45% 40% 43% 50% 51% 53% 0% 10% 30% 40% 50% 60% 70% 80% 90% 100% Percentage of Nursing Staff 2003 2004 2005 2006 Workplace Changes Observed by RNs in the Last Three Years Voluntary Overtim e Larger Patient Care Load Decreased Quality Care Inc reased Use of LPNs 26% 26% 27% 31% 17% 18% 17% 49% 42% 48% 50% 51% 42% 47% 52% Organizational Decisionmaking Non-patient Care Duties Increased Floating 14% 19%21% 15% 19% 19% 32% 37% 32% 37% 36% 38% Mandatory Overtim e 19% 23%27% 19% 0% 10% 30% 40% 50% 60% 70% 80% 90% 100% Percentage of Nursing Staff 2003 2004 2005 2006 7
Nurses with a Secondary Nursing Job 100% 90% 80% 70% 60% 50% 40% 30% 33% 31% 35% 27% 23% 22% 21% 10% 0% 2003 2004 2005 2006 LPN RN Nurses Working Part-Time 100% 90% 80% 70% 60% 50% 40% 30% 10% 0% 33% 24% 25% 23% 2003 2004 2005 2006 8
Salary Issues C H R Starting Salary from the Facility Survey 9
Starting Hourly Wage by Education Level APN $25.49 Bachelor RN $16.46 Associate RN $16.69 Associate LPN $11.14 Diploma LPN $12.12 $0.00 $5.00 $10.00 $15.00 $20.00 $25.00 $30.00 Wage Starting Hourly Wage by Rurality LPN RN $13.02 $12.10 $11.68 $18.30 $16.05 $15.34 APN $23.91 $22.61 $27.80 $0 $5 $10 $15 $20 $25 $30 Starting Wage Rural Semi-rural Urban 10
Starting Hourly Wage by State Quadrant Comparison of Starting Wage by Year LPN $11.45 $11.99 $12.13 RN $15.46 $15.97 $16.82 APN $18.10 $21.50 $25.06 0 5 10 15 20 25 30 Starting Wage 2006 2005 2004 11
C H R Average Salary from Facility Survey Average Hourly Wage by Nursing level APN $34.27 Bachelor RN $19.10 Associate RN $19.19 Associate LPN $15.77 Diploma LPN $13.72 $0 $5 $10 $15 $20 $25 $30 $35 $40 Average Wage 12
Average Hourly Wage by Rurality LPN $15.47 $13.77 $13.89 RN $18.63 $17.51 $21.55 APN $32.94 $33.57 $37.61 $0 $5 $10 $15 $20 $25 $30 $35 $40 Average Wage Rural Semi-rural Urban Average Hourly Wage by State Quadrant 13
Comparison of Average Wage by Year LPN $13.75 $14.00 $14.02 RN $18.90 $19.12 $19.90 APN $21.68 $29.00 $34.27 0 5 10 15 20 25 30 35 Average Salary 2006 2005 2004 C H R Self-reported Salary from Licensed Nurse Survey 14
Average Income by Urban-Rural Status Nurse Level & Rurality LPN $24,742 (n=104) RN $42,057 (n=429) APN $80,987 (n=31) Overall Mean Urban Semi-Rural Rural Overall Mean $22,490 (n=108) $37,974 (n=294) $80,000 (n=14) $26,300 (n=20) $37,039 (n=48) $67,667 (n=6) $23,828 $40,188 $79,149 $40,941 $35,290 $36,620 $38,409 LPN Reported Salary and Rurality $50,000 $45,000 $40,000 $35,000 $30,000 $25,000 $20,000 $28,408 $25,285 $21,941 $26,300 $23,321 $24,742 $23,218 $22,490 $22,145 $15,000 $10,000 $5,000 $0 LPN 2004 LPN 2005 LPN 2006 Urban Semi-Rural Rural 15
RN Reported Salary and Rurality $50,000 $46, 571 $45,000 $40,000 $41, 322 $41,467 $39,807 $42,057 $35,000 $30,000 $34,117 $34,616 $37,974 $37,039 $25,000 $20,000 $15,000 $10,000 $5,000 $0 RN 2004 RN 2005 RN 2006 Urba n Semi-Rural Rural Nursing Supply Pipeline 16
LPN Clinical Education 50% 45% 40% 35% 30% 25% 15% 10% 5% 0% 31% 32% 22% 19% 13% Urban Semi-rural Rural 2003 2006 30% RN Clinical Education 60% 50% 56% 44% 43% 50% 40% 30% 33% 33% 10% 0% Urban Semi-rural Rural 2003 2006 17
High School Student Field of Future Career healthcare 38% business technology engineering 26% 21% 21% sciences teaching law construction agriculture finance 16% 16% 14% 14% 9% 6% 0% 10% 30% 40% 50% 60% 70% 80% 90% 100% Percent Area of Healthcare nursing physician physical therapist chiro practor pharmacist dentist lab/radiology/med tech physician's assistant o ccu patio nal therapis t 30% 25% 19% 18% 16% 11% 9% 38% 0% 10% 30% 40% 50% 60% 70% 80% 90% 100% Percent 18
Reasons for Not Planning on Nursing dislike nursing settings 18% unpleasant work hours hate blood dislike ill people salary 11% 11% 9% 8% 6% 0% 10% 30% 40% 50% 60% 70% 80% 90% 100% Percent Highest Degree Planned 100% 90% 80% 70% 60% 50% 40% 30% 10% 0% 33% 21% 25% 12% 8% CNA LPN RN A PN Ph.D. Level 19
Location of Future Employment 100% 90% 80% 70% 60% 50% 40% 30% 10% 0% 29% 25% 18% 12% 10% 5% Urban Semi-rural Rural MN, SD, or MT Other state Uncertain Location Scenarios that would Encourage Healthcare Careers emplo yer agreed to p ay tuition if work for them 61% workers would be in high demand jobs have starting salary > 30k guaranteed a job in ND after college 51% 50% 49% 0% 10% 30% 40% 50% 60% 70% 80% 90% 100% Percent who Ag ree 20
Overall Conclusions Year 5 data collection efforts will help to determine if the decrease in severity of the RN shortage is just a one-year blip or a real phenomenon. There is a large pool of currently licensed nurses (23%) that are not currently fully utilized in the workforce. There is a pool of high school students interested in healthcare (38%) and potentially the nursing profession. Almost half of students plan to work in North Dakota and ¼ are unsure. Efforts should be increased to recruit and retain these future nurses in North Dakota. Efforts to coordinate facilities with education programs would increase the potential for increased clinical education opportunities in rural areas. Year 5 and 6 Data Collection Projects Year 5 Facility Survey Licensed Nurse Survey Year 6 Faculty Survey Supply and Demand Projections 21
C H R For more information contact: Center for Rural Health University of North Dakota School of Medicine and Health Sciences Grand Forks, ND 58202-9037 Tel: (701) 777-3848 Fax: (701) 777-6779 http://medicine.nodak.edu/crh 22