2013 & 2014 NSP I Data Joan Warren, PhD, RN-BC, NEA-BC, FAAN HSCRC Contractor Associate Professor, University of Maryland School of Nursing

2001 to 2013 NSP I $80,600,000 . 2006 – 2015 NSP II $63, 374,650 Between 2001 and 2013 $80.6 million have been funded in rates to support NSP I programs for hospitals

NSP I Program In 2012, NSP I program aims aligned with IOM Future of Nursing recommendations: “Education and career advancement Nurse Residency Program Orientation Critical Need Transitional (nurse refresher) program RN Tuition Assistance RN Tuition Assistance NURSING STUDENTS

NSP I Program Patient quality and satisfaction RN Professional certification RN Technical certification RN continuing education Advancing the practice of nursing Nursing Excellence (ANCC Magnet or Pathway to Excellence Designation) Shared Governance Model Evidence-based Practice, Quality Improvement, and/or Research projects

NSP I Data Hospital Completion Rate Response Rate 2013 90% (45/50) 2014 88% (44/50)

Stress Not number of hospitals-rather funds

Budget Distribution 2014 2013 5 M Nurse Residency Programs 1.4 M Tuition Assistance RNs 1.4 M RN Continuing Education 1.1M RN Nursing Excellence 1M Orientation Critical Need Areas 441K Research 3.3 M Nurse Residency Programs 2 M Orientation Critical Need Areas 2 M Tuition Assistance RNs 1.2 M RN Nursing Excellence 1 M RN Continuing Education 773 K Shared Governance

Budget Distribution 2014 2013 405 K Tuition Assistance Nursing Students 312 K Shared Governance 276 K Transitional RN Programs 229 K Initial RN Certification 143 K RN Recertification 617 K Research 220 K Tuition Assistance Nursing Students 220 K Initial RN Certification 73 K RN Recertification 53 K Transitional RN Programs

NSP I Budget Variance 4,852,006 6,299,636 39% Variance 30% Variance 2013 30% Variance 2014 39% Variance Reported Total Budget 16.7 M Budget Distribution 11.8 M Variance 4,852,006 Reported Total Budget 16.1 Budget Distribution 11.5 M Variance 6,299,636 Increased variance may account for changes in amounts reported for each category

Education & Career Advancement Nurse residency programs, Orientation for critical need, Transitional (refresher) RN programs, Tuition assistance programs

Nurse Residency Programs ADN 33% (319) BSN 61% (581) MS/MSN 3% (30) Reported Total 960 N=22 ADN 37% (387) BSN 60% (628) MS/MSN 2% (23) Reported Total 1045 N=22 Hospitals funding residency programs for new RN graduates were asked to report recruitment and retention outcome metrics. Table 3 compares the year-to-year differences. Comparing hospital hiring practices for baccalaureate-prepared RN (BSN) and RN prepared at the associate degree level, it appears hospitals are more likely to hire BSN RN. BSN RN were practically twice as likely to be hired in 2013 (BSN RN=581, 61%; AND RN = 319; 33%) and 2014 (BSN=628, 60%; ADN=387; 37%). Of note, between 2013 and 2014 the turnover rate for newly licensed RN enrolled in a residency program was reduced by 6%.

Nurse Residency Programs 2013 2014 Voluntary Turnover 9% (83) Involuntary Turnover 3% (24) Total Turnover 12% (107) Voluntary Turnover 4% (40) Involuntary Turnover 3% (30) Total Turnover 7% (70)

Orientation Programs: Critical Need Total RN 264 Voluntary Turnover 34% (89) Involuntary Turnover 7% (18) Total Turnover 41% (107) N=15 Total RN 248 Voluntary Turnover 59% (146) Involuntary Turnover 7% (17) Total Turnover 66% (163) N=16 Hospitals with orientation programs for transitioning RN into hard-to-fill critical need positions were asked to report turnover data (Table 4). Although fewer hospitals (2103 N= 23; 2014 N= 18) funded these programs in 2014, the amount of funding doubled in 2014. However even after this large infusion of money, the turnover rate substantially increased from an already high 41% in 2013 to 66% in 2014.

RE Transitional (Refresher) Program 2013 276K 2014 53K ADN N=17 BSN N= 6 Total 23 N=3 ADN N = 0 BSN N = 2 Total 2 N=3

RN Tuition Assistance Number Enrolled BSN 52% (261) MS/MSN 30% (150) DNP/PhD 4% (7) Reported Total 499 N = 14 BSN 52% (322) MS/MSN 26% (158) DNP/PhD 1% (7) Reported Total 618 N = 15

RN Tuition Assistance Academic Progression 2013 2014 Graduates BSN 66% (78) MS/MSN 34% (40) DNP/PhD 0 Reported Total 119 Attrition 2% Graduates BSN 83% (92) MS/MSN 17% (19) DNP/PhD 0 Reported Total 111 Attrition 3.6%

Nursing Student Tuition Assistance Number Enrolled 2013 405 K 2014 168 K ADN 48% (60) BSN 43% (53) MS/MSN 1% (11) Reported Total 124 N = 13 ADN 37% (47) BSN 51% (65) MS/MSN 12% (15) Reported Total 127 N = 14 Similar to RN tuition assistance hospitals reported on maximum amounts allotted to students for tuition support using NSP I funding. The maximum amount in 2013 was $6,500 with a mean of $2,218. In 2014 the maximum amount increased to $10,000 with a mean of $3,239 Table 8 compares hospital responses regarding tuition assistance support for student nurses. The number of hospitals offering tuition assistance to student nurses declined by more than 25% (2013 N= 23; 2014 N= 17) however the number of students supported by NSP I funds remained essentially unchanged (2013 N= 124; 2014 N=127). With the change in amount of tuition assistance were changes in the type of nursing degree program between these two years. In 2013, a greater number of students were enrolled in AD nursing programs. But in 2014, more students were enrolled in BSN programs. Additionally, student attrition rate declined from 14% (2013 N=9) to 5% (2014 N=9). Of interest, although a greater number of students were enrolled in AD programs in 2013, fewer students graduated from these programs compared to their BSN counterparts (Table 9). It is unclear if this change in program preference for BSN programs is student or hospital preference desiring more BSN prepared RN. Finally, hospitals shared student hiring rates. The number of student hires by the supporting hospitals increased from 85% (Hired N= 61; Total Graduates = 72) in 2013 to 91% in 2014 (Hired N = 84; Total Graduates = 92).

Nursing Student Tuition Assistance Academic Progression 2013 2014 ADN 22% (17) BSN 63 % (49) MS/MSN 14% (11) Reported Total 77 Attrition 14% ADN 16% (10) BSN 66% (41) MS/MSN 18% (11) Reported Total 62 Attrition 5%

Patient Quality and Safety Certification & Continuing Education

Certification RN New Cert 115 RN Recert 201 Cert Rate FY Start 23% 2013 Initial 229 K Recert 143 K 2014 Initial 168 K Recert 73 K RN New Cert 131 RN Recert 100 Cert Rate FY Start 17% FY End 20% N= 11 RN New Cert 115 RN Recert 201 Cert Rate FY Start 23% FY End 25% N= 14 Includes both technical and professional certification; 2-3 % growth over 2 years

RN Continuing Education 2013 1.4 M 2014 1M EBP 39% (507) Other 24% (306) Leadership 12% (155) Patient Safety 9% (122) Quality 9% (117) Excellence 3% (47) Suc Plan 3% (33) Total 1287 N = 20 Other 34% (306) EBP 33% (297) Patient Safety 15% (140) Quality 7% (60) Leadership 6% (52) Excellence 3% (29) Suc Plan 2% (20) Total 904 N= 20 Combined Magnet and Pathway

External Continuing Education 2013 2015 Total Number 2446 Hospital M= 116 N = 20 Total Number 3494 Hospital M = 159 N = 20

Advancing the Practice of Nursing Nursing excellence programs, Shared governance models, Evidence-based practice and research

Nursing Excellence Designation 2013 2014 No plan 25 Magnet designated 7 Magnet Journey 10 Pathway 3 No plan 25 Magnet designated 7 Magnet Journey 11 Pathway 2

Shared Governance 2013 312 K 2014 774K 15 Hospitals 2013 & 2014 Qualitative Funds used to pay staff for education/meeting time Used to backfill staff during meetings

Research 2013 5 Hospitals 2014 8 Hospitals 2013 441 K 2014 618 K Qualitative Nurse residency retention Healthy work environments Perinatal depression Used to support nurse residents with EBP project

Hospital Metrics RN Vacancy Rate 11% RN Vacancy Rate 9% Turnover 2013 2014 RN Vacancy Rate 11% Turnover Voluntary 14% Involuntary 4% New Hire Retention 76% RN Vacancy Rate 9% Turnover Voluntary 12% Involuntary 4% New Hire Retention 76%

Summary Education Steering Committee Revised data collection tool including definitions Importance of accurate data Attestation of data by CFO, CNO, & NSP I Coordinators Orientation Steering Committee Software for reporting and analyzing outcomes data Program monitoring/audits