State Involvement in LPN Education in Florida Mary Lou Brunell, MSN, RN Executive Director

Program Topics Department of Education – Standard Curriculum Board of Nursing – Program Approval & Annual Report Board of Nursing – License Regulation Multistate Compact Florida Center for Nursing – Data Collection Annual for Education Programs Biennial for Licensees Biennial for Employers

FL Department of Education Career & Technical Education Develop & maintain educational programs that prepare individuals for occupations important to Florida’s economic development. Each program is aligned to a career cluster and is detailed in curriculum frameworks. With partners from education, business and industry, and trade associations, the curriculum frameworks include program standards that are both academically integrated and responsive to business and industry. Includes Secondary & Post-Secondary Practical Nursing Practical Nursing is scheduled for review in 2018

FL Board of Nursing Program Approval Program Annual Report Program Accountability LPN Licensure Regulation – Multistate Compact

Program Application Fee $1,000 / program offered Completed Application Form Program Director & at least 50% of faculty are registered nurses with a bachelor’s or higher degree in nursing Curriculum 50% of clinical in US or US Territory No more than 50% of clinical through simulation Signed agreements with clinical sites At least 1 faculty per 12 students Clinical Preceptor must be RN or LPN Outlines other curriculum requirements

Program Annual Report Submitted to Board of Nursing by November 1 of each year Certifies continued compliance and documents: # of applications # qualified # accepted # applicants enrolled # students enrolled # graduates Retention rates Accreditation status

Program Accountability NCLEX-PN passage rate for first-time takers not more than 10 percentage points lower than the national average of the same calendar year If not met for 2 consecutive years – probationary status & appearance before the Board with remediation plan On probation until achieves passage rate  national for 1 calendar year If does not achieve acceptable passage rate may have probation extended or may be terminated If program fails to submit the required annual report – appearance before the Board to explain the delay If fails to appear or does not submit report within 6 months – terminated

New in 2017 A program terminated or closed may not seek program approval under original or a new name for 3 years. The Board may adopt rules relating to the nursing curriculum, including rules relating to the uses and limitations of simulation technology. Annual survey previously managed by the Office of Program Policy Analysis & Government Accountability is now managed by the FL Center for Nursing.

Regulation – Enhanced Nurse Licensure Compact (eNLC) Allows LPN to practice across state lines in another Compact state MUST adhere to laws & rules of the state in which one is practicing ‘Home’ state is that in which the nurse establishes residency Effective January 19, 2018 with 26 states Issued to new applicants if all requirements are met Existing LPNs will have the option to convert to a multistate license

Multistate License Requirements Have a current, Clear, Active license Graduated from a qualifying education program (or graduated from a foreign program verified by independent credentials review agency) Pass the NCLEX exam Have no active discipline on a license Submit to a federal criminal background check Have no felony conviction Not currently enrolled in an alternative to discipline program (i.e. IPN) Have a valid U. S. Social Security number

Florida Center for Nursing Established in law (FS 464.0195) 2001 Purpose – to address issues related to the nursing shortage in Florida Overseen by 16 member Board appointed through the Governor’s Office Obligation is to the people of Florida Vision To be the definitive source for information, research, and strategies addressing the dynamic nurse workforce needs in Florida.

Statutory Mandate – 2017 Submit reports to the Governor, the President of the Senate, and the Speaker of the House of Representatives annually by January 30, through January 30, 2020. Annual reports shall Address the previous academic year Provide data on the specified Include an evaluation of such data for purposes of determining whether this section is increasing the availability of nursing education programs and the production of quality nurses The department and each approved program or accredited program shall comply with requests for data from the Florida Center for Nursing.

Statutory Mandate – Existing Without state funding need not comply. Develop a strategic statewide plan for nursing manpower in this state by:  Establishing and maintaining a database on nursing supply and demand in the state, to include current supply and demand; Analyzing the current supply and demand in the state and making future projections of such, Effort through the work of the Florida Action Coalition Convene various groups representative of nurses, other health care providers, business and industry, consumers, legislators, and educators Enhance and promote recognition, reward, and renewal activities for nurses in the state

Nurse Workforce Information The nurse data “trifecta”: Nurse Supply Data – licensure and renewal survey data analyzed biennially (consistent with renewal cycle) Nurse Demand Data – employer surveys of 6 industries conducted and analyze biennially (odd years) Nurse Education Data – LPN / RN pre-licensure and graduate programs surveyed and analyzed annually These data elements permit forecasting.

Florida’s Nurse Supply, January 2016

Age Distribution of Florida’s Working Nurses Average ages ARNP: 47.4 RN: 47.5 LPN: 45.9 Average Age RN = 47.5; slightly down LPN = 45.9; slightly up ARNP = 47.4; decreased

Age Distribution of Florida’s Working Nurses Average Age RN = 47.5; slightly down LPN = 45.9; slightly up ARNP = 47.4; decreased

Race/Ethnicity of Florida’s Working Nurses

Employment Settings and Practice Areas Where nurses work LPNs – 39% in Long-term Care; 15% in Home Health RNs – 64% in Hospitals ARNPs – 44% in Hospitals; 21% in Provider Offices Practice Preferences LPNs – Geriatrics; Home Health; Adult/Family; Rehabilitation RNs – Acute/Critical Care; Medical Surgical; Maternal-Child ARNPs – Adult/Family; Acute/Critical Care; Anesthesia; Peds/Neonatal

Nurse Demand Survey Every 2 years – Hospitals, Home Health, Skilled Nursing, Public Health, Hospice, Psychiatric Hospitals Last completed Summer 2015 Response rates overall 20%, ranged from 13% to 48% Down from 25% in 2013 This year responses even lower, so pulled the survey Exploring new approaches to data collection – perhaps a randomized sampling model

LPN FTE Vacancy Rates (%) by Industry 2007 – 2015 2007 – pre-economic downturn 2015 – post-economic recovery

LPN Average Turnover Rates

Vacant Positions (2015) /Projected Growth (2016) for RNs by Industry   LPN Vacancies 2015 LPN Growth 2016 Combined Hospitals 184 Skilled Nursing Insufficient data Home Health 2,380 4,655 7,035 Public Health 62 Hospice 64 17 81 Total (all groups) 2,654 4,672 7,362

Most Difficult to Fill are Specialty Positions Rank  Hospitals Skilled Nursing Home Health Public Health Hospice 1st Adult Critical Care (5-52 weeks) Nurse Aides (2-16 weeks) Home Care Staff RNs (1-52 weeks) School Nurses (4-45 weeks) Home Hospice Staff RNs (4-40 weeks) 2nd Emergency Department (4-52 weeks) Staff RNs (4 – 21 weeks) HHA/CNA Clinic Staff Nurses (4-63 weeks) Nurse Practitioners (4-33 weeks) 3rd Operating Room (2-52 weeks) LPNs (2-15 weeks) Nurse Supervisors (12-63 weeks) Patient Care Coordinators (3 to 36 weeks) 4th Cardiac Cath Lab Unit level manager (4-26 weeks) Case Managers NPs and Midwives (3-21 weeks) 5th Labor and Delivery Rehabilitation (6-12 weeks) Admin (8-52 weeks) Care Coordinators Inpatient Staff RN (4-25 weeks)

Trend in FT Faculty Vacancy Rates, 2007-2013

Do we know demand? Actual survey of Florida nurse employers (2015) Current Need = 2,654 LPN vacancies Future Growth = 4,672 RN positions Increasing Faculty vacancies Population Estimates – 3rd most populous state in US Growth / In-Migration Age (Increasing age = Increasing Demand) Difficult to Fill Positions Skilled Nursing; Home Health; Hospice

Education – Highest Degree Among Employed LPNs BSN and Higher Degree 2008-09 = 37.3% 2010-11 = 39.5% 2012-13 = 41.9% 2014-15 = 45.7%

Trend in New Graduate LPN

LPN Workforce Gains / Losses

For more information, to follow our work: Florida Center for Nursing visit: www.FLCenterForNursing.org