Update on the Texas Nursing Workforce Okay, so I am going to share a few demographics points with you, then I am going to jump over to projections, then we’ll go over some of the numbers from the 2017 NEPIS, and breeze through a few results from the 2017 staffing studies. And then hopefully I will still have time to walk you through the education dashboard that is now on our website. But first, allow me introduce you to Frank Gonzalez, if you’ve been working on the 2018 NEPIS you may have been in contact with him. He’s going to give you a few reminders about this survey. Pam Lauer, Texas Center for Nursing Workforce Studies, DSHS

The nursing workforce has become increasingly more diverse The nursing workforce has become increasingly more diverse. In 2009, the proportion of Whites in the nursing workforce was 68%. The proportion of males has remained relatively consistent Hospitals continue to employ the greatest percentage of nurses at nearly 2/3 of the RN workforce.

RNs per 100,000 Population Great, now how are we doing relatively speaking? Better than we were – using a standardized measure, nurses per 100,000 population, we are currently at 851.3. That’s 200 more nurses than 10 years ago and 300 more than 20 years ago. National measures are slightly higher but I’m hesitant to continue making that comparison until our methods for counting nurses align. Some sources use licensees, some use employed nurses…it varies and we will dive further into that when we update our demographics report. 2/24/2019

RNs with a BSN or Higher in Nursing As you’re all very much aware, we’ve been tracking Texas’ progress toward having 80% of nurses with a BSN or higher. As of September 2018, we are at 61.7% of nurses licensed and practicing in Texas with a BSN or higher in nursing. Source: TX BON relicensure data

Now let’s jump over to the projections Now let’s jump over to the projections. These have been out for a while now and we’ve presented these here before so I know most of you have seen this slide. I try to keep these in all of our presentations to keep everything in context of the bigger picture. Our projection model shows a shortage of nearly 60,000 RN FTEs by 2030. But this is just RNs and we really need to think about that in the context of all nurse types because in terms of training nurses there are limited resources that don’t just impact professional nursing education, but also vocational and advanced practice nursing education. 2/24/2019

While we are projecting a surplus of LVNs in Texas through 2027, by 2030 that surplus turns into a shortage of 4700 LVN FTEs. 2/24/2019

The shortage of nurse practitioners is projected to increase from about 4600 FTEs to almost 6500 FTEs by 2030. 2/24/2019

The demand for CRNAs will outpace supply leading to a shortage of almost 700 FTEs by 2030 2/24/2019

And there is a even a shortage projected for nurse midwives of over 900 FTEs by 2030. So combined there is a projected shortage of over 72,000 nurse FTEs, across the different nurse types, and based on 2014 levels of health care utilization. We plan to update these projections in the spring of 2020, and before then, at least chart our actual number of nurses to compare our supply lines. So look forward to that. 2/24/2019

Pre-licensure Admissions Moving on to education. There were 119 programs who responded to the NEPIS in 2017. The yellow line represents seats for new students, or their enrollment capacity, the red line represented number of applications submitted to programs, the green line represents the number of students actually offered admission, the brown line are ones who actually enrolled and were present on the 10th class day. In 2017 the 119 programs had space for 17,878 and they offered admission to over 18,000. 15,686 actually enrolled. 10,353 were not offered admission 2/24/2019

Pre-licensure RN Graduates In terms of graduates, the number peaked in 2014, dropped in 2015 and has been on an upward trend since then. In Texas we had 11,677 graduates from professional nursing programs during the 2016-2017 academic year.

Demographics of Pre-licensure RN Graduates In terms of demographics, In 2017, almost 46% of graduates from professional nursing education programs were under the age of 25 and less than half were white. In 2011, the earliest year we collected these same categories, about 39% of graduates were under 25 and 54% of graduates were white. Those are considerable changes over a the 7 year period. So our nursing graduates are younger and more racially/ethnically diverse than they were at the beginning of this decade.

RN to BSN Graduates There were 41 post-licensure RN programs in during the 2016-2017 academic year they graduated 3,319 students. This represents a decrease of over 200 graduates from the previous year.

Demographics of RN to BSN Graduates In terms of the demographics of the RN to BSN graduates, the age group with the greatest proportion was the 31-40 year age group, with more than 1/3 of graduates being in this age category. Nearly 51% of these graduates were white, nearly a quarter Hispanic, and 15% were black/African American ( a slightly higher proportion than among the pre-licensure graduates – 12.5%).

Barriers to Increasing RN Graduates Pre-licensure Graduates Lack of qualified faculty and lack of available clinical sites (30.6% each) Lack of classroom or lab space (9.0%) RN to BSN Graduates Lack of clinical space/competition with other programs (24.4%) Cost of program or student financial difficulties (12.2%) Not offering an online program (9.8%) We also asked programs to identify their barriers to increasing graduates. 30.6% of pre-licensure programs identified lack of qualified faculty applicants and the same number identified lack of available clinical sites. Barriers to increasing RN to BSN graduates, lack of clinical space or competition for clinical space was the most frequently identified barrier by nearly a quarter of programs. Program cost and not offering an online program were the other two identified barriers.

Faculty Vacancy & Turnover Rates Vacancy and turnover rates have been on the decline since reaching their highest levels in 2015. The average vacancy rate going back to 2008 is 6.6% and the average turnover rate is 13.4%. We find that rates for both of these measures are higher in ADN programs than in BSN programs.

Faculty Age We hear a lot about faculty shortages and specifically the aging of faculty. So I’ve presented this figure before but this time I’ve included a comparison to 2009. 22.5% of faculty in Texas are 62 or over. Now the significance of 62 is that it is the earliest someone can pull social security benefits, or early retirement, but even still more than 10% of faculty are 66 or older, so already eligible for retirement. In 2009, it was 7.5%.

RN Vacancy Rates by Setting, 2017 All surveys include questions related to staffing that can be used to calculate vacancy and turnover rates. Vacancy and turnover are just two measures that can help us better understand the nurse job market. These measures help us assess: the availability of jobs and the work environment. In lieu of sophisticated projection models, vacancy and turnover rates have been used as key indicators of a nursing shortage. The bars in this figure represent state-level vacancy rates among employers of nurses. Vacancy rates are calculated by taking the total number of vacant FTEs and dividing it into the total number of filled and vacant positions. Hospitals had the lowest vacancy rate during the 2017 reporting period at 8.1%. LTC facilities had the highest vacancy rate at 18.9%. 2/24/2019

Median RN Turnover Rates by Setting, 2017 Turnover rates are calculated by taking the total number of separations in an agency and dividing it into the average number of nurses over a calendar year. We calculate the turnover rate for every surveyed facility and then report the median among all facilities. Turnover rates are based on head counts. Among surveyed employers, the median facility turnover rate ranged from 0% in governmental public health agencies to 50% in long term care. That means that 50% of long term care facilities that responded to our survey had a turnover rate of at least 50%. 2/24/2019

Hospital RN Vacancy and Turnover Rates, 2010-2017 Hospitals employ about 65% of nurses in Texas so lets focus in on vacancy and turnover trends in just hospitals. This figure shows vacancy and turnover rates between 2010 and 2017. Vacancy rates are represented by the yellow line and ranged from 6.8% in 2010 to 9.8% in 2016, then they dropped to 8.1% in 2017. Turnover rates are represented by the red line and ranged from 20.0% in 2010 to the highest rate of 24.5% in 2017. Source: Hospital Nurse Staffing Study, 2010-2017

Nursing Dashboards Texas Health Data healthdata.dshs.texas.gov

2/24/2019

Coming up next 2018 NEPIS 2018 WPV Facility Survey 2019 Staffing Studies Hospital Home Health and Hospice Long Term Care Texas Governmental Public Health Agencies Workplace Violence grant program Updated projections in mid-2020 More nursing data on Texas Health Data

Pamela.Lauer@dshs.texas.gov Frank.Gonzalez@dshs.texas.gov www.dshs.texas.gov/chs/cnws 2/24/2019