The Present & Future of California’s Registered Nurse Labor Market: Shortages, Surpluses, and Surprising Trends Joanne Spetz, University of California, San Francisco Deloras Jones, California Institute for Nursing and Health Care September 29, 2011

The market, it is a-changin’…. Is the shortage over? Does California have a surplus of RNs? Will health care providers be able to hire all the RNs needed now and in the long term? 2

Goals for this webinar Learn how employers perceive the current RN labor market Link employer perceptions with recent data on RN employment and education Compare regions of California with a newly updated “report card” Forecast future supply and demand Review next steps for understanding California’s RN labor market 3

The collaboration Betty Irene Moore Nursing Initiative California Institute for Nursing and Health Care Institute for Health Policy Studies, University of California, San Francisco Hospital Association of Southern California Acknowledgements & thanks to… –California Hospital Association –Hospital Council of Northern & Central California –Hospital Association of San Diego & Imperial Counties –UCSF Staff & Interns: Dennis Keane, Tim Bates, Lela Chu, Jessica Lin –Nikki West at CINHC 4

What is going on in our RN labor market? More than a decade of severe shortage, Reports that new graduates cannot find jobs 2009-now Stories that nurses are not retiring when expected Shortages in some regions Context: Ongoing recession, high unemployment, severe regional differences 5

Goals for this webinar Learn how employers perceive the current RN labor market Link employer perceptions with recent data on RN employment and education Compare regions of California with a newly updated “report card” Forecast future supply and demand Review next steps for understanding California’s RN labor market 6

Survey of Nurse Employers, Fall 2010 Collaboration between UCSF, CINHC, and HASC survey with option to return paper survey via fax or Questions based on previous CINHC survey and National Forum of State Nursing Centers “Minimum Demand Data Set” recommendations Follow-up short survey conducted Spring

Perceptions of employers, fall

Differences across regions, Fall 2010 & Spring Lower number = more shortage

Rural versus urban perceptions 10 Lower number = more shortage

Differences by hospital size 11 Lower number = more shortage

Change in difficulty recruiting, compared to last year, Fall

Change in difficulty recruiting, compared to last quarter, Spring

Share of budgeted positions filled, Fall

Per diem, traveler, and agency use 15 Traveler RN share rose to 2.9% in Spring 2011

Turnover & hiring 16

Hiring of newly graduated RNs 17

New graduate training programs 67.4% have a formal training program 80.4% developed program internally Most common capacity is new grads (up to 60 grads) Most common length is 12 weeks (up to 24 weeks) 18

Clinical areas for new graduate training 19

Staff RN Vacancies, Fall 2010 & Spring Estimated 1,772 vacancies for new RN graduates in Fall 2010

Hiring expectations for 2011, from Fall

Average expected change in hiring, Spring 2011 vs. Summer

Planned employment growth for 2011 & 2012, from Fall These data are for respondents, not all California hospitals

New graduate hiring plans, Average growth of 12% expected

Reasons for planned changes in new graduate hiring, Fall

Reasons for expected change in hiring 26

Goals for this webinar Learn how employers perceive the current RN labor market Link employer perceptions with recent data on RN employment and education Compare regions of California with a newly updated “report card” Forecast future supply and demand Review next steps for understanding California’s RN labor market 27

Employment rates by age, 2008 & Source: California Board of Registered Nursing Survey of RNs, 2010

Share of RNs working in multiple jobs, 2008 & Source: California Board of Registered Nursing Survey of RNs, 2010

Reasons for not working in nursing % important or very important 30 Source: California Board of Registered Nursing Survey of RNs, 2010

Nurse earnings over time 31 Source: California Board of Registered Nursing Survey of RNs, 2010

Job satisfaction over time 32 Source: California Board of Registered Nursing Survey of RNs, 2010

Future plans of RNs 33 Source: California Board of Registered Nursing Survey of RNs, 2010

RN Graduations are expected to drop in New enrollment Projected enrollment from 1 yr Projected enrollment from 2 yrs Graduations ,98814,62113,69210, ,22814,91714,21611, ,05514,83512,447* ,22313,273* ,616* ,766* 34 Source: California Board of Registered Nursing Annual Schools Report,

Goals for this webinar Learn how employers perceive the current RN labor market Link employer perceptions with recent data on RN employment and education Compare regions of California with a newly updated “report card” Forecast future supply and demand Review next steps for understanding California’s RN labor market 35

CA MSA Report Card: RN Jobs per capita 2004 Report Card of RN jobs/capita replicated with 2010 data Comparison of the RN workforce in different areas of the state…measurement of “density’ of RN jobs Comparison of CA RN workforce to the rest of the country Useful for regional planning

Methodology Formula: # RN Jobs x 100,000 = RN jobs/100,000 population Measurement: based on data from Bureau of Labor Statistics & US Census Bureau Rpt card values (letter grade): grading rubric constructed based on S.D. from median of RN jobs/capita of 50 states + D.C. (198 jobs = 1 S.D.) Letter grade given to 23 MSA Represents # of RN jobs NOT # of RNs working

Grading Rubric Grading Rubric: Letter Grade Range of RN jobs per 100,000 population values DefinitionNumber of States Number of California P/MSAs A1257 or more2 + SD > mean30 B SD > mean50 C SD > mean101 C SD mean221 C SC <mean77 D SD < mean410 F462 or less2 + SD < mean04 Mean:859.9 SD:198.2

Results National average RN jobs/capita = 860 (C) CA received a D with RN jobs ratio = MSAs = or > Nat’l average (SF and Redding) 4 MSAs = Fs with RN job ratio < 462/capita 10 MSAs = D Most MSAs retained same grade as in 2004; 5 improved; 5 dropped their grade Although CA RN job ratio increased by 22 jobs/capita, CA ranking relative to the rest of the country remained the same, as the rest of the country also added RN jobs

Letter grade by States

CA Letter Grades by P/MSA

Distribution of CA Letter Grades

Goals for this webinar Learn how employers perceive the current RN labor market Link employer perceptions with recent data on RN employment and education Compare regions of California with a newly updated “report card” Forecast future supply and demand Review next steps for understanding California’s RN labor market 43

Board of Registered Nursing Forecasts of Supply 44 Nurses with Active Licenses Living in California Outflow of nurses Inflow of nurses Full-time equivalent supply of RNs Share of nurses who work, and how much they work

The range of supply forecasts (RNs living in California) 45 Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2011

Variation in FTE employment with assumptions about work and retirement 46 Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2011

Forecast of Full-time Equivalent RNs per 100,000 population 47 Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2011

What is demand? National benchmarks: Employed RNs per 100,000 Bureau of Labor Statistics, forecast of 2018 demand Growth based on current hospital employment & expected growth in patient days Potential impact of PPACA 48

Forecasts of RN demand 49 Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2011

Best supply and demand forecasts for RNs, Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2011

Implications for policy How do we define shortage? –Are current employment levels adequate? –Should California be at the national average? 25 th percentile? Bottom? –Economic demand vs. need-based demand In this economy… –Demand estimates have dropped and supply is high 51

Goals for this webinar Learn how employers perceive the current RN labor market Link employer perceptions with recent data on RN employment and education Compare regions of California with a newly updated “report card” Forecast future supply and demand Review next steps for understanding California’s RN labor market 52

Check out our website! hboard.htmlhttp://futurehealth.ucsf.edu/SupplyDemand/Das hboard.html 53

Also go to the BRN website Forms  Publications 54

Available from the BRN website Annual Schools Report –Public-use Excel workbook to summarize data by region, type of program… RN Surveys (every 2 years) –Full reports –Link to a webpage with summary data, and ability to get regional and other cuts of the data RN Forecasts –Full reports –Regional reports when we have them Other studies 55

What is happening next? CINHC & BRN are launching a survey of recently-graduated RNs UCSF, CINHC, and the Hospital Associations are launching Year 2 of the employer survey UCSF & BRN are soon collecting Annual Schools Survey 2012 BRN Survey of RNs (mailed in spring) 56

Questions? Thoughts? Ideas? Perspectives? 57