California’s Nursing Workforce: New Research Joanne Spetz, Ph.D. University of California, San Francisco February 7, 2012

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 2

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 6 Lower number = more shortage

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

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

BRN surveys Survey of RNs, 2010 –10,000 RNs sampled, ~65% response rate –Paper survey with option to do online survey Annual Schools Survey, –Online survey of all nursing programs –100% response rate 9

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

Reasons for not working in nursing % important or very important 11 Source: California Board of Registered Nursing Survey of RNs, 2010

Nurse earnings over time 12 Source: California Board of Registered Nursing Survey of RNs, 2010

Future plans of RNs 13 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* 14 Source: California Board of Registered Nursing Annual Schools Report,

Board of Registered Nursing Forecasts of Supply 15 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) 16 Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2011

Variation in FTE employment with assumptions about work and retirement 17 Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2011

Forecast of Full-time Equivalent RNs per 100,000 population 18 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 19

Forecasts of RN demand 20 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 22

What is happening next? UCSF, CINHC, and the Hospital Associations is analyzing Year 2 of the employer survey UCSF & BRN are nearly done with the Annual Schools Survey 2012 BRN Survey of RNs (mailed in spring) 23

Questions? Thoughts? Ideas? Perspectives? 24