CNO (Insert your name & organization here) The IOM Recommendations & An Update on the Wisconsin Nursing Workforce The Need to Advance Education in Nursing CNO (Insert your name & organization here)

WCN Mission Assure an adequate, well-prepared and diverse nurse workforce to meet the needs of the people of Wisconsin

Data Driven Process Three surveys: RN, LPN, & Educational Survey designs; based on National Minimum Dataset: Supply, Demand & Education from National Forum of State Nursing Workforce Centers DSPS - Distribution of surveys DWD – Data security & initial analysis WCN – analyses by nursing researchers & dissemination with recommendations Benchmark data from national reports (HRSA)

Trends impacting nursing workforce Growing elderly populations Increased diversity of population Aging healthcare workforce Faculty shortage & age Potential impact of healthcare reform (ACA) Economy

RN workforce per 100,000 population Source: The U. S RN workforce per 100,000 population Source: The U.S. Nursing Workforce: Trends in Supply and Education (HRSA, 2013).

Wisconsin projected population growth 2000-2035 Table 1. Wisconsin Projected Population by Age Group, 2000-2035 Age Group Census 2000 Projected 2015 Projected 2035 Percent Change 0-17 1,368,756 1,349,090 1,448,200 5.8 18-64 3,292,406 3,739,160 3,720,200 13.0 18-24 520,629 553,530 577,800 11.0 25-44 1,581,724 1,547,380 1,570,350 -0.7 45-64 1,190,053 1,638,250 1,572,050 32.1 65 & over 702,553 900,170 1,485,570 111.5 65-84 606,928 764,710 1,263,020 108.1 85 & over 95,625 135,460 222,550 132.7 Source: Egan-Robertson, D., Harrier, D. & Wells, P. (2008).  

2012 Wisconsin RN Survey Findings 83.9% actively working as nurse in healthcare 3.1% working in healthcare non-nurse 1.8% working in another field 50,315 working in direct patient care (75% who answered the question) 5,664 Advanced Practice with Masters or higher 5.7% APRNs vs 8.7% nationally; lowest per population in the nation. 78,159 online and 3000 manual

Employment Status & Location 2012 RNs: 53.6% hospitals 17.3% ambulatory care 10.7 % nursing home/extended care 5.7% home health Average age: 48 Average experience: 15 years 2013 LPNs: 10.7% hospitals 29.1 % ambulatory care 42.1% nursing home/extended care 6.8% home health Average age: 50 Average experience: 20 years

Median RN age: 48 Average 15 years of experience Median LPN age almost 50

RNs 55 & older by work setting

LPNs 55 & older by work setting

Gender in Wisconsin Nurses Assembly of Men in Nursing Goal: 20% Men by 2020 Wisconsin Nurses by Gender   % Female % Male WI 2010 RN 93.2 6.8 WI 2012 RN 93.1 6.9 WI 2011 LPN 95.4 4.6 WI 2013 LPN 95.6 4.4 Source: WCN DWD 2010-2012-2013 Wisconsin Nurse Survey Summaries

Race/Ethnicity In Wisconsin Nurses Source: 2012 RN & 2011 WI LPN At-a-Glance Caucasian African American Hispanic Other WI RN 93.5 2.0 1.4 3.0 WI LPN 91.0 6.3 1.9 3.8 WI Population 85.0 6.0 US Population 78.1 13.1 16.7 6.4

RN Plans to Leave Direct Patient Care

LPNs – Plan to Leave Direct Patient Care Source: 2013 Wisconsin LPN Survey

RN/LPN Intent to Leave Within 9 years 59.5% LPN’s leave the workforce (Northern region-63.3%) Next 2 years- 3,000 RN will leave Next 4 years 9,622 holding DCP will leave (retirement, job stress, physical demands) Within 5-9 years another 22.3% of RN DCP providers expressed intent to leave Significant shortages projected at same time as physician shortages & other health professionals

New Graduate RN Pipeline Approximately 3100 RN and 1000 LPN’s a year.

Add your hospital nursing data here

DWD Forecasting Tool Developed by economists Projections include a variety of scenarios Potential gap: 34- 36% by 2035 Potential gap of 15-20,000 direct care nurses Source: Walsh, T., Udalova, V. & Winters, D. (2011). Wisconsin Registered Nurse Supply and Demand Forecasting: Results Report 2010-2035. Wisconsin Department of Workforce Development, Office of Economic Advisors. Retrieved from http://worknet.wisconsin.gov/worknet_info/projects/rn_forecasting/results_report_printer_friendly.pdf

Projections by Work Setting 2010 Wisconsin RNs and Projected Demand Change by Work Setting   2010 RNs % Change 2010-2035 Nursing Home/Extended Care 7,291 88 Home Health 3,008 82 Inpatient 21,484 41 Emergency 3,068 16 Surgery 5,700 36 Ambulatory 8,939 30 Public Health 2,963 17 Other 8,664 Nurse Educators 1,844 38 Total 62,962 Source: 2010 OEA RN Forecasting Model

Closing the RN Gap   New Graduates needed annually to close the projected demand 2010 Observation 2,700 2015 Scenario Estimate 4,500 2020 Scenario Estimate 7,500 2025 Scenario Estimate 11,300 2030 Scenario Estimate 14,100 2035 Scenario Estimate 15,500 Source: DWD, OEA, 2010 RN Forecasting Model, Broad Nursing Workforce - Head Count

Goal 80% BSN by 2020

Add your hospital nursing data here

2011 WI Education Survey Findings 79% response rate (43 programs) 20 ADN programs (70% return) 10 BSN (70%) ,13 graduate(100%) Online out-of-state programs not included Preparing large numbers at undergrad & graduate level. Barriers: limited clinical sites, insufficient resources, lack of funds to hire qualified faculty. Faculty significantly older than nurses in general- expect increased retirements Diversity-student demographics mirror population, ADN most diverse Insufficient capacity in nursing in second degree programs resulted in 61% rejected Once again, as with practicing nurses, we see impact of economy on nursing educators staying in the job market – for now. Takes time to prepare pipeline of future educators; “Degree a decade”. Need to streamline the process to get them prepared.

Wisconsin Challenges 53.4% BSN Approximately 30,000 ADNs to advance Mean age for MSN completion is age 41; “degree a decade.” 67% RN’s had no immediate plans to return to school 0.6% Doctorates (includes PhDs & DNPs) 42.8% faculty are over age 55; average age 58 47.7% nurses plan to leave workforce in 10 years Only 5% of nurses from underrepresented populations APRNs are not completely independent

2013 Strategic Workforce Report The Wisconsin Nursing Workforce: Status & Recommendations Landmark, historical report; framed w/ IOM report Executive Summary & Full Report http://www.wisconsincenterfornursing.org/workforce_report.html

Academic Progression - 80% BSN by 2020 Triple the number of ADNs returning to school for BSN or higher Hiring practices & scheduling policies Partnerships Access in rural areas; innovative pilots Remove barriers- funding, access & time Dual track enrollment Expansion of shared curriculum Increase scholarships Push-Pull models, flex programs Outreach, support for under-represented groups Cost and lost work time and larges issues identified in 2012 RN survey

Increase Doctoral Degrees Increase faculty positions, mentorship programs Recruit & increase diversity Remove salary inequities to provide market compensation to recruit & retain Enhance loan forgiveness programs

The WHY? Patient Safety & Outcomes Need for a more highly educated workforce Research linking nursing education to Patient Outcomes See AACN Fact sheet Lower mortality rates, fewer adverse outcomes, decreases in readmissions Every 10% increase in BSN decreases risk of death and failure to rescue by 5%- Aiken 2003 Support from IOM, Tri-Council, AONE, NLN, ACCA

Inquiries for your organization Assessment of nursing workforce in your organization- age & education by unit? Do you have a plan in place to get to 80% BSN or higher by 2020. Ongoing dashboard to measure? Communication of issues to CEO, board, foundation, medical staff leadership? Role of APRN’s Scholarships in addition to tuition reimbursement? School/Community partnerships Enhanced residency programs Innovations in redesign Use of simulation Enhancing interprofessional education & practice Nursing presence on Board of Directors

Multi-prong approach Retention of the workforce w/ new models of care Recruitment & successful transition of new nurses to double the pipeline-Expand residency programs Recruitment and retention of faculty Academic progression in partnership w/ employers & schools Innovative partnerships w/adoption & spread of best practices

Websites Wisconsin Center for Nursing www.wicenterfornursing.org Future of Nursing™ Campaign for Action www.campaignforaction.org