Nurses Leading the IOM Report in Wisconsin: Pathways, Progress, & Potential Judith M. Hansen, MS, BSN WCN Executive Director Taking the LEAD for Nursing in Wisconsin RWJF State Implementation Program Grant #70696 July, 2014

Objectives Present nursing workforce data from the Wisconsin Center for Nursing, Inc. Share overview of Wisconsin Action Coalition Provide updates on RWJF (SiP) Taking the LEAD for Nursing in WI grant focus areas Present concepts for RWJF (SiP) Round 2 Identify key regional issues & strategies to prevent workforce shortages, advance grant initiatives

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, forecasting tools WCN – analyses by nursing researchers & dissemination w/ recommendations Benchmark data from national reports

Data Model Workforce Report Education RN and LPN Diversity DWD ModelIOM Report

Trends impacting nursing workforce Growing elderly population Increasing diversity Aging healthcare workforce Faculty shortage & age Potential impact of healthcare reform, changing delivery systems Economy, postponed retirements

Table 1. Wisconsin Projected Population by Age Group, Age Group Census 2000Projected 2015 Projected 2035Percent Change 0-171,368,7561,349,0901,448, ,292,4063,739,1603,720, ,629553,530577, ,581,7241,547,3801,570, ,190,0531,638,2501,572, & over702,553900,1701,485, ,928764,7101,263, & over95,625135,460222, Source: Egan-Robertson, D., Harrier, D. & Wells, P. (2008). Wisconsin projected population growth

2012 Wisconsin RN Survey Findings n = 78, % actively working as nurse in WI healthcare settings 3.1% working in healthcare non-nurse 1.8% working in another field 45,821 working in direct patient care in WI 5,664 APRNs with Masters or higher 5.7% APRNs in Wisconsin vs 8.7% nationally

2013 Wisconsin LPN Survey Findings n=11, % actively working as nurse in healthcare 6.5% working in healthcare non-nurse 4.2% working in another field 8,402 (87.3%) working in direct patient care 98.3% LPN Diploma, 4.5% ADN, 0.7% Bachelors 4,025 (36%) enrolled to further education

Wisconsin Nursing Employment 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

Wisconsin RNs 55 & older by work setting

Wisconsin 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 WI 2012 RN WI 2011 LPN WI 2013 LPN Source: WCN DWD Wisconsin Nurse Survey Summaries

Race/Ethnicity In Wisconsin Nurses Source: 2012 RN & 2013 WI LPN At-a-Glance Caucasian African American HispanicOther WI RN WI LPN WI Population US Population

RNs – Plan to Leave Direct Patient Care

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

DWD Forecasting Tool Developed by economists Projections include a variety of scenarios All show similar results 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 Wisconsin Department of Workforce Development, Office of Economic Advisors. Retrieved from

DWD 2013 Updated Workforce Projections Source: Wisconsin Registered Nurse Supply and Demand Forecasting Update: Wisconsin Department of Workforce development Office of Economic Advisors Feb 2014

Closing the RN Gap New graduates needed annually to close the projected demand 2010 Observation2, Scenario Estimate4, Scenario Estimate7, Scenario Estimate11, Scenario Estimate14, Scenario Estimate15,500 Source: DWD, OEA, 2010 RN Forecasting Model, Broad Nursing Workforce - Head Count

2013 Strategic Workforce Report The Wisconsin Nursing Workforce: Status & Recommendations Landmark, historical report Aligned w/ IOM Report – The Future of Nursing: Leading Change, Advancing Health Identified issues in Wisconsin

Wisconsin Challenges 43.7% BSN 25,292 ADNs to advance Mean age for MSN completion is age 41; “degree a decade” 67% RN’s no immediate plans to return to school 0.6% Doctorates (includes PhDs & DNPs) 48% faculty are over age % nurses plan to leave workforce within 10 years Only 5% of nurses from under-represented populations APRNs are not completely independent

Wisconsin Regional Differences WI RNsSouthSENEWestNorth Median age48 49 % Female % White % Unemployed % ADN % BSN

Overarching Recommendations Triple the number of ADNs returning to school for BSN or higher, expand educational capacity Double # APRNs graduating by 2020 Remove Scope of Practice barriers Double # doctoral degrees graduating by 2020 Increase diversity in nurses to reflect the population Expand participation of nurses as full partners in redesign of care models Enhance healthcare workforce data collection

Multi-prong approach Retention of the workforce w/in new models of care Recruitment & successful transition of new nurses to double the pipeline, but “keep the wisdom” Recruitment of faculty; curricular redesign Academic progression in partnership w/employers & schools Innovative partnerships w/adoption & spread of best practices

Wisconsin Action Coalition Wisconsin Center for Nursing, Inc. Rural Wisconsin Health Cooperative Future of Nursing™ Campaign for Action national partners: Center to Champion Nursing in America Robert Wood Johnson Foundation® AARP

Wisconsin IOM Report ‘Inventory’ National Summit Feb – Washington DC; developed Wisconsin ‘gameplan’ – course of action Formal launch Wisconsin AC – May, 2013 Inventory questionnaire based on IOM Report recommendations. WHA, ANEW, WI Nurses Coalition, WALHDAB, WI School Nurses, WI Health & Homecare Assn, WI Longterm Care Assn, RWHC, WMS, Wisconsin Medical Group Management Assn, WI Minority Nurses Assns. & more! 100+ responses, 500+ comments Report being developed by WCN (Fall 2014) Receiving national attention

Taking the LEAD for Nursing in Wisconsin RWJF State Implementation Program (SiP) grant 2/1/13- 1/31/15 FOCUS AREAS: Leadership - WONE, leadership development (20%), assess nurses on boards (10%), leadership tool kits Educational Advancement – Increase BSN completion (15% - 10%), WHA website, CNO Tool kit, push-pull models, rural/urban partnerships Diversity – inclusive excellence organizations, outreach to increase numbers of minority, male nurses, WI Diversity Assessment Tool

Wisconsin Funders Network Integrated into grant proposal Linking CNOs, Health system foundation directors, deans Regional meetings– Madison, Green Bay (to date) Next outreach; beyond healthcare, i.e., business, private foundations, etc. Faye McBeath Foundation – grant to assess nursing funding in Wisconsin being compiled by Public Policy Forum Philanthropy - Need assistance making connections throughout state

NEXT: RWJF SiP Grants Round 2 Proposals: October 1, Grant period 2/1/15-1/31/17 $150,000 over 2 years/$75,000 match by 10/1/14 Continue: BSN completion, leadership, diversity New focus areas for consideration: Interprofessional education/practice Employer/Educator partnerships Enhanced BSN completion programs Team & community-based care models Repository, mentorship for boards Pilot Wisconsin Diversity Assessment Tool

Thank you! Questions?

Group Discussion What is currently going on in this region to implement recommendations from: IOM Future of Nursing Report ? WCN 2013 Nursing Workforce Report? What are the greatest needs in this region? What might be possible strategies to address these needs? Where would you like to see activities in the next grant round?

Websites & Contact Info Wisconsin Center for Nursing Judith Hansen, Executive Director Future of Nursing™ Campaign for Action