A Presentation of the Colorado Health Institute 1576 Sherman Street, Suite 300 Denver, Colorado Colorado RN Workforce Survey Findings October 2, 2009 Christine Demont-Heinrich, MPH

Thanks to the following for their assistance in designing, analyzing and funding the survey… The Colorado Trust Colorado Center for Nursing Excellence The Joffit Group Key Informants 2

Survey methods 3,000 surveys were mailed to a randomly selected sample of active licensed RNs in mid- October 2008 –92 surveys undeliverable –2,908 surveys delivered (57 out of state, 16 declined) –2,835 met eligibility criteria –1,457 RNs completed a survey (51% response rate) Data were cleaned and weighted to represent 49,167 licensed RNs in Colorado 3

Profile of Colorado RNs [next 5 slides] 4

5 Age demographics of licensed Colorado RNs, 2008 Age groupRNs 2008 Colorado workforce* 34 years or younger17.9% 35.8% years20.3% 23.2% years29.3% 23.7% years24.8% 13.7% 65 years or older7.7% 3.5% *Included workers 19 years or older in workforce percentages SOURCES: CHI 2008 Colorado RN Workforce Survey, Q36; U.S. Census Bureau

6 Gender and race/ethnicity of licensed Colorado RNs, 2008 Demographics Colorado RNs 2008 Colorado population Female92.8%49.6% Male7.2%50.4% White, non-Hispanic92.7%71.1% Hispanic3.4%19.9% Asian1.6%2.7% Multi-racial/multi-ethnic0.9%1.9% Native American0.7%0.1% Pacific Islander0.4%0.1% Black0.3%4.2% SOURCES: CHI 2008 Colorado RN Workforce Survey, Q35 and Q37; U.S. Census Bureau

7 Geographic profile of licensed Colorado RNs, 2008 Geographic characteristicRNs Grew up in a rural community35.7% Live in a rural community14.4% Work in a rural community13.2% Grew up in and work in rural community 8.0% Grew up in urban community and work in rural community 1.6% SOURCE: CHI 2008 Colorado RN Workforce Survey, Q17, Q34, Q40

Practice setting of licensed Colorado RNs, Practice settingRNs Acute care facility61.4% Community-based clinical setting18.5% Nursing home/extended care facility9.1% Non-clinical setting7.5% Other3.4% SOURCE: CHI 2008 Colorado RN Workforce Survey, Q18

Focus of primary nursing position, Colorado licensed RNs, Focus of nursing practiceRNs Specialty care32.9% General acute care29.8% Administrator15.7% Ambulatory care10.7% Emergency/urgent care5.8% Other5.1% SOURCE: CHI 2008 Colorado RN Workforce Survey, Q19

Educational Preparation of Colorado RNs [next 4 slides] 10

Basic RN training program, ProgramPercent Diploma 16.2% Associate degree 33.8% Baccalaureate degree 48.8% Master's degree 0.5% Doctorate 0.7% SOURCE: CHI 2008 Colorado RN Workforce Survey, Q2

Number of years since graduation from basic RN program 12 YearsPercent 5 years or less19.2% 6 – 15 years22.4% 16 – 25 years21.5% 26 – 35 years19.2% 36 – 45 years14.0% 46 years or more3.6% SOURCE: CHI 2008 Colorado RN Workforce Survey, Q3

Characteristics of RNs with and without APN certifications* 13 CharacteristicAPNNon-APN Male9.8%6.7% Is primary wage earner in the family57.9%47.5% Basic nurse education is baccalaureate68.9%48.1% Employed as an RN as of 9/ %82.6% Self-employed6.2%1.6% Working in an acute care facility36.7%64.7% Working in a community-based practice49.2%15.6% Working in a skilled nursing facility4.3%9.7% SOURCE: CHI 2008 Colorado RN Workforce Survey, Q11 *Approximately 8 percent of RNs identified themselves as an APN.

Rating of classroom instruction of RN education program 14 Highest ranked content for classroom instruction (Very Good or Excellent*)Percent Administration of medications and treatments90.6% Developing patient assessment skills86.4% Using critical thinking/problem-solving skills79.6% Lowest ranked content for classroom instruction (Fair or Poor**)Percent Caring for persons with disabilities48.1% Caring for persons with dementia, mental impairments51.7% Caring for persons with behavioral problems53.0% *On a scale of 1 to 5, with 4 representing “very good” and 5 representing “excellent”. **On a scale of 1 to 5, with 1 and 2 representing “poor” and 3 representing “fair”. SOURCE: CHI 2008 Colorado RN Workforce Survey, Q5

Rating of clinical experience of RN education program 15 *On a scale of 1 to 5, with 4 representing “very good” and 5 representing “excellent”. **On a scale of 1 to 5, with 1 and 2 representing “poor” and 3 representing “fair”. SOURCE: CHI 2008 Colorado RN Workforce Survey, Q6 Highest ranked content for clinical instruction (Very Good or Excellent*)Percent Clinical rotation in acute care facility84.1% Clinical rotation in a psychiatric/behavioral health setting70.2% Understanding the RN role on the interdisciplinary care team68.4% Lowest ranked content for clinical instruction (Fair or Poor**)Percent Clinical rotation in public health agency44.9% Clinical rotation in the operating room45.7% Clinical simulation using mannequins40.7%

Interest in a nurse faculty position [next 3 slides] 16

17 Interest in becoming faculty member in nursing program Interest in becoming faculty memberPercent Interest16.8% No interest56.2% Undecided23.5% Already faculty member3.5% SOURCE: CHI 2008 Colorado RN Workforce Survey, Q31

Incentives considered important for pursuing a nurse faculty position, SOURCE: CHI 2008 Colorado RN Workforce Survey, Q32 IncentivesPercent* Flexibility to balance studies and work95.1% Tuition assistance through their employer86.4% More scholarship opportunities81.8% Loan forgiveness program75.5% Accelerated degree program71.1% Credit transfers from other academic programs69.4% *Percentage of RNs who were interested or undecided in becoming nurse faculty who rated these incentives as important.

Barriers to pursuing a nurse faculty position, SOURCE: CHI 2008 Colorado RN Workforce Survey, Q33 BarriersPercent* Lack of financial incentives to pursue more education71.5% Time to obtain additional education70.6% Loss of income while in school68.4% Lack of tuition assistance53.6% Lack of information about how to pursue a faculty position46.7% Have no interest36.2% Live in rural area without access to programs12.1% *Percentage of all RNs who rated these factors as being a barrier.

Retention and Recruitment [next 4 slides] 20

Annual earnings from primary RN nursing position in 2007* by highest degree earned 21 *Earnings from RNs working 30 hours or more per week in primary nursing position SOURCE: CHI 2008 Colorado RN Workforce Survey, Q7, Q20, Q24 Earnings from primary nursing position Diploma (N=2,268) Associate degree (N=8,704) Bachelors degree (N=15,972) Masters degree (N=5,723) Doctorate degree (N=597) $15,000 or less1.7%0.7%1.4%2.1%0.0% $15,001 to $25,0002.1%5.0%2.3%0.3%0.0% $25,001 to $35, %3.7%8.1%3.6%0.0% $35,001 to $50, %31.5%26.1%18.9%9.8% $50,001 to $75, %44.4% 31.9%56.6% $75,001 to $100, %11.4%12.9%26.6%19.3% $100,001 to $150,0001.1%1.6%2.0%8.1%7.8% More than $150,0000.1%0.3%0.2%7.0%6.6% Not working0.0%1.4%2.7%1.6%0.0%

Assessment of primary nursing position, Assessment of primary nursing positionPercent* The quality of care is high at current work setting 79.6% I have a positive relationship with the physicians 76.7% RNs are valued by my current employer 71.1% RNs are encouraged to participate in decisions 68.5% Career development opportunities exist 56.0% Cultural competency training prepared me well for population served 50.7% Salary and benefits reflect training and experience 49.2% Documentation is manageable and appropriate 49.1% Staffing levels are appropriate 47.8% *Percentage of RNs who rated these factors a 4 or 5 indicating “strongly agree”. SOURCE: CHI 2008 Colorado RN Workforce Survey, Q23

Professional career plans over next two years, StatementPercent* Plan to remain with my current employer74.0% Plan to advance with my organization28.1% Plan to obtain an advanced degree27.8% Plan to become an advanced practice nurse12.0% Plan to retire9.7% Plan to become a nurse administrator6.8% Plan on becoming a faculty member in a nursing program 6.5% Plan to become a traveling nurse5.1% Plan to transition to a community practice nurse5.0% *Percentage of RNs who rated these statements a 4 or 5 indicating “strongly agree.” SOURCE: CHI 2008 Colorado RN Workforce Survey, Q28

Top 5 reasons of RNs who plan to leave their employer in next 12 months* 24 *13 percent of RNs reported that they plan to leave their current employer within the next 12 months **Percentage of RNs who rated these reasons a 4 or 5 indicating “strongly agree” SOURCE: CHI 2008 Colorado RN Workforce Survey, Q30 ReasonPercent** Insufficient wages given workload and responsibilities45.2% Too much stress on the job42.1% Lack of respect for RNs40.6% Insufficient fringe benefits33.1% Work is not professionally challenging24.4%

Top 5 reasons of RNs not working in a position that requires an active RN license* 25 ReasonPercent** Insufficient wages given the workload and responsibilities 43.9% Too much stress on the job 41.8% Inconvenient hours 40.6% Retired from the active workforce 37.1% Have a job that does not require an active RN license 33.4% SOURCE: CHI 2008 Colorado RN Workforce Survey, Q15 *16.5 percent of RNs reported not working in a position that required an active RN license **Percentage of RNs who rated these reasons a 4 or 5 indicating “strongly agree.”

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