Will the RN workforce weather the retirement of the boomers? David Auerbach, PhD 6/11/2015

2 The baby boom bulge

3 In 2000, we had forecast RNs would peak in 2012 Buerhaus, PI, Staiger DO, and David Auerbach, “Implications of a rapidly aging registered nurse workforce,” Journal of The American Medical Association (JAMA), 238 (22), June 14, 2000

4 Then nursing school enrollment surged… Buerhaus, PI, Staiger DO, and David Auerbach, “The Rapid Growth of Graduates from Associate, Baccalaureate and Graduate Programs in Nursing,” Nursing Economics, 2015 Number of nursing degrees awarded, by type

5 …As did total RN supply

6 But demand has now ratcheted up as well HRSA (2014) new demand estimate and projection *HRSA (2014) 2012 demand estimate was adjusted to match our 2012 FTE RN count 21% growth 3.27m

7 1m RNs over 50, but surging enrollment

8 Will new entry outpace retirements to reach 3.27m RNs in 2025? Little uncertainty on retirement New entry is the bigger question

9 In our most recent forecast, we were uncertain whether enrolment surge would continue David I. Auerbach et al. Health Aff 2011;30: ©2011 by Project HOPE - The People-to-People Health Foundation, Inc.

10 Propensity to become an RN for birth year (1955=1.0) Prev forecast (2 scenarios) New forecast

11 Annual NCLEX-RN test takers

12 New forecast assumptions Future cohorts will be of similar population-adjusted size as most recently observed ( birth years Age patterns will reflect recent delayed retirement trends* Auerbach, David I., Peter I. Buerhaus, and Douglas O. Staiger. "Registered Nurses Are Delaying Retirement, A Shift That Has Contributed To Recent Growth In The Nurse Workforce." Health Affairs (2014):

13 Supply forecast: 3.14m in 2025Shortage ~100,000 RNs HRSA demand est : 2.8% ann. growth : 3.1% ann. growth : 1.2% ann. growth

14 Workforce dynamics, past and projected Entry, e.g.: start with RNs age in Compare to RNs age in 2013 (same cohort). Add in 23 yr olds in 2013.

15 Age distribution of RN workforce

16 Conclusion Assuming new entry continues at recent levels, supply growth will outpace retirements – Workforce will continue to grow, in absolute numbers, and per-capita Net growth will be slower than in prior periods – And not quite enough to reach HRSA’s demand estimate ~100,000, or 3% shortfall in 2025

17 Comparison to HRSA supply estimate ,000 ‘entry’ per year between 2014 and 2025 – Leaves shortage of ~100,000 RNs by 2025 HRSA supply model, in contrast assumes ~150,000 entry per year – Based on domestic NCLEX test-takers – Results in surplus of ~300,000

18 Attrition from test-takers Domestic NCLEX test-takers FTE RNs + Internationally-educated RNs - Never pass test - Never become licensed - Work part time (~20%) - Never work in nursing (~10%)

19 Observed workforce: Test-takers 850, ,000 Retirements 580, ,000 Expected net increase Actual net increase

20 Extensions How does the supply/demand story vary regionally How have ACOs and delivery system reforms affected RN workforce – Numbers – Hospital/ambulatory – Earnings overall and by setting Do we have the ‘right’ supply of skills, competencies

21 Thank you Peter I. Buerhaus, Douglas O. Staiger, Christine M. Friedman Center for Interdisciplinary Health Workforce Studies – Annual (MDs, NPs, PAs, MAs) and quarterly (RNs) workforce data Earnings, employment, work setting, hours – Issue briefs and other publications

22

23 Percent of RN workforce with >= Master’s degree

24 >1,000,000 RNs over age 50 today (36% of workforce)