2005 Report Building Education/Service Partnerships: The Service Perspective California Institute for Nursing & Health Care Optimizing the Health of Californians through Nursing Excellence c i n h c

2005 Chief Nursing Officer (CNO) Survey Background 2005 Sample size: 156 data submissions received Data represents 172 acute care facilities Data represents 172 acute care facilities 375 surveys sent; 46% response rate 375 surveys sent; 46% response rate Data represents the period of January 1, 2005 through September 30, 2005 Data represents the period of January 1, 2005 through September 30, 2005 Reporting period was December 2005 Reporting period was December 2005

Background Information California’s Nursing Shortage In 2004, California ranked 50 th in supply of nurses per capita In 2004, California ranked 50 th in supply of nurses per capita Nearly 45% of the current California RN workforce was educated outside the state or country Nearly 45% of the current California RN workforce was educated outside the state or country Over 70% of current graduates are educated in associate degree programs Over 70% of current graduates are educated in associate degree programs California faces a shortfall of up to 116,000 RNs by 2020 California faces a shortfall of up to 116,000 RNs by 2020 Careforce Consulting Group 2003

CINHC & HASC History of Initiatives Initiated in 2001 by the Hospital Association of Southern California, a regional healthcare association Initiated in 2001 by the Hospital Association of Southern California, a regional healthcare association Primary Objective: Increasing local nursing school enrollments by 400 in 2 years Primary Objective: Increasing local nursing school enrollments by 400 in 2 years HASC outcomes have resulted in an increase of over 1400 slots over a 5 year period HASC outcomes have resulted in an increase of over 1400 slots over a 5 year period Bay Area Survey conducted in 2003 Bay Area Survey conducted in 2003

Survey Sample by California Region (76) (10) (70)

Survey Sample - Northern CA (HCNCC Areas) (9) (16) (11) (4) (14) (6) (10)

Survey Sample - Southern CA (HASC Areas – including San Diego) (12) (7) (13) (11) (9) (8) (5) (11) (10)

Participation by Economic Regions Respondents Economic Regions %# Northern California 6%9 Northern Sacramento Valley 3%5 Greater Sacramento 1%2 Bay Area 19%29 San Joaquin Valley 12%18 Central Sierra 2%3 Central Coast 4%7 Southern California I 32%50 Southern California II 16%23 Southern Border 6%10

CNO’s Perception of Shortage (n=132)Current One Year Ago #%#% A surplus of RN resources, requiring cancellations, and/or layoffs 1.8%32% Adequate RN resources in all clinical areas 86%32% A mild RN shortage: RN shortages on some shifts in limited clinical areas 4937%4433% A moderate shortage: RN shortages in many clinical areas 5542%5642% A severe RN shortage: RN shortage across entire facility 1914%2620%

Response to the Shortage

Costly Expenses for Temporary Solutions Category # (%) Average 2005 Expense Contract Labor (including travelers) 81 (52%) $2,899,028 ($7,000 - $9,705,514) Overtime (excluding 12 hour shifts) 80 (51%) $2,326,344 ($5,000 – $13,035,432) Hiring Bonus 56 (36%) $172,043 ($2,000 – $1,575,000) Employee Referral Bonus 59 (37%) $55,365 ($100 - $500,000) Incentives Bonus, above overtime, for working extra shifts 44 (28%) $633,059 ($5 - $3,600,000)

Foreign Nurse Recruitment (Statewide) 43% of hospitals have engaged in foreign nurse recruitment in last 2 years (68 respondents) 43% of hospitals have engaged in foreign nurse recruitment in last 2 years (68 respondents) 30% are actively recruiting (47 respondents) 30% are actively recruiting (47 respondents) 35% of hospitals are considering in the future (54 respondents) 35% of hospitals are considering in the future (54 respondents) 25% are considering and have rejected (39 respondents) 25% are considering and have rejected (39 respondents) Recruitment cost per foreign nurse averages $19,914 ($2,500 – $80,000) Recruitment cost per foreign nurse averages $19,914 ($2,500 – $80,000)

Foreign Nurse Recruitment by Economic Region Engaged (N = 68) Active (N = 47) Considering (N = 54) Rejected (N = 39) Northern California 3% (2) 2% (1) 4% (2) 10% (4) Northern Sacramento Valley 1% (1) 2% (1) 4% (2) 8% (3) Greater Sacramento 0% (0) 3% (1) Bay Area 16%(11) 11% (5) 17% (9) 21% (8) San Joaquin Valley 21% (14) 23% (11) 17% (9) 5% (2) Central Sierra 0% (0) 3% (1) Central Coast 6% (4) 11% (5) 7% (4) 3% (1) Southern California I 26% (18) 28% (13) 35% (19) 31% (12) Southern California II 18% (12) 15% (7) 11% (6) 15% (6) Southern Border 9% (6) 9% (4) 6% (3) 3% (1)

RN Vacancy Trends (Statewide) Most report a decline in vacancy rate over the last year Most report a decline in vacancy rate over the last year The average vacancy rate is 12% (Range: 2% - 10% - 46%) The average vacancy rate is 12% (Range: 2% - 10% - 46%) 76% define vacancy as unfilled budgeted positions that are currently being recruited for even if filled by traveler staff or other temporary staff 76% define vacancy as unfilled budgeted positions that are currently being recruited for even if filled by traveler staff or other temporary staff 105 facilities reported 9,304 vacancy positions 105 facilities reported 9,304 vacancy positions

Average Vacancy Rate by Economic Region Vacancy# Economic Regions RateResp. Northern California 9%6 Northern Sacramento Valley 13%3 Greater Sacramento 3%1 Bay Area 8%26 San Joaquin Valley 11%15 Central Sierra 7%3 Central Coast 17%7 Southern California I 14%39 Southern California II 14%17 Southern Border 13%8

Improving New Graduate Retention (Statewide) 94% of respondents monitor turnover/retention of nursing staff and 86% monitors why nurses leave 94% of respondents monitor turnover/retention of nursing staff and 86% monitors why nurses leave 133 respondents reported an average RN turnover rate of 9.4% 133 respondents reported an average RN turnover rate of 9.4% Median 6 Months (n=104) 71% 12 Months (n=105) 72% 2 Years (n=87) 57% New Graduate Retention Rates

New Graduate Retention Rates by Economic Region Avg. Retention Rates Economic Regions 6 mo. 12 mos. 2 yrs. Northern California 90%90%58% Northern Sacramento Valley 67%67%42% Greater Sacramento 100%95%85% Bay Area 71%69%65% San Joaquin Valley 96%91%76% Central Sierra 100%100%87% Central Coast 57%59%49% Southern California I 63%61%47% Southern California II 61%82%47% Southern Border 77%65%55%

Average Turnover Rate by Economic Region Turnover# Economic Regions RateResp. Northern California 7%5 Northern Sacramento Valley 8%4 Greater Sacramento 6%2 Bay Area 7%25 San Joaquin Valley 9%16 Central Sierra 7%3 Central Coast 15%7 Southern California I 8%42 Southern California II 13%20 Southern Border 12%9

New Graduate Recruitment 94% of respondents hire new graduate RNs 94% of respondents hire new graduate RNs Number of new graduates hired/plan to hire: Number of new graduates hired/plan to hire: # Respondents Total New Grads Hired 4,9555,6846,288

New Graduate RN Orientation Average number of days of usual orientation: Average number of days of usual orientation: -41 days for new graduate hires (131 respondents) Average cost of usual orientation per nurse: Average cost of usual orientation per nurse: -$15,600 for new graduate hires and range from $1,726 - $50,000 (65 respondents)

Experienced RN Orientation - Average number of days for orientation is 13 days (136 respondents) - Average cost per orientation per experienced nurse is $5,600 and range from $400 - $40,000 (60 respondents)

New Graduate Clinical Internship 74% (116 respondents) provide a new graduate clinical internship program that extends beyond regular nursing orientation 74% (116 respondents) provide a new graduate clinical internship program that extends beyond regular nursing orientation These programs extend beyond the regular nursing orientation an average of 41 days (103 respondents) These programs extend beyond the regular nursing orientation an average of 41 days (103 respondents)

Hiring New Graduates into Specialties 76% hire new graduates into specialty areas and require a specialty training program (119 respondents) 76% hire new graduates into specialty areas and require a specialty training program (119 respondents) Program lengths vary widely depending on area Program lengths vary widely depending on area

Specialty Training Programs Top reported specialty areas hospitals require a specialty training program: Top reported specialty areas hospitals require a specialty training program: -Intensive Care - 66% (103) -Emergency Room - 56% (87) -Labor and Delivery - 53% (83) -Step Down/Telemetry - 51% (80) -Operating Room - 47% (74)

Specialty Program Orientation and Cost Avg. # Days Beyond New Graduate Orientation AverageCostICU49$18,800 ER48$18,200 L&D47$21,500 Step Down/Telemetry 23$15,900 OR135$31,100

Faculty/Resource Commitment to Education 58% of hospitals have internal resources assigned to assist or facilitate student rotations (91 respondents) 58% of hospitals have internal resources assigned to assist or facilitate student rotations (91 respondents) 42% of hospitals have staff functioning in a joint appointment (faculty/practice) (66 respondents) 42% of hospitals have staff functioning in a joint appointment (faculty/practice) (66 respondents) - A total of 386 staff serving in this role 36% of hospitals have additional masters prepared staff who are interested and willing to serve as clinical faculty (56 respondents) 36% of hospitals have additional masters prepared staff who are interested and willing to serve as clinical faculty (56 respondents) 70% reported that schools pay for the staff time for adjunct faculty (45 respondents) 70% reported that schools pay for the staff time for adjunct faculty (45 respondents)

Faculty/Resource Commitment to Education Resources Assigned to Assist in Rotation (N = 91) StaffFunct. In Joint Appt.Role (N = 66) TotalServing In Joint Appt.Role Who Pays for Time? MSN Prep. Nurses Willing Willing To Serve (N = 56) Hospital (N = 20) School (N = 46) Northern California 4% (4) 3% (2) 4 5% (1) 2% (1) Northern Sac. Valley 3% (3) 2% (1) 3 5% (1) 0% (0) 2% (1) Greater Sacramento 1% (1) 2% (1) 125%(1) 0% (0) Bay Area 18% (16) 21% (14) 40 15% (3) 20% (9) 20% (11) San Joaquin Valley 11% (10) 14% (9) 24 15% (3) 9% (4) 14% (8) Central Sierra 1% (1) 2% (1) 2 0% (0) 2% (1) Central Coast 4% (4) 5% (3) 3 5% (1) 2% (1) 5% (3) Southern California I 33% (30) 32% (21) % (7) 37% (17) 36% (20) Southern California II 14% (13) 15% (10) 63 10% (2) 24% (11) 11% (6) Southern Border 10% (9) 6% (4) 39 5% (1) 7% (3) 9% (5)

Hospitals Capacity for Students (Statewide) 58% of reported hospitals feel they can absorb more students for clinical rotation (90 respondents) 58% of reported hospitals feel they can absorb more students for clinical rotation (90 respondents) 55% of respondents contribute additional support to schools. (86 respondents) 55% of respondents contribute additional support to schools. (86 respondents) No significant difference in preference for Bachelor’s or AD students No significant difference in preference for Bachelor’s or AD students 39% of hospitals will take LVN students 39% of hospitals will take LVN students

Hospital Capacity for Clinical Students by Economic Regions Absorb More Absorb More Contribute Support Contribute Support Economic Regions Students ? (N = 90) To Schools (N = 86) #% #% Northern California 6 7% 33% Northern Sacramento Valley 4 4% 45% Greater Sacramento 0 0% 11% Bay Area 11 12% 1619% San Joaquin Valley 12 13% 1012% Central Sierra 1 1% 00% Central Coast 5 6% 56% Southern California I 26 29% 2529% Southern California II 19 21% 1315% Southern Border 6 7% 910%

Clinical Capacity for Student Rotations % of Hospitals with Space Available by Specialty & Time

What Kind of Students Can Hospitals Take? (Statewide) %# Associate degree RN students 69%108 Bachelors degree RN students 69%108 BSN degree completion students 59%92 Entry level Masters students 50%78 Graduate degree students 47%74 LVN Students 39%61

What Kind of Students Can Hospitals Take? (Economic Regions) AD to RN (N = 108) Bach. RN (N = 108) BSN (N = 92) ELM (N = 78) Grad. (N = 74) LVN (N = 61) Northern California 6% (6) 7% (6) 4% (3) 3% (5) 8% (5) Northern Sacramento Valley 4% (4) 4% (3) 5% (4) 4% (3) 4% (7) Greater Sacramento 0% (0) Bay Area 17% (18) 18% (19) 13% (12) 17% (13) 19% (14) 5% (3) San Joaquin Valley 11% (12) 10% (11) 12% (11) 10% (8) 11% (8) 16% (10) Central Sierra 1% (1) 0% (0) 2% (1) Central Coast 6% (6) 7% (6) 5% (4) 7% (5) 10% (6) Southern California I 33% (36) 31% (33) 33% (30) 33% (26) 34% (25) 30% (18) Southern California II 16% (17) 19% (20) 17% (16) 17% (13) 15% (11) 15% (9) Southern Border 7% (8) 9% (8) 9% (7) 8% (6) 8% (5)

Hospitals Financial Support to Students (Statewide)

Hospitals Financial Support to Students (Economic Region) Tuition (N = 134) Student Loans (N = 42) Work Stipend (N = 46) Scholar-Ships (N = 91) Forgivable Loans (N = 52) RN to BSN (N = 53) Work Study (N = 32) Northern California 4% (5) 5% (2) 2% (1) 4% (4) 4% (2) 2% (1) 0% (0) Northern Sacramento Valley 3% (4) 5%(2) 2% (1) 4% (4) 2% (1) 4% (2) 0% (0) Greater Sacramento 1% (2) 0% (0) Bay Area 19% (26) 26% (11) 17% (8) 16% (15) 21% (11) 17% (9) 6% (2) San Joaquin Valley 9% (12) 10% (4) 17% (8) 14% (13) 6% (3) 9% (5) 9% (3) Central Sierra 1% (2) 2% (1) 1% (1) 0% (0) Central Coast 5% (7) 5% (2) 4% (2) 4% (4) 8% (4) 3% (1) Southern California I 35% (46) 29% (12) 33% (15) 31% (28) 31% (16) 34% (18) 44% (14) Southern California II 15% (21) 14% (6) 15% (7) 16% (15) 21% (11) 31% (10) Southern Border 7% (9) 5% (2) 7% (3) 8% (7) 8% (4) 6% (3) 6% (2)

Hospitals Financial Support to Schools 55% of respondents provide financial subsidies or support local nursing educational programs. 55% of respondents provide financial subsidies or support local nursing educational programs. Financial support range between $500 - $2.1 million. Financial support range between $500 - $2.1 million.

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