1. The Present & Future of California’s Registered Nurse Labor Market: Shortages, Surpluses, and Surprising Trends Joanne Spetz, University of California, San Francisco Deloras Jones, California Institute for Nursing and Health Care September 29, 2011

2. The market, it is a-changin’…. Is the shortage over? Does California have a surplus of RNs? Will health care providers be able to hire all the RNs needed now and in the long term? 2

3. Goals for this webinar Learn how employers perceive the current RN labor market Link employer perceptions with recent data on RN employment and education Compare regions of California with a newly updated “report card” Forecast future supply and demand Review next steps for understanding California’s RN labor market 3

4. The collaboration Betty Irene Moore Nursing Initiative California Institute for Nursing and Health Care Institute for Health Policy Studies, University of California, San Francisco Hospital Association of Southern California Acknowledgements & thanks to… –California Hospital Association –Hospital Council of Northern & Central California –Hospital Association of San Diego & Imperial Counties –UCSF Staff & Interns: Dennis Keane, Tim Bates, Lela Chu, Jessica Lin –Nikki West at CINHC 4

5. What is going on in our RN labor market? More than a decade of severe shortage, 1998-2008 Reports that new graduates cannot find jobs 2009-now Stories that nurses are not retiring when expected Shortages in some regions Context: Ongoing recession, high unemployment, severe regional differences 5

6. Goals for this webinar Learn how employers perceive the current RN labor market Link employer perceptions with recent data on RN employment and education Compare regions of California with a newly updated “report card” Forecast future supply and demand Review next steps for understanding California’s RN labor market 6

7. Survey of Nurse Employers, Fall 2010 Collaboration between UCSF, CINHC, and HASC Email survey with option to return paper survey via fax or email Questions based on previous CINHC survey and National Forum of State Nursing Centers “Minimum Demand Data Set” recommendations Follow-up short survey conducted Spring 2011 7

8. Perceptions of employers, fall 2010 8

9. Differences across regions, Fall 2010 & Spring 2011 9 Lower number = more shortage

10. Rural versus urban perceptions 10 Lower number = more shortage

11. Differences by hospital size 11 Lower number = more shortage

12. Change in difficulty recruiting, compared to last year, Fall 2010 12

13. Change in difficulty recruiting, compared to last quarter, Spring 2011 13

14. Share of budgeted positions filled, Fall 2010 14

15. Per diem, traveler, and agency use 15 Traveler RN share rose to 2.9% in Spring 2011

16. Turnover & hiring 16

17. Hiring of newly graduated RNs 17

18. New graduate training programs 67.4% have a formal training program 80.4% developed program internally Most common capacity is 20-30 new grads (up to 60 grads) Most common length is 12 weeks (up to 24 weeks) 18

19. Clinical areas for new graduate training 19

20. Staff RN Vacancies, Fall 2010 & Spring 2011 20 Estimated 1,772 vacancies for new RN graduates in Fall 2010

21. Hiring expectations for 2011, from Fall 2010 21

22. Average expected change in hiring, Spring 2011 vs. Summer 2011 22

23. Planned employment growth for 2011 & 2012, from Fall 2010 23 These data are for respondents, not all California hospitals

24. New graduate hiring plans, 2010-2011 24 Average growth of 12% expected

25. Reasons for planned changes in new graduate hiring, Fall 2010 25

26. Reasons for expected change in hiring 26

27. Goals for this webinar Learn how employers perceive the current RN labor market Link employer perceptions with recent data on RN employment and education Compare regions of California with a newly updated “report card” Forecast future supply and demand Review next steps for understanding California’s RN labor market 27

28. Employment rates by age, 2008 & 2010 28 Source: California Board of Registered Nursing Survey of RNs, 2010

29. Share of RNs working in multiple jobs, 2008 & 2010 29 Source: California Board of Registered Nursing Survey of RNs, 2010

30. Reasons for not working in nursing % important or very important 30 Source: California Board of Registered Nursing Survey of RNs, 2010

31. Nurse earnings over time 31 Source: California Board of Registered Nursing Survey of RNs, 2010

32. Job satisfaction over time 32 Source: California Board of Registered Nursing Survey of RNs, 2010

33. Future plans of RNs 33 Source: California Board of Registered Nursing Survey of RNs, 2010

34. RN Graduations are expected to drop in 2012-2013 New enrollment Projected enrollment from 1 yr Projected enrollment from 2 yrs Graduations 2008-200913,98814,62113,69210,526 2009-201014,22814,91714,21611,512 2010-201113,05514,83512,447* 2011-201213,22313,273* 2012-201311,616* 2013-201411,766* 34 Source: California Board of Registered Nursing Annual Schools Report, 2009-2010

35. Goals for this webinar Learn how employers perceive the current RN labor market Link employer perceptions with recent data on RN employment and education Compare regions of California with a newly updated “report card” Forecast future supply and demand Review next steps for understanding California’s RN labor market 35

36. CA MSA Report Card: RN Jobs per capita 2004 Report Card of RN jobs/capita replicated with 2010 data Comparison of the RN workforce in different areas of the state…measurement of “density’ of RN jobs Comparison of CA RN workforce to the rest of the country Useful for regional planning

37. Methodology Formula: # RN Jobs x 100,000 = RN jobs/100,000 population Measurement: based on data from Bureau of Labor Statistics & US Census Bureau Rpt card values (letter grade): grading rubric constructed based on S.D. from median of RN jobs/capita of 50 states + D.C. (198 jobs = 1 S.D.) Letter grade given to 23 MSA Represents # of RN jobs NOT # of RNs working

38. Grading Rubric Grading Rubric: Letter Grade Range of RN jobs per 100,000 population values DefinitionNumber of States Number of California P/MSAs A1257 or more2 + SD > mean30 B1059-12561-2 SD > mean50 C+960-10580.5-1 SD > mean101 C761-9590.5 SD mean221 C-662-7600.5-1 SC <mean77 D463-6611-2 SD < mean410 F462 or less2 + SD < mean04 Mean:859.9 SD:198.2

39. Results National average RN jobs/capita = 860 (C) CA received a D with RN jobs ratio = 644 2 MSAs = or > Nat’l average (SF and Redding) 4 MSAs = Fs with RN job ratio < 462/capita 10 MSAs = D Most MSAs retained same grade as in 2004; 5 improved; 5 dropped their grade Although CA RN job ratio increased by 22 jobs/capita, CA ranking relative to the rest of the country remained the same, as the rest of the country also added RN jobs

40. Letter grade by States

41. CA Letter Grades by P/MSA

42. Distribution of CA Letter Grades

43. Goals for this webinar Learn how employers perceive the current RN labor market Link employer perceptions with recent data on RN employment and education Compare regions of California with a newly updated “report card” Forecast future supply and demand Review next steps for understanding California’s RN labor market 43

44. Board of Registered Nursing Forecasts of Supply 44 Nurses with Active Licenses Living in California Outflow of nurses Inflow of nurses Full-time equivalent supply of RNs Share of nurses who work, and how much they work

45. The range of supply forecasts (RNs living in California) 45 Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2011

46. Variation in FTE employment with assumptions about work and retirement 46 Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2011

47. Forecast of Full-time Equivalent RNs per 100,000 population 47 Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2011

48. What is demand? National benchmarks: Employed RNs per 100,000 Bureau of Labor Statistics, forecast of 2018 demand Growth based on current hospital employment & expected growth in patient days Potential impact of PPACA 48

49. Forecasts of RN demand 49 Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2011

50. Best supply and demand forecasts for RNs, 2009-2030 50 Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2011

51. Implications for policy How do we define shortage? –Are current employment levels adequate? –Should California be at the national average? 25 th percentile? Bottom? –Economic demand vs. need-based demand In this economy… –Demand estimates have dropped and supply is high 51

52. Goals for this webinar Learn how employers perceive the current RN labor market Link employer perceptions with recent data on RN employment and education Compare regions of California with a newly updated “report card” Forecast future supply and demand Review next steps for understanding California’s RN labor market 52

53. Check out our website! http://futurehealth.ucsf.edu/SupplyDemand/Das hboard.htmlhttp://futurehealth.ucsf.edu/SupplyDemand/Das hboard.html 53

54. Also go to the BRN website Forms  Publications 54

55. Available from the BRN website Annual Schools Report –Public-use Excel workbook to summarize data by region, type of program… RN Surveys (every 2 years) –Full reports –Link to a webpage with summary data, and ability to get regional and other cuts of the data RN Forecasts –Full reports –Regional reports when we have them Other studies 55

56. What is happening next? CINHC & BRN are launching a survey of recently-graduated RNs UCSF, CINHC, and the Hospital Associations are launching Year 2 of the employer survey UCSF & BRN are soon collecting Annual Schools Survey 2012 BRN Survey of RNs (mailed in spring) 56

57. Questions? Thoughts? Ideas? Perspectives? 57