1. California’s Nursing Workforce: New Research Joanne Spetz, Ph.D. University of California, San Francisco February 7, 2012

2. 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 2

3. 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 3

4. Perceptions of employers, fall 2010 4

5. Differences across regions, Fall 2010 & Spring 2011 5 Lower number = more shortage

6. Rural versus urban perceptions 6 Lower number = more shortage

7. Staff RN Vacancies, Fall 2010 & Spring 2011 7 Estimated 1,772 vacancies for new RN graduates in Fall 2010

8. Planned employment growth for 2011 & 2012, from Fall 2010 8 These data are for respondents, not all California hospitals

9. BRN surveys Survey of RNs, 2010 –10,000 RNs sampled, ~65% response rate –Paper survey with option to do online survey Annual Schools Survey, 2010-11 –Online survey of all nursing programs –100% response rate 9

10. Employment rates by age, 2008 & 2010 10 Source: California Board of Registered Nursing Survey of RNs, 2010

11. Reasons for not working in nursing % important or very important 11 Source: California Board of Registered Nursing Survey of RNs, 2010

12. Nurse earnings over time 12 Source: California Board of Registered Nursing Survey of RNs, 2010

13. Future plans of RNs 13 Source: California Board of Registered Nursing Survey of RNs, 2010

14. 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* 14 Source: California Board of Registered Nursing Annual Schools Report, 2009-2010

15. Board of Registered Nursing Forecasts of Supply 15 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

16. The range of supply forecasts (RNs living in California) 16 Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2011

17. Variation in FTE employment with assumptions about work and retirement 17 Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2011

18. Forecast of Full-time Equivalent RNs per 100,000 population 18 Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2011

19. 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 19

20. Forecasts of RN demand 20 Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2011

21. Best supply and demand forecasts for RNs, 2009-2030 21 Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2011

22. 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 22

23. What is happening next? UCSF, CINHC, and the Hospital Associations is analyzing Year 2 of the employer survey UCSF & BRN are nearly done with the 2011-12 Annual Schools Survey 2012 BRN Survey of RNs (mailed in spring) 23

24. Questions? Thoughts? Ideas? Perspectives? 24