1. Texas Statewide Health Coordinating Council February 19, 2010 Symposium Presented by Aileen Kishi, PhD, RN, Program Director for the Texas Center for Nursing Workforce Studies "A Roadmap to a Healthy Texas" 2011 – 2016 Texas State Health Plan

2. Nursing Education Issues Recruitment & Retention of a Diverse Student Population in Nursing  Sullivan Commission: “Diversity strengthens cultural competence; cultural competency of the provider profoundly influences the way in which health care is provided.”  Multiple stakeholders have been working on increasing admission and graduation of nursing students.  Barriers to recruitment & retention: lack of diversity, financial or administrative support, rigid institutional environment, lack of family support, financial limitations, family/work responsibilities, lack of sufficient, qualified and diverse faculty.

3. Race/Ethnicity of Faculty Decrease in % of Caucasian faculty between 2003 (86%) and 2008 (80.1%). Increase in African American faculty from 6% in 2003 to 7.7% in 2008. Increase in Hispanic faculty from 2003 (5.6%) to 2008 (7.6%)

4. Recruitment & Retention of a Diverse Student Population in Nursing (con’t) Swinney & Dobal’s Support Model for Student Retention: S Social support A Academic support F Financial support E Empowerment of students R Responsibility by students

5. Faculty Demographics & Shortage 92 Professional Nursing Programs in AY 2008 2 diploma, 60 ADN, 29 BSN, and 1 alternate entry MSN programs 74% FT faculty and 26% PT Median budgeted FTE positions per program = 17 in AY 2008 Very little change in median budgeted FTEs in AY 2007 and 2006 Data source: 2008 Nursing Education Survey done in collaboration with Texas Board of Nursing

6. Faculty Vacancy & Turnover In 2008, faculty vacancy rate was 5.9% In 2008, faculty turnover rate was 12.1 Faculty positions remain vacant on an average of 29 weeks – some programs reported vacancies lasting up to 2 academic years.

7. Faculty Demographics: Age In AY 2008, faculty age (n=2257) ranged from 23-86 years. Median age was 53; mean age = 52. 22% were under age of 45. 64% of faculty are 50 or older and will be eligible for retirement now and during the next 12 years.

8. Educational Preparation of Faculty 73% (1,680) of nursing faculty have MSNs. 294 of the 371 (79.2%) faculty with a Doctoral degree teach in a BSN program.

9. Master’s & Doctoral Degrees Conferred in Nursing FY 2008-09 Type Program Master’sDoctoral Nrsg Administration161 Advanced Practice787 Nursing Education91 MSN - General17 PhD in Nursing41 Doctorate in Nrsg Practice 32 Total1,05673 Data Source: Texas Higher Education Coordinating Board, November 2009

10. Educational Pipeline Trends 20072009

11. Health Information Technology & Nursing Education Dr. David Blumenthal, National Coordinator for Health Information Technology: “As health care providers and hospitals across the nation incorporate electronic health records into routing patient care, the demand for highly skilled health IT professionals will rapidly grow.” Nurses understand the logistics of what medical information is needed, where it should be sent between & within institutions. Nurse specialists can orchestrate how health information is gathered, integrated and disseminated.

12. Health Information Technology & Nursing Education (con’t) Informatics nurse specialists have the combined skill set of clinical and informatics knowledge to support future advances in health information technology. Texas does not currently have any educational programs for informatics nurse specialists at the graduate level. Technology Informatics Guiding Educational Reform (TIGER) Initiative recommend addressing 3 key areas:  Develop a nursing workforce capable of using EHRs to improve delivery of health care.  Engage more nurses in development of the HIT infrastructure.  Accelerate adoption of smart, standards-based, interoperable technology that makes health care delivery safer, more efficient, timely, accessible and patient-centered.

13. Retention of Nurses in the Workforce In addition to increasing the number of nurses graduating from nursing programs and entering practice, retention of those already in practice provides another avenue of having an adequate supply of nurses to meet the increasing health care demands. Although the current recession somewhat masks the nursing shortage, we have the opportunity to continue to build the supply of nurses to meet future demand for nurses in all avenues of health care.

14. Retention of Nurses in the Workforce (con’t) Newly graduated nurses tend to be more successful in their practice and see lower turnover rate in their first year of practice when they participate in a formal, comprehensive transition to practice program. Recommendations regarding development of a transition to practice program are found in the Comprehensive Strategic Plan. Comprehensive Strategic Plan include recommendations on positive changes to the work environment, retention strategies, and strategies to encourage pre-retirement nurses to extend their work-life careers.

15. Advanced Practice Registered Nurses (APRNs) in Texas The growing shortage of primary care physicians, emphasis on quality health care, increasing demand for health care services, and need to control costs will increase APRNs’ roles in health care delivery. Factors that impact on access to care that APRNs could provide:  Texas law requiring physician delegation of prescriptive authority to APRNs: reduces number of patients APRNs and physicians can see and reduces ability of APRNs to work in rural sites distant from a physician.  Texas has only 1 nurse-midwifery program that will produce 3 CNMs in 2010 and 4-5 in 2011. Supply ratio of CNMs continues to be lower than national ratios and other states.

16. Issues in Public Health Nursing Major issues facing Texas with regard to its public health nursing workforce (in both traditional public health nursing and psychiatric-mental health nursing) fall in 3 major categories:  Support for educational preparation of baccalaureate and graduate level nurses to public health nursing that promotes workforce diversity and cultural competence.  Development of an infrastructure and work environment that optimizes the use of public health nurses in such areas as health promotion, disease prevention, emergency preparedness and response in all regions of Texas.  Develop a comprehensive, strategic plan and implement strategies to recruit and retain well qualified and educated public health nurses.