1. Leveraging Data to Make Better Decisions - An Overview of Databases Webinar Series Webinar 4: Development of a New Graduate Nurse Employment Database Andrea Baumann RN, PhD Mary Crea-Arsenio MSc. Nursing Health Services Research Unit (NHSRU) McMaster University Leveraging Data to Make Better Decisions - An Overview of Databases Webinar Series Date: Monday January 21, 2013 Time: Noon- 1:00PM (EST) 1

2. Leveraging Data to Make Better Decisions - An Overview of Databases Webinar Series Big Picture Thinking...  Potential for long-term context  Think carefully about the development of survey even if it is for one study (e.g. Master’s thesis)  If possible, collect data over time 2

3. Leveraging Data to Make Better Decisions - An Overview of Databases Webinar Series Benefits of Longitudinal Research One-time versus annual survey – Cross-sectional study provides snapshot at one point in time – Longitudinal surveying allows for tracking individuals over time; change, context and trends 3

4. Leveraging Data to Make Better Decisions - An Overview of Databases Webinar Series Issues of Longitudinal Surveys Survey development – establish reliability and validity – issues of comparability over time – responding to changing context – how much to change survey and re-testing 4

5. Leveraging Data to Make Better Decisions - An Overview of Databases Webinar Series Sources of Data for HHR * Planning Workforce trends – historical and current employment, sector and practice Workforce profile – demographic, education Transition into the workforce – orientation/mentorship Workforce stability – retention/turnover 5 * Health Human Resources (HHR)

6. Leveraging Data to Make Better Decisions - An Overview of Databases Webinar Series Databases for Decisions 6 PRIMARY SECONDARY New Graduate Nurse Employment College of Nurses Of Ontario (CNO) Ministry of Health and Long-Term Care (i)Health Data Branch (ii) Health Professions Database Healthcare Employers Canadian Institute for Health Information (CIHI)

7. Leveraging Data to Make Better Decisions - An Overview of Databases Webinar Series Why study nurse employment? 7

8. Leveraging Data to Make Better Decisions - An Overview of Databases Webinar Series A Focus for Policy  Largest health care workforce  There were 150,149 * nurses in 2011  Changing population needs (e.g. aging population)  Global nursing shortages  Technological changes 8 *Source: College of Nurses of Ontario (CNO) 2011

9. Leveraging Data to Make Better Decisions - An Overview of Databases Webinar Series Historical Context  Fiscal constraints: Ontario health-care restructuring in the 1990s  Organizations reduced full-time nursing positions; hired part-time and casual positions  Result: – Loss of nurses from the workforce – Casualization nursing workforce 9 Source: Alameddine et al., (2006)

10. Leveraging Data to Make Better Decisions - An Overview of Databases Webinar Series A Call for Change: Policy-setting  Required to collect statistics to provide information to government  Ontario Nursing Task Force (1998)  Impact of SARs (2003): Walker report  Variety of government committees and presentations 10 Source: MOHLTC, 1999.

11. Leveraging Data to Make Better Decisions - An Overview of Databases Webinar Series Impact of Casualization 11 Source: CNO, 2010. College of Nurses of Ontario: Renewal Counts for Registered Nurses, 1995-2012

12. Leveraging Data to Make Better Decisions - An Overview of Databases Webinar Series Impact of Casualization on New Graduate Nurse Employment  Early indication that new graduates were least likely to obtain full-time work  There was a need to study new graduates 12 Source: Baumann et al. (2006). Educated and Underemployed

13. Leveraging Data to Make Better Decisions - An Overview of Databases Webinar Series Generating the Evidence  Survey developed in 2004 – at graduation and six months post-graduation  First wave of data collection (2004) included new graduate RNs  Wave 2 (2005): new graduate RPNs included 13 Source: Baumann et al. (2006). Educated and Underemployed

14. Leveraging Data to Make Better Decisions - An Overview of Databases Webinar Series Evidence for Policy  Data collected presented to the Ministry of Health and Long-Term Care (MOHLTC)  One-third (35%) of 2005 new graduates employed full-time  Policy Recommendation: − Target investment toward increasing full-time opportunities for new graduates 14 Source: Baumann et al. (2006). Educated and Underemployed

15. Leveraging Data to Make Better Decisions - An Overview of Databases Webinar Series Evidence Informed Decision-Making 15 Source: MOHLTC 1999, 2004, 2006, 2007. Source for photo: http://www.votethomson.ca/Document/168 Nursing Enhancement Fund 70% Full-Time Commitment New Graduate Initiative Nursing Graduate Guarantee (NGG) 1999 2005 2007-2012 2004-2006

16. Leveraging Data to Make Better Decisions - An Overview of Databases Webinar Series Nursing Graduate Guarantee 2007-2012  Policy initiative launched in 2007  Incentive funding for employers –hire new graduate nurses –temporary full-time supernumerary positions –six months  Evaluated annually 16 Source: Ministry of Health and Long-Term Care (2011). Guidelines for participation in the Nursing Graduate Guarantee.

17. Leveraging Data to Make Better Decisions - An Overview of Databases Webinar Series Policy Evaluation  Trend study * design  New graduate nurses grouped into annual cohorts and employment status compared over time  New graduate survey data validated with CNO new member employment data * Trend studies are a type of longitudinal research that focuses on a particular population (e.g., new graduate nurses) sampled repeatedly (Cohen, Manion, and Morrison 2000). 17

18. Leveraging Data to Make Better Decisions - An Overview of Databases Webinar Series Methodology Real-time data collection – New graduate nurse employment survey was adapted to include questions about the NGG – Revised survey was re-tested in 2007 Secondary database – CNO new members employment data * 18 *early survey findings are validated with CNO new member employment data

19. Leveraging Data to Make Better Decisions - An Overview of Databases Webinar Series New Graduate Nurse Data Elements  Demographic data: – Age, sex, employment status, type of employer, position in nursing, primary area of practice, and practice location (geographic region).  Preferences data: – employment status (FT/PT/casual) – sector of employment (hospital/long-term care/community/other) – geographical location (urban/rural) 19

20. Leveraging Data to Make Better Decisions - An Overview of Databases Webinar Series CNO Administrative Database  Administrative database is an annual mandatory census (total population of nurses in Ontario).  New graduates included as new members.  New members are nurses who have registered with the CNO in a given year and renew their membership for the first time 20

21. Leveraging Data to Make Better Decisions - An Overview of Databases Webinar Series CNO Administrative Database: Variables of Interest Nurse category – Category of nursing registration (RN/RPN). Location of initial nursing education – Country or province in which the nurse’s initial nursing education was obtained. Employment status –FT/PT/casual Sector of employment –hospital, long-term care, community and other. 21

22. Leveraging Data to Make Better Decisions - An Overview of Databases Webinar Series New Graduate Data  Just-in-time data  Data are leading  Used to advise decision- makers on effectiveness of policy  Sample (30%) representative of population CNO Data  Database composed of total population of new graduate nurses employed in nursing  Data are lagging  Historical data available for trending 22

23. Leveraging Data to Make Better Decisions - An Overview of Databases Webinar Series Sample Data Validation 23 Age NG Survey N=715 CNO New Members N=2800Chi-square 18-2436151%149553% χ2=4.037 p=0.4010 25-2918025%72526% 30-34639%2328% 35-39568%1827% >40517%1666% Total711100%2800100% Gender Female65392%256592% χ2=0.00600 p=.9383 Male578%2358% Total710100%2800100% Source: Baumann et al., 2009; CNO, 2008 *significant at p<.05 Comparison of Demographic Variables of RN New Graduate Survey Respondents and CNO General Class RN New Members, 2008

24. Leveraging Data to Make Better Decisions - An Overview of Databases Webinar Series Sample Data Validation 24 Source: Baumann et al., 2008; CNO, 2007 *significant at p<.05 Comparison of age categories RN New graduate Survey Respondents and CNO New Member RNs, 2007

25. Leveraging Data to Make Better Decisions - An Overview of Databases Webinar Series Key Issues in Data Integration  Timing − data collection − length of time to integrate, link and validate − report publication/data access  Lack of standardization  Data quality 25

26. Leveraging Data to Make Better Decisions - An Overview of Databases Webinar Series Full-time Employment of New Member RNs by Location of Nursing Education 26 Note. Year of first renewal reflects new graduates of previous year (e.g. new graduates in 2009 are included in first renewal for 2010. Source: CNO, unpublished data, 2012 First cohort of NGGs

27. Leveraging Data to Make Better Decisions - An Overview of Databases Webinar Series Features of Database  Standardized  Aligned with secondary databases  Annual reports generated (employment and preferences) 27

28. Leveraging Data to Make Better Decisions - An Overview of Databases Webinar Series Types of Analysis  Develop indicators (e.g. full-time employment rate)  Trend analysis of preferences over 8 cohorts of new graduates  Trend analysis of employment across 8 cohorts of new graduates 28

29. Leveraging Data to Make Better Decisions - An Overview of Databases Webinar Series Points to consider  View survey in context of the field of study  If there is an opportunity, collect data over time  Establish validity and reliability; re-establish based on changes over time  Linking of databases enhance data quality  Multiple sources of data for decision-makers 29

30. Leveraging Data to Make Better Decisions - An Overview of Databases Webinar Series References Baumann, A. Hunsberger, M & Crea-Arsenio, M (2012). Impact of Public Policy on Nursing Employment: Providing the Evidence. Canadian Public Policy. Baumann, A., Hunsberger, M., & Crea-Arsenio, M. (2011). Workforce Integration of New Graduate Nurses: Evaluation of a Health Human Resource Employment Policy. Healthcare Policy. Vol 7(2), 47-59. Baumann, A. Hunsberger, M & Crea-Arsenio, M (2012). Full-Time Work for Nurses: Employers' Perspectives Journal of Nursing Management. Baumann, Blythe, J., Cleverley, K., &Grinspun, G. (2006, May). Health Human Resource Series Number 2. Educated and underemployed: The paradox for nursing graduands. Hamilton, Ontario: Nursing Health Services Research Unit, McMaster University. 30

31. Leveraging Data to Make Better Decisions - An Overview of Databases Webinar Series Contact Information Andrea Baumann, PhD Scientific Director Nursing Health Services Research Unit McMaster University Michael DeGroote Centre for Learning MDCL 3500 (905) 525-9140 ext. 22581 baumanna@mcmaster.ca 31