California’s Nursing  Workforce:  New ResearchJoanne Spetz, Ph.D.University of California, San FranciscoFebruary 7, 2012
What is going on in our RN labormarket?• More than a decade of severe shortage,  1998-2008• Reports that new graduates can...
Survey of Nurse Employers,Fall 2010• Collaboration between UCSF, CINHC, and HASC• Email survey with option to return paper...
Perceptions of employers, fall 2010                                      4
Differences across regions,Fall 2010 & Spring 2011Lower number = more shortage   5
Rural versus urban perceptionsLower number = more shortage     6
Staff RN Vacancies,Fall 2010 & Spring 2011Estimated 1,772 vacancies for new RN graduates inFall 2010                      ...
Planned employment growth for2011 & 2012, from Fall 2010These data are for respondents, not all California hospitals   8
BRN surveys• Survey of RNs, 2010   – 10,000 RNs sampled, ~65% response rate   – Paper survey with option to do online surv...
Employment rates by age, 2008 &2010Source: California Board of Registered Nursing Survey of RNs, 2010                     ...
Reasons for not working in nursing% important or very important                                 Laid off      Difficult to...
Nurse earnings over timeSource: California Board of Registered Nursing Survey of RNs, 2010                                ...
Future plans of RNs100%90%                                              Plan to retire80%70%                              ...
RN Graduations are expected to drop in2012-2013               New        Projected Projected Graduations               enr...
Board of Registered Nursing            Forecasts of Supply                      Nurses with ActiveInflow of nurses        ...
The range of supply forecasts(RNs living in California)2,500,0002,000,000                             Best Supply Forecast...
Variation in FTE employment withassumptions about work andretirement500,000450,000400,000350,000300,000250,000200,000     ...
Forecast of Full-time Equivalent RNsper 100,000 population1,000 900 800 700 600 500                                       ...
What is demand?• National benchmarks: Employed RNs per 100,000• Bureau of Labor Statistics, forecast of 2018  demand• Grow...
Forecasts of RN demand400,000350,000300,000250,000200,000                      National 25th percentile FTE RNs/population...
Best supply and demand forecastsfor RNs, 2009-2030450,000400,000350,000300,000250,000200,000150,000               Best Sup...
Implications for policy• How do we define shortage?  – Are current employment levels adequate?  – Should California be at ...
What is happening next?• UCSF, CINHC, and the Hospital  Associations is analyzing Year 2 of the  employer survey• UCSF & B...
Questions?Thoughts?Ideas?Perspectives?                24
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California’s Nursing Workforce: New Research

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California’s Nursing Workforce: New Research
A presentation given by Joanne Spetz to the
California Healthcare Workforce Policy Commision

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California’s Nursing Workforce: New Research

  1. 1. California’s Nursing Workforce: New ResearchJoanne Spetz, Ph.D.University of California, San FranciscoFebruary 7, 2012
  2. 2. What is going on in our RN labormarket?• 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 regionsContext: Ongoing recession, highunemployment, severe regionaldifferences 2
  3. 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. 4. Perceptions of employers, fall 2010 4
  5. 5. Differences across regions,Fall 2010 & Spring 2011Lower number = more shortage 5
  6. 6. Rural versus urban perceptionsLower number = more shortage 6
  7. 7. Staff RN Vacancies,Fall 2010 & Spring 2011Estimated 1,772 vacancies for new RN graduates inFall 2010 7
  8. 8. Planned employment growth for2011 & 2012, from Fall 2010These data are for respondents, not all California hospitals 8
  9. 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. 10. Employment rates by age, 2008 &2010Source: California Board of Registered Nursing Survey of RNs, 2010 10
  11. 11. Reasons for not working in nursing% important or very important Laid off Difficult to find a nursing positionInconvenient schedules in nursing jobs Wanted to try another occupation 2010 Dissatisfaction with the nursing… 2008 Other dissatisfaction with your job Dissatisfied with benefits Salary Job-related illness/injury Stress on the job Childcare responsibilities Retired 0% 20% 40% 60% Source: California Board of Registered Nursing Survey of RNs, 2010 11
  12. 12. Nurse earnings over timeSource: California Board of Registered Nursing Survey of RNs, 2010 12
  13. 13. Future plans of RNs100%90% Plan to retire80%70% Plan to leave60% nursing entirely, but not retire50% Plan to increase40% hours of nursing30% work20% Plan to reduce hours of nursing10% work 0% Plan to work Under Under 65+, 65+, approximately as 35, 35, 2008 2010 much as now 2008 2010 Source: California Board of Registered Nursing Survey of RNs, 2010 13
  14. 14. RN Graduations are expected to drop in2012-2013 New Projected Projected Graduations enrollment enrollment enrollment from 1 yr from 2 yrs2008-2009 13,988 14,621 13,692 10,5262009-2010 14,228 14,917 14,216 11,5122010-2011 13,055 14,835 12,447*2011-2012 13,223 13,273*2012-2013 11,616*2013-2014 11,766* Source: California Board of Registered Nursing Annual Schools Report, 2009-2010 14
  15. 15. Board of Registered Nursing Forecasts of Supply Nurses with ActiveInflow of nurses Licenses Outflow of nurses Living in California Share of nurses who work, and how much they work Full-time equivalent supply of RNs 15
  16. 16. The range of supply forecasts(RNs living in California)2,500,0002,000,000 Best Supply Forecast Low Supply Forecast1,500,000 High Supply Forecast 2009 Forecast1,000,000 500,000 0 Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2011 16
  17. 17. Variation in FTE employment withassumptions about work andretirement500,000450,000400,000350,000300,000250,000200,000 Best Supply Forecast150,000 Low Employment Rate Forecast High Employment Rate Forecast100,000 2009 Forecast 50,000 0 Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2011 17
  18. 18. Forecast of Full-time Equivalent RNsper 100,000 population1,000 900 800 700 600 500 Best Supply Forecast 400 U.S. average 300 US 25th percentile 200 100 0 Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2011 18
  19. 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. 20. Forecasts of RN demand400,000350,000300,000250,000200,000 National 25th percentile FTE RNs/population150,000 National average FTE RNs/population California Employment Development Dept. forecast100,000 Maintain 2011 FTE RNs/Population OSHPD hours per patient day-based forecast, BRN calibration 50,000 OSHPD hours per patient day-based forecast, EDD calibration 0 Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2011 20
  21. 21. Best supply and demand forecastsfor RNs, 2009-2030450,000400,000350,000300,000250,000200,000150,000 Best Supply Forecast National 25th percentile FTE RNs/population100,000 OSHPD hours per patient day-based forecast, BRN calibration Low Supply Forecast (low count & employment) 50,000 National average FTE RNs/population 0 Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2011 21
  22. 22. Implications for policy• How do we define shortage? – Are current employment levels adequate? – Should California be at the national average? 25th percentile? Bottom? – Economic demand vs. need-based demand• In this economy… – Demand estimates have dropped and supply is high 22
  23. 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. 24. Questions?Thoughts?Ideas?Perspectives? 24

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