Presentation by Joanne Spetz & Susan Chapman, The Healthforce Center at UCSF and The Philip R. Lee Institute for Health Policy Studies, UCSF

1. The California Nurse Workforce
Initiative Evaluation
Joanne Spetz & Susan Chapman
January 11, 2016

2. Overview of program:
What was the Nurse Workforce Initiative?
§ “Demonstration project” using Governor’s discretionary funds from
the federal Workforce Investment Act
• Launched in 2002 (Gov. Davis)
‒ Nursing shortage
‒ Legislation to establish minimum hospital nurse staffing ratios
§ $28 million to 22 regional groups
• $30 million in matching funds raised by grantees
§ Grantee collaborations led by or involved Workforce Investment
Boards (WIBs)
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3. Overview of program:
Strategies of the grantees
§ Financial support to current students
• Books, commute costs, child care
• Case management and mentoring
• Employer-paid time off (partnerships with hospitals)
§ Expanded nursing education slots
• Contract education paid by WIB or hospitals
• Grants to schools to expand traditional programs
• Distance education
• On-site education at hospitals
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4. Overview of program:
Apparent challenges
§ Diversity of programs
§ WIBs don’t know much about training at college level
• Some WIBs identified “qualified students” and then couldn’t find
them slots in nursing schools
§ Cherry-picking of student enrollees
• Many would likely graduate without the support
• Time constraint of grants favored supporting students already in
some phase of the nursing program
§ Mix of nursing levels: RN, LVN, psychiatric technicians
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5. Evaluation design
§ Mixed methods approach
§ 4 telephone interviews with all sites: define their scope of work,
track progress
§ 1 visit to every site
§ Focus Site Visits: 4 diverse sites
• Visited 3 times
• 25-50 interviews total per site
§ 2 surveys
• Baseline survey on each enrollees
• Early departure survey for enrollees who did not complete
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6. Evaluation design
§ Data analyses
• BRN Annual Schools Reports
• California Community Colleges Chancellors Office data
‒ Tracked progress and attrition of all students in participating
colleges
§ % of students per person enrolled in NWI as predictor of
graduation/attrition
§ Did not match to actual NWI enrollees
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7. Key Findings
§ All strategies met with at least some success
§ Academic support programs
• Target enrollment was 1,310. Final enrollment was 2,599
• 64% graduation rate for the NWI enrollees
• NWI programs can be credited for 342 RNs and LVNs who
otherwise would not have graduated
§ New education slots
• Entry-level target was 993. Final was 1370
‒ Graduated 989 new nurses
• Non-entry-level target was 854. Final was 1149
‒ Not known if these slots were retained after funding ended
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8. Key Findings
§ Cost per new nurse calculation
• $62,538 per “new RN” from financial support programs
• $12,277 per “new RN” from expanded slots
• Significant data limitations
• Operating both strategies in tandem most likely to be effective
§ Some evidence that the NWI supported career ladders (CNA to
LVN, LVN to RN)
§ Collaborations that had existing partnerships functioned better
§ Programs relied heavily on other contributions from partners
§ Few sites thought they could sustain the program
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9. Lessons for evaluators
§ State government funding is not reliable
• 20% budget cut one year in
§ Developing relationships with the grantees was essential
• Susan knew many of the WIBs from a prior evaluation
§ Grantees may not have depth of knowledge to be optimally
effective
• If you have a hammer, everything looks like a nail
§ Funder did not necessarily want critique
• They were not thrilled with the cost-per-new-nurse analysis
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