California’s Nursing Workforce: New Research

California’s Nursing Workforce: New Research

Joanne Spetz, Ph.D. University of California, San Francisco February 7, 2012

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

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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

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Perceptions of employers, fall 2010

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Differences across regions, Fall 2010 & Spring 2011

5 Lower number = more shortage

Rural versus urban perceptions

6 Lower number = more shortage

Staff RN Vacancies, Fall 2010 & Spring 2011

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Estimated 1,772 vacancies for new RN graduates in Fall 2010

Planned employment growth for 2011 & 2012, from Fall 2010

8 These data are for respondents, not all California hospitals

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

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Employment rates by age, 2008 & 2010

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Source: California Board of Registered Nursing Survey of RNs, 2010

Reasons for not working in nursing % important or very important

0% 20% 40% 60%

Retired

Childcare responsibilities

Stress on the job

Job-related illness/injury

Salary

Dissatisfied with benefits

Other dissatisfaction with your job

Dissatisfaction with the nursing…

Wanted to try another occupation

Inconvenient schedules in nursing jobs

Difficult to find a nursing position

Laid off

20102008

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Nurse earnings over time

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Future plans of RNs

0%10%20%30%40%50%60%70%80%90%

100%

Under35,

2008

Under35,

2010

65+,2008

65+,2010

Plan to retire

Plan to leavenursing entirely, butnot retirePlan to increasehours of nursingworkPlan to reducehours of nursingworkPlan to workapproximately asmuch as now

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RN Graduations are expected to drop in 2012-2013

New enrollment

Projected enrollment from 1 yr

Projected enrollment from 2 yrs

Graduations

2008-2009 13,988 14,621 13,692 10,526 2009-2010 14,228 14,917 14,216 11,512 2010-2011 13,055 14,835 12,447* 2011-2012 13,223 13,273* 2012-2013 11,616* 2013-2014 11,766*

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

Board of Registered Nursing Forecasts of Supply

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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

The range of supply forecasts (RNs living in California)

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0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

Best Supply ForecastLow Supply ForecastHigh Supply Forecast2009 Forecast

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

Variation in FTE employment with assumptions about work and retirement

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0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

450,000

500,000

Best Supply ForecastLow Employment Rate ForecastHigh Employment Rate Forecast2009 Forecast


Forecast of Full-time Equivalent RNs per 100,000 population

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0

100

200

300

400

500

600

700

800

900

1,000

Best Supply Forecast

U.S. average

US 25th percentile


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

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Forecasts of RN demand

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0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

National 25th percentile FTE RNs/population

National average FTE RNs/population

California Employment Development Dept. forecast

Maintain 2011 FTE RNs/Population

OSHPD hours per patient day-based forecast, BRN calibration

OSHPD hours per patient day-based forecast, EDD calibration


Best supply and demand forecasts for RNs, 2009-2030

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0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

450,000

Best Supply ForecastNational 25th percentile FTE RNs/populationOSHPD hours per patient day-based forecast, BRN calibrationLow Supply Forecast (low count & employment)National average FTE RNs/population


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

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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)

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Questions?

Thoughts? Ideas? Perspectives?

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California’s Nursing Workforce: New Research

Education

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