Nursing Shortage

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Transcript of Nursing Shortage

MARYLANDS NURSING SHORTAGE: A WORKFORCE CRISISBarbara R. Heller, Ed.D., R.N., F.A.A.N. Del Sweeney, Ph.D.

The Nursing Workforce Project March 2003

Center for Health Workforce Development University of Maryland 515 West Lombard Street, Suite 479

Baltimore, Maryland 21201

CENTER FOR HEALTH WORKFORCE DEVELOPMENT UNIVERSITY OF MARYLANDMission The core mission of the Center for Health Workforce Development, which was founded in 2002, is to assist health care professionals, educators, the health care industry, and public policy makers in anticipating and effectively responding to the challenges of recruiting, educating, managing, and retaining an evolving health workforce in order to promote the safety, quality, and accessibility of health care in an era of cost containment. Strategic Initiatives Document shortage areas and other major health workforce challenges in Maryland and the region by conducting and reporting research related to workforce recruitment, retention, distribution, and utilization; In partnership with the health care industry and government agencies, develop interventions aimed at resolving workforce and workplace issues; Strengthen and institutionalize interdisciplinary education, community-based learning, and regional cooperation among educational institutions; Help inform and shape public policy as it relates to health workforce development; Develop innovative strategies to promote health professions careers and increase the diversity of the workforce.

Executive Director Barbara R. Heller, Ed.D., R.N., F.A.A.N., is Executive Director, Center for Health Workforce Development, and Rauschenbach Distinguished Professor of Nursing. Dr. Heller served as dean of the University of Maryland School of Nursing, 1990-2002. She is a national leader in health workforce policy and education and envisions the Center as a dynamic resource that is quick to respond to the challenges facing all health care professions. For further information, please contact the Center at 410-706-1146.

PREFACEThe Nursing Workforce Project was undertaken to gain a better understanding of the causes, extent, and impact of the nursing shortage in Maryland and to help inform and shape public policy as it relates to the future development of the nursing workforce. This report provides compelling evidence that the current nursing shortage differs quantitatively and qualitatively from those of the past and that, while some progress has been made in addressing the shortage from a recruitment and retention perspective, the underlying problems contributing to the shortage remain unresolved. The recommendations are a call to action to the many stakeholders that share concern about this issuenurses, academic institutions, the health care industry, professional associations, government agencies, legislators, philanthropic organizations, and consumersfor collaborative efforts to seek innovative solutions to this public health crisis. We are indebted to the Aaron Straus and Lillie Straus Foundation, Inc., for providing funding for the project and also to Carefirst BlueCross Blueshield, MedStar Health, the Governors Workforce Investment Board, the Maryland Board of Nursing, and the University of Maryland School of Nursing for their additional support. The authors would like to thank the many individuals who contributed to this report, especially Ms. Jan Rivitz, Executive Director of the Aaron Straus and Lillie Straus Foundation, Inc., for her prescience in originally commissioning the research and to Marla Oros, M.S., R.N., Associate Dean for Clinical and External Affairs, University of Maryland School of Nursing, for assisting in the initial conceptualization and development of the project. We also wish to thank Donna M. Dorsey, M.S., R.N., Executive Director, Maryland Board of Nursing, for providing access to Board of Nursing databases, for her critical review of the manuscript, and for sharing her extensive knowledge of current nursing issues. Scott E. McBride, M.S., M.P.A., of Hollander Cohen & McBride conducted and analyzed the focus groups and other interviews. Donna Kenly, M.B.A., also of Hollander Cohen & McBride, assisted in collecting and analyzing demographic and salary data. Anirban Basu, M.A., formerly Executive Director of RESI Research and Consulting, Towson University, developed the methodology and the projections of supply and demand for registered nurses in Maryland; Hal Cohen, Ph.D., former Executive Director of the Maryland Health Services Cost Review Commission, assisted in interpreting financial data and critically reviewed the draft report. Edward ONeill, Ph.D., M.P.A., Director, Center for the Health Professions, University of California, San Francisco, helped to develop the methodologies employed in this study. Lesley A. Perry, Ph.D., R.N., Senior Associate Dean, School of Nursing, University of Medicine and Dentistry of New Jersey, provided assistance in the early management of the project and contributed to the chapter

on nursing education. Michele M. Molesworth, Database Administrator, Maryland Board of Nursing, furnished demographic and education data collected by the Board of Nursing. Many people gave of their time to provide information relevant to this study. We wish especially to thank Mr. Calvin Pierson, President, Association of Maryland Hospitals and Health Systems; Clare E. Hastings, Ph.D., R.N., Chief, Nursing and Patient Care Services, and Carol A. Romano, Ph.D., R.N., Deputy Chief, Department of Clinical Research Informatics, both of the Warren Magnuson Clinical Center, National Institutes of Health; Judy Reitz, Sc.D., R.N., Executive Vice President and Chief Operating Officer, and Lisa Rowen, M.S., R.N., Director of Nursing, Surgery, both of the Johns Hopkins Hospital; and Karen Drenkard, M.S.N, R.N., C.N.A.A., Chief Nurse Executive, Inova Health System. Finally, we wish to thank the members of the Advisory Board of the Center for Health Workforce Development for their ongoing support of the Center and their insights into health workforce issues; and the University of Maryland Office of Academic Affairs and faculty and staff of the School of Nursing for their assistance. We deeply appreciate the advice of all of those individuals who discussed nursing shortage issues with us. The views expressed in this report, however, are solely those of the authors. B.R.H. D.S.

TABLE OF CONTENTSPreface 4 Table of Contents...............................................................................................................................6 Executive Summary.......................................................................................................................vii

CharacteristicsoftheNursingShortageinMaryland ...................................... vii SupplyandDemandProjections ..................................................................... viii CausesoftheShortageinMaryland ............................................................... viii ImpactoftheNursingShortageonAccess,Quality,Safety,andCost ............... x Recommendations ............................................................................................. xi Conclusions ...................................................................................................... xv 1. Purpose and Methodology .............................................................................................................1

A.PurposeoftheStudy ...................................................................................... 1 B.MethodologyandDataSources ..................................................................... 2 C.ANationalProblem ........................................................................................ 3 D.TheImpactofaNursingShortage ................................................................ 10 E.RecentNationalandStateInitiatives ............................................................ 13 F.InitiativesinMaryland .................................................................................. 15 2. Supply and Demand Analysis of the ...........................................................................................19 Nursing Market in Maryland ..........................................................................................................19

A.DemandAnalysis .......................................................................................... 19 B.SupplyAnalysis ............................................................................................ 23 C.Projections .................................................................................................... 25 D.Conclusions .................................................................................................. 26 3. The Maryland Nurse Workforce...................................................................................................29 29

A.Demographics ............................................................................................... 29 B.EmploymentSettingsofNurses ................................................................... 36 C.Salaries .......................................................................................................... 41 D.VacancyandTurnoverRates ........................................................................ 43 4. Workplace Issues..........................................................................................................................46

A.SourcesofSatisfaction ................................................................................ 47 B.SourcesofDissatisfaction ............................................................................ 49 C.RecentChangesintheWorkplace ..................................................