The California Nurse Workforce Initiative Evaluation

Joanne Spetz & Susan Chapman

January 11, 2016

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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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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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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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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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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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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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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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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