The Present & Future of California’s Registered Nurse Labor Market: Shortages, Surpluses, and Surprising Trends
Joanne Spetz, University of California, San Francisco
Deloras Jones, California Institute for Nursing and Health Care
September 29, 2011
The market, it is a-changin’….
• Is the shortage over?
• Does California have a surplus of RNs?
• Will health care providers be able to hire all the RNs needed now and in the long term?
2
Goals for this webinar
• Learn how employers perceive the current RN labor market
• Link employer perceptions with recent data on RN employment and education
• Compare regions of California with a newly updated “report card”
• Forecast future supply and demand• Review next steps for understanding
California’s RN labor market
3
The collaboration• Betty Irene Moore Nursing Initiative• California Institute for Nursing and Health Care• Institute for Health Policy Studies, University of
California, San Francisco• Hospital Association of Southern California
Acknowledgements & thanks to…– California Hospital Association– Hospital Council of Northern & Central California– Hospital Association of San Diego & Imperial Counties– UCSF Staff & Interns: Dennis Keane, Tim Bates, Lela
Chu, Jessica Lin– Nikki West at CINHC
4
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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Goals for this webinar
• Learn how employers perceive the current RN labor market
• Link employer perceptions with recent data on RN employment and education
• Compare regions of California with a newly updated “report card”
• Forecast future supply and demand• Review next steps for understanding
California’s RN labor market
6
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
7
Perceptions of employers, fall 2010
8
Differences across regions, Fall 2010 & Spring 2011
9Lower number = more shortage
Rural versus urban perceptions
10Lower number = more shortage
Differences by hospital size
11Lower number = more shortage
Change in difficulty recruiting, compared to last year, Fall 2010
12
Change in difficulty recruiting, compared to last quarter, Spring 2011
13
Share of budgeted positions filled, Fall 2010
14
Per diem, traveler, and agency use
Per diem Traveler Agency0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
RNsLVNsAides/assts
15Traveler RN share rose to 2.9% in Spring 2011
Turnover & hiring
Separations Hiring0%
2%
4%
6%
8%
10%
12%
RNsLVNsAides/assts
16
Hiring of newly graduated RNs
17
New graduate training programs
• 67.4% have a formal training program• 80.4% developed program internally• Most common capacity is 20-30 new grads (up
to 60 grads)• Most common length is 12 weeks (up to 24
weeks)
18
Clinical areas for new graduate training
19
Staff RN Vacancies, Fall 2010 & Spring 2011
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Estimated 1,772 vacancies for new RN graduates in Fall 2010
Hiring expectations for 2011, from Fall 2010
Hire more in 201131.4%
Hire fewer in 201118.6%
No change50.0%
21
Average expected change in hiring, Spring 2011 vs. Summer 2011
San Francisco Bay Area
Central California
Sacramento & Northern California
Los Angeles
Inland Empire & Southern Border
California -35%
-30%
-25%
-20%
-15%
-10%
-5%
0%
22
Planned employment growth for 2011 & 2012, from Fall 2010
23These data are for respondents, not all California hospitals
New graduate hiring plans, 2010-2011
24Average growth of 12% expected
Reasons for planned changes in new graduate hiring, Fall 2010
Change in nursing vacancies
Too many novice nurses relative to expert nurses
Change in number of experienced nurses available
Change in budget constraints
Cost of transition programs (residencies)
Hiring freeze started or ended
Entry level salaries for new graduates
Other
0% 10%20%30%40%50%60%70%
Expect no increase Expect hiring increase
25
Reasons for expected change in hiring
26
Goals for this webinar
• Learn how employers perceive the current RN labor market
• Link employer perceptions with recent data on RN employment and education
• Compare regions of California with a newly updated “report card”
• Forecast future supply and demand• Review next steps for understanding
California’s RN labor market
27
Employment rates by age, 2008 & 2010
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Source: California Board of Registered Nursing Survey of RNs, 2010
Share of RNs working in multiple jobs, 2008 & 2010
Working 2 or more jobs0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
20082010
29
Source: California Board of Registered Nursing Survey of RNs, 2010
Reasons for not working in nursing% important or very important
Retired
Childcare responsibilities
Stress on the job
Job-related illness/injury
Salary
Dissatisfied with benefits
Other dissatisfaction with your job
Dissatisfaction with the nursing profession
Wanted to try another occupation
Inconvenient schedules in nursing jobs
Difficult to find a nursing position
Laid off
0% 10% 20% 30% 40% 50%
20102008
30
Source: California Board of Registered Nursing Survey of RNs, 2010
Nurse earnings over time
31
Source: California Board of Registered Nursing Survey of RNs, 2010
Job satisfaction over time
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Source: California Board of Registered Nursing Survey of RNs, 2010
Future plans of RNs
Under 35,
2008
Under 35,
2010
65+, 2008
65+, 2010
0%10%20%30%40%50%60%70%80%90%
100%
Plan to retirePlan to leave nurs-ing entirely, but not retirePlan to increase hours of nursing workPlan to reduce hours of nursing workPlan to work approx-imately as much as now
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Source: California Board of Registered Nursing Survey of RNs, 2010
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 10,5262009-2010 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*
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Source: California Board of Registered Nursing Annual Schools Report, 2009-2010
Goals for this webinar
• Learn how employers perceive the current RN labor market
• Link employer perceptions with recent data on RN employment and education
• Compare regions of California with a newly updated “report card”
• Forecast future supply and demand• Review next steps for understanding
California’s RN labor market
35
CA MSA Report Card: RN Jobs per capita• 2004 Report Card of RN jobs/capita replicated
with 2010 data• Comparison of the RN workforce in different
areas of the state…measurement of “density’ of RN jobs
• Comparison of CA RN workforce to the rest of the country
• Useful for regional planning
Methodology
• Formula: # RN Jobs x 100,000 = RN jobs/100,000 population
• Measurement: based on data from Bureau of Labor Statistics & US Census Bureau
• Rpt card values (letter grade): grading rubric constructed based on S.D. from median of RN jobs/capita of 50 states + D.C. (198 jobs = 1 S.D.)
• Letter grade given to 23 MSA • Represents # of RN jobs NOT # of RNs
working
Grading RubricGrading Rubric:Letter Grade
Range of RN jobs per 100,000 population values
Definition Number of States
Number of California P/MSAs
A 1257 or more 2 + SD > mean 3 0B 1059-1256 1-2 SD > mean 5 0C+ 960-1058 0.5-1 SD > mean 10 1C 761-959 0.5 SD < to 0.5 SD > mean 22 1C- 662-760 0.5-1 SC <mean 7 7D 463-661 1-2 SD < mean 4 10F 462 or less 2 + SD < mean 0 4
Mean: 859.9
SD: 198.2
Results
• National average RN jobs/capita = 860 (C)• CA received a D with RN jobs ratio = 644• 2 MSAs = or > Nat’l average (SF and Redding)• 4 MSAs = Fs with RN job ratio < 462/capita• 10 MSAs = D• Most MSAs retained same grade as in 2004; 5
improved; 5 dropped their grade• Although CA RN job ratio increased by 22
jobs/capita, CA ranking relative to the rest of the country remained the same, as the rest of the country also added RN jobs
Letter grade by States
United States Letter Grade Distribution
0
5
10
15
20
25
A B C+ C C- D F
Letter Grade
Num
ber o
f Sta
tes
CA Letter Grades by P/MSA
California Letter Grade Distribution
0
2
4
6
8
10
12
A B C+ C C- D F
Letter Grade
Num
ber o
f MSA
s/PM
SAs
Distribution of CA Letter Grades
Central California Distribution of Letter Grades: 6 Central California P/MSAs
0
1
2
3
4
A B C+ C C- D F
Lett er Grade
Num
ber o
f M
SAs/
PMSA
s
Northern California Distribution of Letter Grades: 11 Northern California P/MSAs
0123456
A B C+ C C- D F
Letter Grade
Num
ber o
f M
SAs/
PMSA
s
Southern California Distribution of Letter Grades: 6 Southern California P/MSAs
0
1
2
3
4
A B C+ C C- D F
Letter Grade
Num
ber o
f M
SAs/
PMSA
s
California Letter Grade Distribution
0
24
6
810
12
A B C+ C C- D F
Lett er Grade
Num
ber o
f MSA
s/PM
SAs
Goals for this webinar
• Learn how employers perceive the current RN labor market
• Link employer perceptions with recent data on RN employment and education
• Compare regions of California with a newly updated “report card”
• Forecast future supply and demand• Review next steps for understanding
California’s RN labor market
43
Board of Registered Nursing Forecasts of Supply
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Nurses with Active Licenses
Living in CaliforniaOutflow of nursesInflow 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 Forecast
Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2011
Variation in FTE employment with assumptions about work and retirement
46
2011
2013
2015
2017
2019
2021
2023
2025
2027
2029
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
Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2011
Forecast of Full-time Equivalent RNs per 100,000 population
47
2011
2013
2015
2017
2019
2021
2023
2025
2027
2029
0
100
200
300
400
500
600
700
800
900
1,000
Best Supply Forecast
U.S. average
US 25th percentile
Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2011
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
48
Forecasts of RN demand
49
20112013
2015201
72019
2021202
32025
20272029
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
Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2011
Best supply and demand forecasts for RNs, 2009-2030
50
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
Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2011
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
51
Goals for this webinar
• Learn how employers perceive the current RN labor market
• Link employer perceptions with recent data on RN employment and education
• Compare regions of California with a newly updated “report card”
• Forecast future supply and demand• Review next steps for understanding
California’s RN labor market
52
Check out our website!• http://futurehealth.ucsf.edu/SupplyDemand/Das
hboard.html
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Also go to the BRN website• Forms Publications
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Available from the BRN website
• Annual Schools Report– Public-use Excel workbook to summarize data by
region, type of program…• RN Surveys (every 2 years)
– Full reports– Link to a webpage with summary data, and ability to
get regional and other cuts of the data• RN Forecasts
– Full reports– Regional reports when we have them
• Other studies
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What is happening next?
• CINHC & BRN are launching a survey of recently-graduated RNs
• UCSF, CINHC, and the Hospital Associations are launching Year 2 of the employer survey
• UCSF & BRN are soon collecting Annual Schools Survey
• 2012 BRN Survey of RNs (mailed in spring)
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Questions?
Thoughts?
Ideas?
Perspectives?
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