1 forecasts of the nursing shortage in the los angeles area joanne spetz, ph.d. university of...
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Forecasts of the Nursing Shortage in the Los Angeles Area
Joanne Spetz, Ph.D.
University of California, San FranciscoJuly 2006
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Goals of this project
Forecast the supply of nurses Forecast the demand for nurses Compare the supply to projected demand
Based on the projected shortage/surplus, we can… Understand the short-term and long-term needs
for nurses in each region of California Identify strategies to address future shortages
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Why is this so hard?
What should demand really be? Are hospitals employing enough RNs now? Are they employing too many? How do you know if they are employing too few or too
many?
How will supply change with market changes? Will more nurses work with rising wages? Fewer? What about traveling nurses?
What is a labor market? How far will nurses travel for jobs?
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Measurement is even harder
Nurse-to-population ratios don’t measure shortage Are the nurses working? Population health needs are important Organization and delivery of care matter
Surveys on vacancies and shortages are not accurate Surveys not collected consistently Respondents can say nearly anything they want
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Our strategy…
Measure the current supply of nurses Using known factors in RN supply, forecast future
supply Measure the current demand for nurses
This is very hard! Forecast future demand
Look at the gap between supply and demand
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A model of the supply of RNs
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
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Inflows of RNs
Graduations from regional nursing programs Immigration from other countries Migration from other states Migration from other regions Transition from inactive license
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Outflows of nurses
Migration to other states Migration to other regions Transition to inactive or lapsed license
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How do I define “Los Angeles”?
LA Region: Los Angeles county Orange county Ventura county
Inland Empire: San Bernardino county Riverside county
The 2006 Survey of RNs will help us understand the labor markets
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Shares of nurses who work
Workforce participation calculated from 2004 BRN Survey, Los Angeles region & Inland Empire region
Average hours per week: over 34 hours until oldest age group!
age group LA region Inland Empire
<30 94.7% 100%
30-34 93.7% 96.4%
35-39 88.1% 96.4%
40-44 83.8% 90.5%
45-49 86.7% 94.1%
50-54 88.6% 95.2%
55-59 90.8% 84.9%
60-64 77.9% 75.9%
65+ 43.6% 31.8%
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How does the supply forecast work?
The supply of actively licensed RNs next year for an age group will equal…. 4/5 of the nurses in the age group (1/5 will “age
up” to the next group) 1/5 of the nurses from the younger age group Inflow of nurses in the age group Outflow of nurses in the age group
Multiply the number of actively licensed RNs by the labor-force participation data to get Full-Time Equivalent Supply
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Forecasted supply of Full-Time Equivalent RNs
0
20,000
40,000
60,000
80,000
100,000
120,000
2005 2010 2015 2020 2025 2030
LA Region
Inland Empire
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A model of the demand for RNs
California Population•Size of population•Age distribution•Health characteristics•Wealth
Demand for Health Care•Inpatient care•Outpatient care
Health Financing•Insurance coverage•Public programs•Uninsured•Payment levels for care
The Economy•Unemployment•Income•Tax revenue
Regulations on Health Care Providers•Licensure of facilities•Licensure of staff•Staffing requirements
Demand for Licensed Nurses•How many•What types (RN, LPN)•Special skills needed
New Technologies•Labor-saving•Labor-demanding
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How do we estimate demand?
Compute hospital patient days for age groups in California using OSHPD hospital discharge data
Project future hospital patient days using Department of Finance projections of population growth for age groups
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…the budgeted positions approach
HASC-CINHC-NWI surveys of Chief Nursing Officers: budgeted FTEs averaged 332.9
Compute hospital FTEs per patient day in 2004
Project future hospital FTEs using the forecast of patient days
Project future total FTEs with hospital FTEs being 60% of total
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Forecasted demand for FTE RNs
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
2005 2010 2015 2020 2025 2030
LA Region
Inland Empire
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Forecasted shortage in LA Region
0
20,000
40,000
60,000
80,000
100,000
120,000
2005 2010 2015 2020 2025 2030
Supply
Demand
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Forecasted shortage in Inland Empire
0
10,000
20,000
30,000
40,000
50,000
2005 2010 2015 2020 2025 2030
Supply
Demand
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What does this mean?
Shortages exist now Large shortage in LA Region Probable understatement of shortage in Inland
Empire RNs commute to LA Richer hospital RN staffing requirements not in model
yet
Shortages will get worse without action