2005 report building education/service partnerships: the service perspective california institute...

2005 Report 2005 Report Building Education/Service Building Education/Service Partnerships: Partnerships: The Service PerspectiveThe Service Perspective

California Institute for Nursing & Health CareOptimizing the Health of Californians through Nursing Excellence c i n h c

2005 Chief Nursing Officer 2005 Chief Nursing Officer (CNO) Survey Background (CNO) Survey Background

20052005

Sample size: 156 data submissions Sample size: 156 data submissions received received

Data represents 172 acute care facilitiesData represents 172 acute care facilities 375 surveys sent; 46% response rate375 surveys sent; 46% response rate Data represents the period of January 1, Data represents the period of January 1,

2005 through September 30, 20052005 through September 30, 2005 Reporting period was December 2005Reporting period was December 2005

Background Information Background Information California’s Nursing California’s Nursing

ShortageShortage In 2004, California ranked 50In 2004, California ranked 50thth in supply in supply

of nurses per capitaof nurses per capita Nearly 45% of the current California RN Nearly 45% of the current California RN

workforce was educated outside the workforce was educated outside the state or countrystate or country

Over 70% of current graduates are Over 70% of current graduates are educated in associate degree programseducated in associate degree programs

California faces a shortfall of up to California faces a shortfall of up to 116,000 RNs by 2020116,000 RNs by 2020

Careforce Consulting Group 2003

CINHC & HASCCINHC & HASC

History of InitiativesHistory of Initiatives Initiated in 2001 by the Hospital Initiated in 2001 by the Hospital

Association of Southern California, a Association of Southern California, a regional healthcare associationregional healthcare association

Primary Objective: Increasing local nursing Primary Objective: Increasing local nursing school enrollments by 400 in 2 yearsschool enrollments by 400 in 2 years

HASC outcomes have resulted in an HASC outcomes have resulted in an increase of over 1400 slots over a 5 year increase of over 1400 slots over a 5 year periodperiod

Bay Area Survey conducted in 2003 Bay Area Survey conducted in 2003

Survey Sample by Survey Sample by California RegionCalifornia Region

Northern45%

San Diego6%

Southern49%

(76)

(10)

(70)

Survey Sample - Northern Survey Sample - Northern CACA (HCNCC Areas)(HCNCC Areas)

Northern Sierra/Redwood

6%

North Coast 4%

East Bay 9%

Sacramento Sierra 6%

Central California 10%

South Bay 7%

West Bay 3%

(9)

(16)

(11) (4)

(14)

(6)

(10)

Survey Sample - Southern Survey Sample - Southern CA CA

(HASC Areas – including San Diego)(HASC Areas – including San Diego)

Los Angeles/Central

8%

Santa Barbara/Ventura

3%

San Diego 6%

San Gabriel 7%

Coast 5%

Harbor 6%Inland

7%

Northwestern 4%

Orange 8%

(12)

(7)

(13)

(11) (9)

(8)

(5)

(11)

(10)

Participation by Economic Participation by Economic RegionsRegions

RespondentRespondentss

Economic RegionsEconomic Regions %% ##

Northern CaliforniaNorthern California 6%6% 99

Northern Sacramento Northern Sacramento ValleyValley

3%3% 55

Greater SacramentoGreater Sacramento 1%1% 22

Bay AreaBay Area 19%19% 2929

San Joaquin ValleySan Joaquin Valley 12%12% 1818

Central SierraCentral Sierra 2%2% 33

Central CoastCentral Coast 4%4% 77

Southern California ISouthern California I 32%32% 5050

Southern California IISouthern California II 16%16% 2323

Southern BorderSouthern Border 6%6% 1010

CNO’s Perception of CNO’s Perception of ShortageShortage

(n=132)(n=132) CurrentCurrent One Year One Year AgoAgo

## %% ## %%

A surplus of RN resources, A surplus of RN resources, requiring cancellations, requiring cancellations, and/or layoffsand/or layoffs

11 .8%.8% 33 2%2%

Adequate RN resources in all Adequate RN resources in all clinical areasclinical areas

88 6%6% 33 2%2%

A mild RN shortage: RN A mild RN shortage: RN shortages on some shifts in shortages on some shifts in limited clinical areaslimited clinical areas

4949 37%37% 4444 33%33%

A moderate shortage: RN A moderate shortage: RN shortages in many clinical shortages in many clinical areasareas

5555 42%42% 5656 42%42%

A severe RN shortage: RN A severe RN shortage: RN shortage across entire shortage across entire facilityfacility

1919 14%14% 2626 20%20%

Response to the ShortageResponse to the Shortage

85%77%

72%

22%16%

0%11%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%Overtime/Extra Shifts

Travelers

Temporary Agency

Increase Use of LVNs

Temporary Limit ofClinical Services

Permanent Closure ofServices

Other

Costly Expenses for Costly Expenses for Temporary SolutionsTemporary Solutions

CategoryCategory # (%)# (%) Average 2005 Average 2005 ExpenseExpense

Contract Labor Contract Labor (including (including travelers)travelers)

81 (52%)81 (52%) $2,899,028$2,899,028

($7,000 - $9,705,514)($7,000 - $9,705,514)

Overtime Overtime (excluding 12 (excluding 12 hour shifts)hour shifts)

80 (51%)80 (51%) $2,326,344$2,326,344($5,000 – $13,035,432)($5,000 – $13,035,432)

Hiring BonusHiring Bonus 56 (36%)56 (36%) $172,043$172,043($2,000 – $1,575,000)($2,000 – $1,575,000)

Employee Referral Employee Referral BonusBonus

59 (37%)59 (37%) $55,365$55,365($100 - $500,000)($100 - $500,000)

Incentives Bonus, Incentives Bonus, above overtime, above overtime, for working extra for working extra shiftsshifts

44 (28%)44 (28%) $633,059$633,059($5 - $3,600,000)($5 - $3,600,000)

Foreign Nurse Recruitment Foreign Nurse Recruitment (Statewide)(Statewide)

43% of hospitals have engaged in 43% of hospitals have engaged in foreign nurse recruitment in last 2 years foreign nurse recruitment in last 2 years (68 respondents)(68 respondents)

30% are actively recruiting (47 30% are actively recruiting (47 respondents) respondents)

35% of hospitals are considering in the 35% of hospitals are considering in the future (54 respondents)future (54 respondents)

25% are considering and have rejected 25% are considering and have rejected (39 respondents)(39 respondents)

Recruitment cost per foreign nurse Recruitment cost per foreign nurse averages $19,914 ($2,500 – $80,000) averages $19,914 ($2,500 – $80,000)

Foreign Nurse Recruitment Foreign Nurse Recruitment by Economic Regionby Economic Region

EngageEngagedd

(N = (N = 68)68)

ActiveActive

(N = (N = 47)47)

ConsiderinConsideringg

(N = 54)(N = 54)

RejecteRejectedd

(N = (N = 39)39)

Northern California Northern California 3% (2)3% (2) 2% (1)2% (1) 4% (2)4% (2) 10% (4)10% (4)


1% (1)1% (1) 2% (1)2% (1) 4% (2)4% (2) 8% (3)8% (3)

Greater SacramentoGreater Sacramento 0% (0)0% (0) 0% (0)0% (0) 0% (0)0% (0) 3% (1)3% (1)

Bay AreaBay Area 16%(11)16%(11) 11% (5)11% (5) 17% (9)17% (9) 21% (8)21% (8)

San Joaquin ValleySan Joaquin Valley 21% 21% (14)(14)

23% 23% (11)(11)

17% (9)17% (9) 5% (2)5% (2)

Central SierraCentral Sierra 0% (0)0% (0) 0% (0)0% (0) 0% (0)0% (0) 3% (1)3% (1)

Central CoastCentral Coast 6% (4)6% (4) 11% (5)11% (5) 7% (4)7% (4) 3% (1)3% (1)

Southern California ISouthern California I 26% 26% (18)(18)

28% 28% (13)(13)

35% (19)35% (19) 31% 31% (12)(12)

Southern California IISouthern California II 18% 18% (12)(12)

15% (7)15% (7) 11% (6)11% (6) 15% (6)15% (6)

Southern BorderSouthern Border 9% (6)9% (6) 9% (4)9% (4) 6% (3)6% (3) 3% (1)3% (1)

RN Vacancy TrendsRN Vacancy Trends(Statewide)(Statewide)

Steady30%

Increasing28%

Decreasing42%

Most report a decline in Most report a decline in vacancy rate over the vacancy rate over the last yearlast year

The average vacancy rate The average vacancy rate is 12% (Range: 2% - 10% is 12% (Range: 2% - 10% - 46%)- 46%)

76% define vacancy as 76% define vacancy as unfilled budgeted unfilled budgeted positions that are positions that are currently being recruited currently being recruited for even if filled by for even if filled by traveler staff or other traveler staff or other temporary stafftemporary staff

105 facilities reported 105 facilities reported 9,304 vacancy positions9,304 vacancy positions

Average Vacancy Rate by Average Vacancy Rate by Economic RegionEconomic Region

VacancVacancyy

##

Economic RegionsEconomic Regions RateRate Resp.Resp.



13%13% 33









Improving New Graduate Improving New Graduate Retention Retention (Statewide)(Statewide)

94% of respondents monitor 94% of respondents monitor turnover/retention of nursing staff and turnover/retention of nursing staff and 86% monitors why nurses leave86% monitors why nurses leave

133 respondents reported an average 133 respondents reported an average RN turnover rate of 9.4%RN turnover rate of 9.4%

MedianMedian

6 Months (n=104)6 Months (n=104) 71%71%

12 Months (n=105)12 Months (n=105) 72%72%

2 Years (n=87)2 Years (n=87) 57%57%

New Graduate Retention Rates

New Graduate Retention Rates New Graduate Retention Rates by Economic Regionby Economic Region

Avg. Retention RatesAvg. Retention Rates

Economic RegionsEconomic Regions 6 mo.6 mo. 12 12 mos.mos.

2 yrs.2 yrs.

Northern CaliforniaNorthern California 90%90% 90%90% 58%58%


67%67% 67%67% 42%42%

Greater SacramentoGreater Sacramento 100%100% 95%95% 85%85%

Bay AreaBay Area 71%71% 69%69% 65%65%

San Joaquin ValleySan Joaquin Valley 96%96% 91%91% 76%76%

Central SierraCentral Sierra 100%100% 100%100% 87%87%

Central CoastCentral Coast 57%57% 59%59% 49%49%

Southern California ISouthern California I 63%63% 61%61% 47%47%

Southern California IISouthern California II 61%61% 82%82% 47%47%

Southern BorderSouthern Border 77%77% 65%65% 55%55%

Average Turnover Rate by Average Turnover Rate by Economic RegionEconomic Region

TurnoveTurnoverr

##

Economic RegionsEconomic Regions RateRate Resp.Resp.



8%8% 44









New Graduate New Graduate RecruitmentRecruitment

94% of respondents hire new graduate RNs94% of respondents hire new graduate RNs Number of new graduates hired/plan to hire:Number of new graduates hired/plan to hire:

20042004 20052005 20062006

# Respondents# Respondents 105105 125125 115115

Total New Grads Total New Grads HiredHired

4,9554,955 5,685,6844

6,286,2888

New Graduate RN New Graduate RN OrientationOrientation

Average number of days of usual Average number of days of usual orientation:orientation:-- 41 days for new graduate hires (131 41 days for new graduate hires (131

respondents)respondents) Average cost of usual orientation per nurse:Average cost of usual orientation per nurse:

-- $15,600 for new graduate hires and $15,600 for new graduate hires and range from $1,726 - $50,000 (65 range from $1,726 - $50,000 (65

respondents)respondents)

Experienced RN Experienced RN OrientationOrientation

- Average number of days for Average number of days for orientation is 13 days (136 orientation is 13 days (136 respondents)respondents)

- Average cost per orientation per Average cost per orientation per experienced nurse is $5,600 and experienced nurse is $5,600 and range from $400 - $40,000 (60 range from $400 - $40,000 (60 respondents)respondents)

New Graduate Clinical New Graduate Clinical InternshipInternship

74% (116 respondents) provide a 74% (116 respondents) provide a new graduate clinical internship new graduate clinical internship program that extends beyond regular program that extends beyond regular nursing orientationnursing orientation

These programs extend beyond the These programs extend beyond the regular nursing orientation an regular nursing orientation an average of 41 days (103 average of 41 days (103 respondents)respondents)

Hiring New Graduates into Hiring New Graduates into SpecialtiesSpecialties

76% hire new graduates into specialty areas 76% hire new graduates into specialty areas and require a specialty training program (119 and require a specialty training program (119 respondents)respondents)

Program lengths vary widely depending on areaProgram lengths vary widely depending on area

Specialty Training Specialty Training ProgramsPrograms

Top reported specialty areas hospitals Top reported specialty areas hospitals require a specialty training program:require a specialty training program:

-- Intensive Care - 66% (103)Intensive Care - 66% (103)

-- Emergency Room - 56% (87)Emergency Room - 56% (87)

-- Labor and Delivery - 53% (83)Labor and Delivery - 53% (83)

-- Step Down/Telemetry - 51% (80)Step Down/Telemetry - 51% (80)

-- Operating Room - 47% (74)Operating Room - 47% (74)

Specialty Program Specialty Program Orientation and CostOrientation and Cost

Avg. # Days Avg. # Days Beyond New Beyond New

Graduate Graduate OrientationOrientation

AverageAverage

CostCost

ICUICU 4949 $18,80$18,8000

ERER 4848 $18,20$18,2000

L&DL&D 4747 $21,50$21,5000

Step Step Down/TelemetryDown/Telemetry

2323 $15,90$15,9000

OROR 135135 $31,10$31,1000

Faculty/Resource Faculty/Resource Commitment to Commitment to

EducationEducation 58% of hospitals have internal resources 58% of hospitals have internal resources

assigned to assist or facilitate student assigned to assist or facilitate student rotations (91 respondents)rotations (91 respondents)

42% of hospitals have staff functioning in a 42% of hospitals have staff functioning in a joint appointment (faculty/practice) (66 joint appointment (faculty/practice) (66 respondents)respondents)- A total of 386 staff serving in this role- A total of 386 staff serving in this role

36% of hospitals have additional masters 36% of hospitals have additional masters prepared staff who are interested and willing prepared staff who are interested and willing to serve as clinical faculty (56 respondents)to serve as clinical faculty (56 respondents)

70% reported that schools pay for the staff 70% reported that schools pay for the staff time for adjunct faculty (45 respondents)time for adjunct faculty (45 respondents)

Faculty/Resource Faculty/Resource Commitment to EducationCommitment to Education

ResourcesResourcesAssigned Assigned

to to Assist in Assist in RotationRotation(N = 91)(N = 91)

Staff Staff Funct.Funct.

In Joint In Joint Appt.Appt.Role Role (N = (N =

66)66)

Total Total ServingServingIn Joint In Joint Appt.Appt.RoleRole

Who Pays for Who Pays for Time?Time?

MSN MSN Prep.Prep.

NursesNurses WillingWillingTo ServeTo Serve(N = 56)(N = 56)

HospitaHospitall

(N = (N = 20)20)

SchoolSchool(N = (N =

46)46)

Northern CaliforniaNorthern California 4% (4)4% (4) 3% (2)3% (2) 44 5% (1)5% (1) 2% (1)2% (1) 2% (1)2% (1)

Northern Sac. Northern Sac. ValleyValley 3% (3)3% (3) 2% (1)2% (1) 33 5% (1)5% (1) 0% (0)0% (0) 2% (1)2% (1)

Greater Greater SacramentoSacramento 1% (1)1% (1) 2% (1)2% (1) 1212 5%(1)5%(1) 0% (0)0% (0) 0% (0)0% (0)

Bay AreaBay Area18% (16)18% (16)

21% 21% (14)(14) 4040 15% (3)15% (3) 20% (9)20% (9) 20% (11)20% (11)

San Joaquin ValleySan Joaquin Valley 11% (10)11% (10) 14% (9)14% (9) 2424 15% (3)15% (3) 9% (4)9% (4) 14% (8)14% (8)

Central SierraCentral Sierra 1% (1)1% (1) 2% (1)2% (1) 22 0% (0)0% (0) 0% (0)0% (0) 2% (1)2% (1)

Central CoastCentral Coast 4% (4)4% (4) 5% (3)5% (3) 33 5% (1)5% (1) 2% (1)2% (1) 5% (3)5% (3)

Southern California Southern California II 33% (30)33% (30)

32% 32% (21)(21) 196196 35% (7)35% (7)

37% 37% (17)(17) 36% (20)36% (20)

Southern California Southern California IIII 14% (13)14% (13)

15% 15% (10)(10) 6363 10% (2)10% (2)

24% 24% (11)(11) 11% (6)11% (6)

Southern BorderSouthern Border 10% (9)10% (9) 6% (4)6% (4) 3939 5% (1)5% (1) 7% (3)7% (3) 9% (5)9% (5)

Hospitals Capacity for Hospitals Capacity for Students Students (Statewide)(Statewide)

58% of reported hospitals feel they can 58% of reported hospitals feel they can absorb more students for clinical rotation absorb more students for clinical rotation (90 respondents)(90 respondents)

55% of respondents contribute additional 55% of respondents contribute additional support to schools. (86 respondents)support to schools. (86 respondents)

No significant difference in preference for No significant difference in preference for Bachelor’s or AD studentsBachelor’s or AD students

39% of hospitals will take LVN students39% of hospitals will take LVN students

Hospital Capacity for Hospital Capacity for Clinical Students by Clinical Students by Economic RegionsEconomic Regions

Absorb More Absorb More Contribute Contribute

Support Support

Economic RegionsEconomic Regions Students ? Students ? (N = 90)(N = 90)

To SchoolsTo Schools(N = 86)(N = 86)

## %% ## %%

Northern CaliforniaNorthern California 66 7%7% 33 3%3%

Northern Sacramento ValleyNorthern Sacramento Valley 44 4%4% 44 5%5%

Greater SacramentoGreater Sacramento 00 0%0% 11 1%1%

Bay AreaBay Area 1111 12%12% 1616 19%19%

San Joaquin ValleySan Joaquin Valley 1212 13%13% 1010 12%12%

Central SierraCentral Sierra 11 1%1% 00 0%0%

Central CoastCentral Coast 55 6%6% 55 6%6%

Southern California ISouthern California I 2626 29%29% 2525 29%29%

Southern California IISouthern California II 1919 21%21% 1313 15%15%

Southern BorderSouthern Border 66 7%7% 99 10%10%

Clinical Capacity for Clinical Capacity for Student RotationsStudent Rotations

0

10

20

3040

50

60

70

80

90100 Weekends

M-F Off Shift

M-F Day

% of Hospitals with Space Available by Specialty & Time

What Kind of Students Can What Kind of Students Can Hospitals Take? Hospitals Take? (Statewide)(Statewide)

%% ##

Associate degree RN studentsAssociate degree RN students 69%69% 108108

Bachelors degree RN studentsBachelors degree RN students 69%69% 108108

BSN degree completion BSN degree completion studentsstudents

59%59% 9292

Entry level Masters studentsEntry level Masters students 50%50% 7878

Graduate degree studentsGraduate degree students 47%47% 7474

LVN StudentsLVN Students 39%39% 6161

What Kind of Students Can What Kind of Students Can Hospitals Take? Hospitals Take? (Economic Regions)(Economic Regions)

AD to AD to RNRN

(N = 108)(N = 108)

Bach. Bach. RN RN

(N = 108)(N = 108)BSN BSN (N = 92)(N = 92)

ELM ELM (N = 78)(N = 78)

Grad. Grad. (N = 74)(N = 74)

LVN LVN (N = 61)(N = 61)

Northern CaliforniaNorthern California 6% (6)6% (6) 6% (6)6% (6) 7% (6)7% (6) 4% (3)4% (3) 3% (5)3% (5) 8% (5)8% (5)


4% (4)4% (4) 4% (4)4% (4) 4% (3)4% (3) 5% (4)5% (4) 4% (3)4% (3) 4% (7)4% (7)

Greater SacramentoGreater Sacramento 0% (0)0% (0) 0% (0)0% (0) 0% (0)0% (0) 0% (0)0% (0) 0% (0)0% (0) 0% (0)0% (0)

Bay AreaBay Area 17% 17% (18)(18)

18% (19)18% (19) 13% 13% (12)(12)

17% 17% (13)(13)

19% (14)19% (14) 5% (3)5% (3)

San Joaquin ValleySan Joaquin Valley 11% 11% (12)(12)

10% (11)10% (11) 12% 12% (11)(11)

10% (8)10% (8) 11% (8)11% (8) 16% (10)16% (10)

Central SierraCentral Sierra 1% (1)1% (1) 1% (1)1% (1) 0% (0)0% (0) 0% (0)0% (0) 0% (0)0% (0) 2% (1)2% (1)

Central CoastCentral Coast 6% (6)6% (6) 6% (6)6% (6) 7% (6)7% (6) 5% (4)5% (4) 7% (5)7% (5) 10% (6)10% (6)


31% (33)31% (33) 33% 33% (30)(30)

33% 33% (26)(26)

34% (25)34% (25) 30% (18)30% (18)

Southern California IISouthern California II 16% 16% (17)(17)

19% (20)19% (20) 17% 17% (16)(16)

17% 17% (13)(13)

15% (11)15% (11) 15% (9)15% (9)

Southern BorderSouthern Border 7% (8)7% (8) 7% (8)7% (8) 9% (8)9% (8) 9% (7)9% (7) 8% (6)8% (6) 8% (5)8% (5)

Hospitals Financial Support Hospitals Financial Support to Students to Students (Statewide)(Statewide)

87%

27% 29%

59%

33%

34%

20%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90% Tuition

Student Loans

Work Stipend

Scholarships

Loans

RN to BSN

Work Study

Hospitals Financial Support Hospitals Financial Support to Students to Students (Economic Region)(Economic Region)

TuitionTuition(N = 134)(N = 134)

Student Student LoansLoans

(N = 42)(N = 42)

Work Work Stipend Stipend (N = 46)(N = 46)

Scholar-Scholar-ShipsShips

(N = 91)(N = 91)

Forgivable Forgivable LoansLoans

(N = 52)(N = 52)RN to BSNRN to BSN(N = 53)(N = 53)

Work Work StudyStudy

(N = 32)(N = 32)

Northern CaliforniaNorthern California 4% (5)4% (5) 5% (2)5% (2) 2% (1)2% (1) 4% (4)4% (4) 4% (2)4% (2) 2% (1)2% (1) 0% (0)0% (0)

Northern Northern Sacramento ValleySacramento Valley

3% (4)3% (4) 5%(2)5%(2) 2% (1)2% (1) 4% (4)4% (4) 2% (1)2% (1) 4% (2)4% (2) 0% (0)0% (0)

Greater SacramentoGreater Sacramento 1% (2)1% (2) 0% (0)0% (0) 0% (0)0% (0) 0% (0)0% (0) 0% (0)0% (0) 0% (0)0% (0) 0% (0)0% (0)

Bay AreaBay Area 19% 19% (26)(26)

26% 26% (11)(11)

17% (8)17% (8) 16% (15)16% (15) 21% (11)21% (11) 17% (9)17% (9) 6% (2)6% (2)

San Joaquin ValleySan Joaquin Valley 9% (12)9% (12) 10% (4)10% (4) 17% (8)17% (8) 14% (13)14% (13) 6% (3)6% (3) 9% (5)9% (5) 9% (3)9% (3)

Central SierraCentral Sierra 1% (2)1% (2) 2% (1)2% (1) 2% (1)2% (1) 1% (1)1% (1) 0% (0)0% (0) 0% (0)0% (0) 0% (0)0% (0)

Central CoastCentral Coast 5% (7)5% (7) 5% (2)5% (2) 4% (2)4% (2) 4% (4)4% (4) 8% (4)8% (4) 8% (4)8% (4) 3% (1)3% (1)


29% 29% (12)(12)

33% 33% (15)(15)

31% (28)31% (28) 31% (16)31% (16) 34% (18)34% (18) 44% 44% (14)(14)

Southern California Southern California IIII

15% 15% (21)(21)

14% (6)14% (6) 15% (7)15% (7) 16% (15)16% (15) 21% (11)21% (11) 21% (11)21% (11) 31% 31% (10)(10)

Southern BorderSouthern Border 7% (9)7% (9) 5% (2)5% (2) 7% (3)7% (3) 8% (7)8% (7) 8% (4)8% (4) 6% (3)6% (3) 6% (2)6% (2)

Hospitals Financial Support Hospitals Financial Support to Schoolsto Schools

• 55% of respondents provide financial 55% of respondents provide financial subsidies or support local nursing subsidies or support local nursing educational programs. educational programs.

• Financial support range between Financial support range between $500 - $2.1 million. $500 - $2.1 million.

3636

Questions?Questions?

2005 report building education/service partnerships: the service perspective california institute...

Documents

new graduate hires

yearthe average vacancy

experienced nurse

foreign nurse averages

average rn turnover

nursing health careoptimizing

years n

nurses leave133 respondents