joanne spetz, university of california, san francisco

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

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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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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

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Perceptions of employers, fall 2010

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Differences across regions, Fall 2010 & Spring 2011

9Lower number = more shortage

Rural versus urban perceptions


Differences by hospital size


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)

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Clinical areas for new graduate training

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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

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Reasons for expected change in hiring

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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

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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


Nurse earnings over time

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Job satisfaction over time

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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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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







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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







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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

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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


Forecast of Full-time Equivalent RNs per 100,000 population

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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


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

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Forecasts of RN demand

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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


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


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

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Check out our website!• http://futurehealth.ucsf.edu/SupplyDemand/Das

hboard.html

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http://futurehealth.ucsf.edu/SupplyDemand/Dashboard.html

http://futurehealth.ucsf.edu/SupplyDemand/Dashboard.html

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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joanne spetz, university of california, san francisco

Documents

rn employment

new rn graduates

university of california

staff rn vacancies

perceptions of employers

agency use15traveler

new graduates

recent data