The IOM Recommendations & An Update on the Wisconsin Nursing Workforce

The Need to Advance Education in Nursing

CNO (Insert your name & organization here)

WCN Mission

•Assure an adequate, well-prepared and diverse nurse workforce to meet the needs of the people of Wisconsin

Data Driven Process

• Three surveys: RN, LPN, & Educational• Survey designs; based on National Minimum Dataset:

Supply, Demand & Education from National Forum of State Nursing Workforce Centers• DSPS - Distribution of surveys• DWD – Data security & initial analysis• WCN – analyses by nursing researchers

& dissemination with recommendations• Benchmark data from national reports

(HRSA)

Trends impacting nursing workforce

• Growing elderly populations • Increased diversity of population • Aging healthcare workforce• Faculty shortage & age• Potential impact of healthcare

reform (ACA)• Economy

RN workforce per 100,000 population Source: The U.S. Nursing Workforce: Trends in Supply and Education (HRSA, 2013).

Table 1. Wisconsin Projected Population by Age Group, 2000-2035

Age Group

Census 2000 Projected 2015

Projected 2035 Percent Change

0-17 1,368,756 1,349,090 1,448,200 5.8

18-64 3,292,406 3,739,160 3,720,200 13.018-24 520,629 553,530 577,800 11.025-44 1,581,724 1,547,380 1,570,350 -0.745-64 1,190,053 1,638,250 1,572,050 32.165 & over 702,553 900,170 1,485,570 111.565-84 606,928 764,710 1,263,020 108.185 & over 95,625 135,460 222,550 132.7

Source: Egan-Robertson, D., Harrier, D. & Wells, P. (2008).

Wisconsin projected population growth 2000-2035

2012 Wisconsin RN Survey Findings

• 83.9% actively working as nurse in healthcare• 3.1% working in healthcare non-nurse• 1.8% working in another field• 50,315 working in direct patient care

(75% who answered the question)• 5,664 Advanced Practice with Masters

or higher • 5.7% APRNs vs 8.7% nationally; lowest per population in

the nation.

Employment Status & Location2012 RNs: • 53.6% hospitals• 17.3% ambulatory care• 10.7 % nursing home/extended care• 5.7% home health• Average age: 48 • Average experience: 15 years2013 LPNs: • 10.7% hospitals• 29.1 % ambulatory care• 42.1% nursing home/extended care• 6.8% home health• Average age: 50• Average experience: 20 years

Median RN age: 48Average 15 years of experience

RNs 55 & older by work setting

LPNs 55 & older by work setting

Gender in Wisconsin NursesAssembly of Men in Nursing Goal: 20% Men by 2020

Wisconsin Nurses by Gender

% Female

% Male

WI 2010 RN 93.2 6.8

WI 2012 RN 93.1 6.9

WI 2011 LPN 95.4 4.6

WI 2013 LPN 95.6 4.4

Source: WCN DWD 2010-2012-2013 Wisconsin Nurse Survey Summaries

Race/Ethnicity In Wisconsin NursesSource: 2012 RN & 2011 WI LPN At-a-Glance

Caucasian African American Hispanic Other

WI RN 93.5 2.0 1.4 3.0WI LPN 91.0 6.3 1.9 3.8WI Population 85.0 6.0 6.0 3.0

US Population 78.1 13.1 16.7 6.4

RN Plans to Leave Direct Patient Care

LPNs – Plan to Leave Direct Patient CareSource: 2013 Wisconsin LPN Survey

RN/LPN Intent to Leave• Within 9 years 59.5% LPN’s leave the workforce

(Northern region-63.3%)• Next 2 years- 3,000 RN will leave• Next 4 years 9,622 holding DCP will leave (retirement,

job stress, physical demands)• Within 5-9 years another 22.3%

of RN DCP providers expressed intent to leave • Significant shortages projected at

same time as physician shortages & other health professionals

New Graduate RN Pipeline

Add your hospital nursing data here

DWD Forecasting Tool• Developed by economists• Projections include a variety of scenarios • Potential gap: 34- 36% by 2035• Potential gap of 15-20,000

direct care nurses

Source: Walsh, T., Udalova, V. & Winters, D. (2011). Wisconsin Registered Nurse Supply and Demand Forecasting: Results Report 2010-2035. Wisconsin Department of Workforce Development, Office of Economic Advisors. Retrieved from http://worknet.wisconsin.gov/worknet_info/projects/rn_forecasting/results_report_printer_friendly.pdf

Projections by Work Setting 2010 Wisconsin RNs and Projected Demand Change by Work Setting

2010 RNs % Change 2010-2035

Nursing Home/Extended Care

7,291 88

Home Health 3,008 82Inpatient 21,484 41Emergency 3,068 16Surgery 5,700 36Ambulatory 8,939 30Public Health 2,963 17Other 8,664 17Nurse Educators 1,844 38Total 62,962 41Source: 2010 OEA RN Forecasting Model

Closing the RN Gap

New Graduates needed annually to close the projected demand

2010 Observation 2,7002015 Scenario Estimate 4,5002020 Scenario Estimate 7,5002025 Scenario Estimate 11,3002030 Scenario Estimate 14,1002035 Scenario Estimate 15,500

Source: DWD, OEA, 2010 RN Forecasting Model, Broad Nursing Workforce - Head Count

Goal 80% BSN by 2020

Add your hospital nursing data here

2011 WI Education Survey Findings

• 79% response rate (43 programs)• 20 ADN programs (70% return)• 10 BSN (70%) ,13 graduate(100%) Online out-of-state programs not

included • Preparing large numbers at undergrad & graduate level.• Barriers: limited clinical sites, insufficient resources, lack of funds to hire

qualified faculty.• Faculty significantly older than nurses in general- expect increased

retirements • Diversity-student demographics mirror population, ADN most diverse

Insufficient capacity in nursing in second degree programs resulted in 61% rejected

Wisconsin Challenges• 53.4% BSN• Approximately 30,000 ADNs to advance• Mean age for MSN completion is age 41; “degree a

decade.”• 67% RN’s had no immediate plans to return to

school • 0.6% Doctorates (includes PhDs & DNPs)• 42.8% faculty are over age 55; average age 58• 47.7% nurses plan to leave workforce in 10 years• Only 5% of nurses from underrepresented

populations• APRNs are not completely independent

2013 Strategic Workforce Report• The Wisconsin Nursing Workforce: Status &

Recommendations• Landmark, historical report; framed w/ IOM report• Executive Summary & Full Report• http://

www.wisconsincenterfornursing.org/workforce_report.html

Academic Progression - 80% BSN by 2020

Triple the number of ADNs returning to school for BSN or higher• Hiring practices & scheduling policies• Partnerships• Access in rural areas; innovative pilots• Remove barriers- funding, access & time• Dual track enrollment• Expansion of shared curriculum• Increase scholarships• Push-Pull models, flex programs• Outreach, support for under-represented groups

Increase Doctoral Degrees

• Increase faculty positions, mentorship programs • Recruit & increase diversity• Remove salary inequities to provide market

compensation to recruit & retain• Enhance loan forgiveness programs

The WHY? Patient Safety & Outcomes Need for a more highly educated workforce

• Research linking nursing education to Patient Outcomes • See AACN Fact sheet• Lower mortality rates, fewer adverse outcomes,

decreases in readmissions• Every 10% increase in BSN decreases risk of

death and failure to rescue by 5%- Aiken 2003• Support from IOM, Tri-Council, AONE, NLN, ACCA

Inquiries for your organization• Assessment of nursing workforce in your organization- age &

education by unit?• Do you have a plan in place to get to 80% BSN or higher by

2020. Ongoing dashboard to measure?• Communication of issues to CEO, board, foundation, medical

staff leadership?• Role of APRN’s• Scholarships in addition to tuition reimbursement?• School/Community partnerships• Enhanced residency programs• Innovations in redesign• Use of simulation• Enhancing interprofessional education & practice• Nursing presence on Board of Directors

Multi-prong approach• Retention of the workforce w/ new models of care• Recruitment & successful transition of new nurses to

double the pipeline-Expand residency programs• Recruitment and retention of faculty• Academic progression in partnership w/ employers &

schools• Innovative partnerships w/adoption & spread of best

practices

Websites

•Wisconsin Center for Nursingwww.wicenterfornursing.org

• Future of Nursing™ Campaign for Actionwww.campaignforaction.org