Southern Oregon Nursing Summit World Café

Southern Oregon Nursing Summit World Café

Information OverviewJanuary 9 & 15, 2008Red Lion Inn Medford

Sponsored by:Gordon Elwood FoundationJefferson Regional Health AllianceRogue Valley Workforce Development Council

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Sponsors

Gordon Elwood Foundation Health Care Coalition of Southern Oregon Jefferson Regional Health Alliance

Ashland Community Hospital Asante Health System Jackson County Health & Human Services Josephine County Public Health OHSU School of Nursing - Ashland Campus Providence Medford Medical Center Rogue Community College Southern Oregon University Veterans Administration - SORCC

Rogue Valley Workforce Development Council Pacific Retirement Services The Job Council

Southern Oregon Cadre of Nurse Executives

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Why We’re Here Today

To promote connection and collaboration between individuals and institutions, employers, educators, and the public at large around the nursing workforce issue.

To identify fresh regional strategies for supporting a strong, excellent nursing workforce in southern Oregon.

To inspire institutional and community action that is aligned with these strategies

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Nursing Summit

Focus Areas Nurse Recruitment & Demand Nursing Education Nurse Retention -

Profession & Practice

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Nursing Summit



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Nurse Recruitment & Demand

National By 2010, the demand for full-time registered

nurses will exceed supply, and grow wider in ensuing years

Nationwide, there are 796 registered nurses per 100,000 persons in the population [1:126]

The national average age of a registered nurse is 44 years

Source: Bureau of Health Professions

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Oregon Currently 844 registered nurses employed in

healthcare per 100,000 Oregonians [1:118], nearly the highest level in a decade

This rate is significantly improved from 1996 when there were 777 registered nurses per 100,000 Oregonians [1:128]

However, the nurse-to-patient ratio increase is due mostly to nurses migrating into Oregon & nurses returning to the workforce, not increased capacity at Oregon’s schools of nursing

Source: Oregon’s Nursing Shortage - Northwest Health Foundation

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Oregon The average age of a registered nurse in Oregon

is 47 years 38% of Oregon’s nursing workforce is aged 50

years and older The demand for registered nurses will grow

steadily; an additional 15,700 registered nurse job openings are expected between 2007 and 2020

Source: Oregon Center for Nursing - 2007

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Oregon The age distribution of Oregon’s population will

change dramatically over the next 20 years Oregonians aged 65 or older just eclipsed one million,

accounting for 25% of all residents [OCN, 2007] By 2012, Oregon will be the fourth oldest state in the

nation with respect to age distribution [US Census Bureau, 2007]

Given that there is a nationwide nursing shortage, it may not be possible to attract out-of-state nurses to Oregon

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Oregon Hospitals:

55% of Oregon’s registered nurses practice in hospitals Percentage of Oregon’s hospitals reporting shortages:

– 60 % report shortages in ICU nurses– 55 % report shortages in surgical nurses– 30% report shortages in obstetrical nurses – Recruiting for float, relief, or night shift positions is

problematic for 40% of Oregon’s hospitals Average time to fill vacant positions: four months Turnover rates average 18% per year, with the highest

levels in newly graduated nursesSource: Northwest Health Foundation

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Oregon Ambulatory Care

15 % of Oregon’s registered nurses practice in physicians’ offices and clinics

Vacancy rates: 10 -15% Average time to fill vacant positions: 50 - 75 days Turnover rates average 18 – 22% Length of time required to fill positions reflects:

– Severity of the shortage; these positions were once easy to fill because of daytime hours and regular work schedules

– Ambulatory care salaries considerably lower than in hospitals

Source: Northwest Health Foundation

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Oregon Long Term Care:

10% of Oregon’s registered nurses practice in long-term care settings

35% of all long-term care facilities report a severe shortage of registered nurses

48% report a severe shortage of certified nursing assistants

20% report a severe shortage of licensed practical nurses

Average time to fill vacancies: 60 days for nurses Turnover rates are very high and average 48% Long-term care shortages escalated steeply between

1998 and 2007, and are expected to worsenSource: Northwest Health Foundation & National Commission on Nursing Workforce for Long Term Care

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Oregon Public Health

7% of Oregon’s registered nurses work in public and community health

Two-year turnover rates have increased from 18% in 2000 to 39% in 2007


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Local Hospitals

Anecdotally, Two-year turnover rates for newly graduated nurses range from 27% to 100%

Public Health and Safety Net Clinics There are 77 nurses and nurse practitioners for 78,995

low-income the medically uninsured persons, a nurse-to-population ratio of 1:1,025 compared to the 1:118 state ratio

Nurse practitioner positions have been open as long as two and one-half years

The shortage of baccalaureate prepared nurses will be most immediately felt in public and community health settings.

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Local The need for nurses in the Rogue Valley is expected to almost double

by 2015 (188% increase) and almost triple by 2020 (289% increase)

We are headed for a dangerous nursing workforce shortage

Community 2010 2015 2020Jackson County Supply Demand Shortage

1,1871,468 281

1,1181,648

530

1,4901,860

811

Josephine County Supply Demand Shortage

493609116

464684220

436772336

Both Counties Shortage 397 750 1,147

(projections based on Nursing Demand Model - HRSA- Bureau of Health Professionals)

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Nursing Summit



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Nursing Education

National With the tightening of the financial circumstances

in hospitals, there is a nationwide shortage of clinical training sites for student nurses

There is evidence that nursing is not attracting young people. Nationally, the average age at graduation is 31.7 years

The average age of new doctoral recipients in nursing is 45 years (compared to 39 years in all other health sciences), and 46% of all nursing professors are age 50 to 59

Source: American Association of Colleges of Nursing

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Nursing Education

Oregon Oregon’s nurse executives prefer employing nurses with

baccalaureate preparation, but also say they would hire a non-degreed, experienced nurse before hiring a new graduate [NWHF]

Enrollment of ethnic minorities in nursing programs has increased from 10% in 1995 to 15% in 2006; however, substantially higher attrition rates are reported [Oregon State Board of Nursing]

Oregon’s average age at graduation from nursing school is 32.1 years, resulting in a shorter work-life [OSBN]

As an alternative to schools of nursing in Oregon’s public education sector, contract nursing education programs are emerging in Oregon (i.e., the Providence system)

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Nursing Education

Oregon Oregon has a large pool of qualified nursing

school applicants - six qualified applicants for every position

Nursing education programs in Oregon expanded their capacity between 2001-2007 and increased the number of graduates by 75%

By 2010, an estimated 65 FTE nursing faculty positions in Oregon will be vacated due to retirement

Source: Oregon Center for Nursing

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Nursing Education

Local In spring 2007, Rogue Community College had

180 qualified applicants for 36 slots in its school of nursing for first year students [RCC]

A smaller number of Josephine County’s registered nurses elect to pursue BSN programs than do their cohorts in other Oregon communities [OSBN]

Local secondary schools lack an adequate ratio of academic advisement counselors, leaving many graduates unprepared for entry to nursing school

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Nursing Summit



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National The volume of work placed on nurses has increased,

adding to nurses’ perception of inadequate staffing and work overload Patients are sicker and discharged sooner There are significant reductions in nursing support staff State and federal regulatory requirements are greatly increased

Starting salaries for registered nurses are competitive and attractive, but salary compression practices result in most nurses reaching their maximum earning potential within seven years of graduation

Nurse Retention – Profession & Practice

Source: HRSA – 2004 National Sample Survey of Registered Nurses

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National Only 83% of currently-licensed registered nurses are

actively employed The average age of employed registered nurses is 43.3

years, with registered nurses less than 30 years old representing only 10% of the total working nurse population

Workplace issues (dissatisfaction with the supervisor, workload, and staffing patterns, limited career prospects) constitute the leading factor contributing to nurse turnover

Newly created positions in clinical informatics, radiographic imaging, quality management, utilization review, case management, and pharmaceutical sales are siphoning nurses from direct patient care.


Source: American Association of Colleges of Nursing

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Oregon Nurses in focus groups express concern about

providing safe patient care. They report inability to perform basic care, patient assessment & monitoring in a timely manner, or provide emotional support to patients or families.

Focus groups report a lack of mentoring available to new nurses, as the number of experienced nurses has substantially decreased.



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Oregon Nurses in focus groups clearly describe the lack of a

supportive working environment. Issues such as effective communication, a feeling of

esprit de corps, and a sense of respect and dignity were reported as diminished in current hospital work environments

Nurses in skilled care facilities reported that nurse managers were less visible and unavailable

Nurses in acute care settings conveyed a sense of powerlessness and frustration, and indicated that they were rarely involved in problem-solving on issues that affected their practice



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Oregon Nurses are frustrated by the lack of attempts to

retain qualified nurses in their practice settings: They point to sign-on bonuses and the payment of

premium wages to temporary staff while their own wages stagnate

They want salary schedules in which competence, advanced training, and experience are rewarded



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Oregon Nearly one-half of Oregon’s registered nurses are 50 years

of age or older; the proportion of older nurses has doubled in the past 20 years

An exodus of retiring nurses is now underway; by 2025, 41% of currently licensed registered nurses will retire

Oregon’s nurses are not leaving the workforce early

80% of nurses are currently employed in nursing Only 58.5% of Oregon’s nurses work full-time Oregon has the fourth highest proportion in the nation of

nurses employed part-time at 41.5%


Source: Oregon Center for Nursing

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Local Anecdotally, high turnover in nurse executive

positions (hospitals and education) lead to inconsistent progress in improving policy change, practice, organizational culture, work environment and empowerment issues


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Nursing Summit


Profession & PracticeNursing Workforce – Summary Analysis & Conclusions

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Nursing Workforce – Summary Analysis and Conclusions

The Rogue Valley is indeed headed for a dangerous nursing workforce shortage

The causes for this shortage are multi-dimensional and complex

The nursing shortage is adversely affecting patient care, safety and morale of the workforce, and driving up the cost of care

The impending decline in the supply of registered nurses will come at a time when the first of the 78 million “Baby Boomers” begin to retire and enroll in the Medicare program

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This shortage will be unlike nursing shortages of the past: left unchallenged, it will not simply cycle back into an adequate supply; it will worsen over the next decade.

The lack of educated and experienced nurses will have profound impacts on every area of health care – most critically in (descending order) Intensive care units Elder care Surgical units Community-based safety net clinics Public health

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The future depends on our community’s ability to draw together collective insight that will inform common action It is imperative to understand the causes of the shortage and

to collaborate with all sectors of the healthcare industry –consumers, government agencies, educational institutions, and health-providing organizations – to forge a path toward a solution

The health of all Oregonians and our Rogue Valley communities, is directly dependent on our combined capacities to craft innovative, enlightened, responsive, strategic, and effective solutions

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World Café

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Problem: Nursing Shortage

Strategy – an approach to an issue

Action Steps – ways to make that strategy happen

Example: Strategy: increase number of nursing faculty at OHSU

(Southern Region) and RCC Action Steps: increase salary by:

Lobbying legislature for additional funding Write a grant __________


Information OverviewJanuary 9 & 15, 2008Red Lion Inn Medford



January 9 & 15, 2008Red Lion Inn Medford


Thank you for attending, for your valuable input and your partnership and commitment in moving forward

Documents

Southern Oregon Nursing Summit World Café