VT. Nurse Workforce Background Information

for theBlue Ribbon Commission on Nursing

October 6, 2011Mary Val Palumbo DNP, APRN

University of VermontAHEC Nursing Workforce Initiatives

Members of the Nursing Workforce

Licensed Nursing Assistant (LNA) 6 wks

Licensed Practice Nurse (LPN) 1 yr

Registered Nurse Diploma – 3 yr ADN – 2yr

Members of the Nursing WorkforceRegistered Nurse BS or BSN – 4 years

Members of the Nursing Workforce – Advanced Practice

MSN – Nurse Practitioner, Nurse Anesthetist, Nurse Midwife, Administrator or EducatorDNP – Doctor of Nursing PracticePhD – Nurse Scientist/Educator

Recent History

Blue Ribbon Nursing Commission January, 2001

“Vermont is in the midst of a crisis. The number of nursingstudents has declined at the same time the number of workingnurses who are retiring is increasing. The confluence of thesetwo dynamics has created unacceptably high nursing vacancyrates in hospitals, nursing homes, and home health agencies.” Vermont Association of Hospital and Health Systems

Vacancy rates has high as 19% reported in 2003

Recommendations of the Blue Ribbon Nursing Commission January 2001

Create an Office on Nursing Workforce Increase salaries Establish a marketing partnership and X Develop a Scholarship Program Fund a Loan Forgiveness Program Increase capacity of nursing schools Expand continuing education programs

Age of RN’s Working in VT

7%6%

20%

14%

42%

24%26%

38%

7%

19%

20-30 31-40 41-50 51-60 61+

Years of Age

2001

2009

Board of Nursing Relicensure Surveys in 2001 n = 6,008 (85% response rate) 2009 n = 3,627 (54% response rate)

The Nurse Age Dilemma

2%4%

7% 7%

10%14%

19%19%

12%

7%

0%

5%

10%

15%

20%

25%

30%

Employed Vermont nurses

Years of Age

2009 RN Relicensure Survey completed in March, 2009 by 3,627 VT employed nurses (54% response rate)

2001- 2003 Focus on Recruitment

Educational change over decade

Five Vermont schools of nursing VTC – online re-entry, LPN, ADN expandedSouthern VT college – ADN, RN to BSNUVM – BS, RN to BSN expanded, MS Castleton – ADN, new BSN, RN to BSNNorwich – BSN, MSN nursing admin/education

Plans: VTC - BSN, UVM - DNP

Educational Level of Vermont Nurses

From re-licensure survey was completed in March, 2009 by 3,627 VT employed nurses (54% response rate)

• 17% completed a Diploma program in nursing• 40% completed an Associate’s Degree in nursing• 35% completed a Bachelor’s Degree in nursing• 5% completed a Master’s Degree in nursing• <1% completed a Doctoral degree

129

0

50

100

150

200

250

300

350

Total RN

VTC LPN

UVM

CSC

S.VT.C

VTC AD

Norwich

Vermont Nurse Graduates1999-2011

301

169

Vermont Nurse Graduate by Type/Degree 2011

BS or BSN; 23%

Asso-ciates; 41%

LPN; 36%

BS or BSNAssociatesLPN

*Does not count – RN to BSN graduates in 2011

2011 RN Graduates in Vermont

BS or BSN; 35%

Associate Degree; 65%

BS or BSN

Associate Degree

VTC, CSC, SVC

UVM, Norwich

17 1026

1325

7786

131

154137

147134

0

20

40

60

80

100

120

140

160

180

Applicants toGraduate NursingProgram

Applications to UVM Masters Program in Nursing 2000 to 2011

21

10 612 10 7

12 8 4 3

18128

4

1

27

27

1 5

2

1

05

10152025303540455055

UVM Clinical SystemsManagement

NorwichAdministration/Educator

UVM Psych/Mental Health

UVM NP

Nursing Masters' Degrees in Vermont 1999 to 2011

2005-2009 Policy Work

• In Collaboration with AHEC and other stakeholders:– Nurse Faculty

Loan Repayment– October Designated as Health Care Career

Awareness Month– Workforce Development Partners (grant and

policy work)

Infrastructure to collect and analyze health care workforce data

• Office of Nursing Workforce collected 10 years of Vermont Supply and Demand data which is available at http://www.choosenursingvermont.org/

• Vermont Board of Nursing is now working with the National Council of State Boards of Nursing to collect a “Minimum Data Set” electronically with relicensure of RNs, LPNs, and APRNs.

• Office of Nursing Workforce (now AHEC)has published studies on educational determinants of satisfaction and retention, intention to leave, emergency preparedness, youth perceptions of a nursing career, nurse perceptions of their health and safety and their employers attention to same. (2004-11)

Implement nurse residency programs

Vermont Nurses In Partnership, Inc. (VNIP) provides an international forum for nurse leaders from academia, regulation and various practice settings that are working to improve transition to practice for direct care providers. The forum has grown from the initial 45 Vermont-based members, to a coalition of over 500 nurse leaders from across the nation and around the world.

http://www.vnip.org/

Remove scope-of-practice barriers

As of June 1, 2011, experienced nurse practitioners are no longer required to have a written “collaborative agreement” with an MD.

Scope of practice barriers remain for APRNs and RNs

22

Magnet Hospitals

• Southwestern Vermont Medical Center (X3)

• Rutland Regional Medical Center

• Dartmouth Hitchcock Medical Center (X2)

A hospital where nursing delivers excellent patient outcomes, where nurses have a high level of job satisfaction, and where there is a low staff nurse turnover rate and appropriate grievance resolution. Magnet status is also said to indicate nursing involvement in data collection and decision-making in patient care delivery . Segen's Medical Dictionary. © 2011

New challenges for Nurses

• Vermont Blue Print for Health requires attention to health promotion and population health

• Transition to Electronic Medical Records requiring nurse input

• Health care reform and primary care provider shortage.

Old Challenges

• Nursing faculty shortage• Availability of clinical

placement sites for nursing programs

• Nurse health and safety (older and younger)

• Pending retirement of half the workforce

• Interest in caring for elders

Why you? Why us? Why now?