State of Nursing 2006 by bigmekahlo

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									State of Nursing 2006
Edward O’Neil, Ph.D., MPA, FAAN Professor Family and Community Medicine and Dental Public Health Director of the Center for the Health Professions, University of California, San Francisco

HTTP://www.healthws.com

HTTP://FUTUREHEALTH.UCSF.EDU

Outline
• Drivers of Change • Strategic Responses
Thanks to: Robert Wood Johnson Foundation Gordon & Betty Moore Foundation California Health Care Foundation California Endowment California Wellness Foundation

A Few Beginning Observations
• Health care is a labor intensive undertaking and a big part of overall US employment. • Nursing workforce crisis will emerge over the next five years • Much of the potential quality of health care is determined by the actions of professionals. • More similarities to rest of workforce than differences. • Strategic risk, but also advantage in response

Source: O’Neil E, Kimball B. Health Care’s Human Crisis: Nursing. (Princeton: Robert Wood Johnson Foundation, 2002)

Why a crisis?
• • • • Demographic perfect storm Culture change Work environment Supply

Source: O’Neil E, Kimball B. Health Care’s Human Crisis: Nursing. (Princeton: Robert Wood Johnson Foundation, 2002)

Demographic perfect storm
• Aging Population

Source: O’Neil E, Kimball B. Health Care’s Human Crisis: Nursing. (Princeton: Robert Wood Johnson Foundation, 2002)

Demographic perfect storm
• Aging Population means more chronic illness
Percent Adults Reporting Chronic Disease in Self or Family, 2005 40 30

Percent

20 10 0 Arthritis Disability Asthma CHD Diabetes

SOURCE: Health Care Cost Survey, Kaiser Family Foundation, Harvard School of Public Health, , August 2005.

Demographic perfect storm
• and older nurses…
Average Age of RNs 1980-2004
40 20 0 40.5 17.2 1980 Age <35 >54 25.5 16.6 2004

SOURCE: RN Sample Survey 2004, 1980 Analysis, Health Workforce Solutions, 2006.

Percent

Demographic perfect storm
• … and fewer to draw from…
US Live Birth by cohort 19462002

5000
Baby Boom

Thousands

Baby Bulge

4000 3000 2000
1946 1970 2002
Baby Bust

SOURCE: Historical Statistical Abstract.

Demographic perfect storm
• … particularly when drawing from only half of population…
RN Gender Distribution, 2004

Males = 5.7%

SOURCE: RN Sample Survey 2004.

Demographic perfect storm
• … and unevenly from different ethnic groups…

Asian PI Black, NH Asian PI TWO > Hispanic

Black, NH

12.2

1.3
Native

4.1
Hispanic

1.8 0.4 3.3

4.6

1.5

TWO >

13.7

0.7
Native

67.9
88.4
White, NH White, NH

SOURCE: RN Sample Survey 2004, 1980 Analysis, Health Workforce Solutions, 2006.

Demographic perfect storm
• … and in the face of new opportunity for women

Percentage Female Students, 2004
79 80 49.5 60 42.4 40 20 0 Dentistry Medicine Pharmacy Vet Med Profession 66.5

SOURCE: ADEA, AAMC, AACP, AACVM, Analysis by Center for the Health Professions, 2006.

Percent

Spiraling Costs
Health Care as total dollars in billions and % of GDP
3145

3000

20 15 10 5 0

Dollars in Billions

16 2387

12 8.8

1000
27

7 5.1 73 246 696

827

937

1039

1150

1309

0 60 70 80 90 92 94 96 98 2000 2004 2008 2012

Source: Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.gov/statistics/nhe/default.asp (2002 National Health Care Expenditures Data Files for Downloading, file nhegdp02.zip). >2004 projections

Percent

2000

13.1

13.3

13.3

13.1

13.3 1793

Lead to redistributed resources
Distribution of NHE by Type, 1990 and 2002
40 30
Percent
36.5 31.3 22.6

21.9 13.7 13.3 10.5 5.8 7.6 6.6 1.8 2.3 13.7 12.4

20 10 0
Hospital Physician

Drugs

LTC

Home

Other Personal Health

Other Health

1990

2002

Source: CMS, Office of Actuary, National Health Statistics Group, 2004

…and pressure on in-service care
Admissions in Thousands and Lenght of Stay in Days
40000
Admissions in Thousands

12 10 8

35000
Admissions

6 4 2

30000 1975 1980 1990 1995 2000 2001

0

SOURCE: Health US, 2003, USHHS, CDC,NCHCS, October 2003, 97.

Days

Length of stay

Declining Interest in Nursing
Candidates for RN Exam*
Number by Training Program
100000 80000 60000 40000 20000 31195 32278 31828 30142 28107 26048 0 7335 6346 5240 3978 3161 2679 1995 1996 1997 1998 1999 2000 Diploma Baccalarate Associate 57908 55554 49045 49045 45255 42665

Decline of 26% 1995 to 2000

* First time candidates, US educated only

Source: National Council of State Boards of Nursing, www.ncsbn.org

How Big of a Gap and When?
Projected Demand to Supply of RNs 2000-2020

0
Percentage

-6 -7 -12 -20 -29

-2 -5 -11 -19 -29

-10 -20 -30 -40 -50

-11 -10 -21 -34

808 K
US 2000 2005

32 K

122 K
-46 CA 2015 2020

OH 2010

Source: Projected Supply, Demand, and Shortages of Registered Nurses: 2000-2020 July 2002 U.S. DHHS, HRSA, BHPr, National Center For Health Workforce Analysis

Recovery: Numbers
1995: 96,610 2001: 68,759

Candidates for RN Exam*
2005: 99,089

Number by Training Program

100000 80000 60000 40000 60053 57908 49045 53275 45255 47423 42665 42310 41567

31828 35496 20000 31195 30648 28107 26048 26630 25806 24832 0 7335 5240 3161 2679 2310 2424 2565 3162 3540 1995 1999 2001 2003 2005 Diploma Baccalarate Associate

* First time candidates, US educated only

Source: National Council of State Boards of Nursing, www.ncsbn.org

Recovery: Quality
RN pass rate for all candidates, 1994-2000
90 80 70 60 50 40 30 20 10 0 82.4 87.3 76.6 71.8 76.2 68.8 80

1994

1996

1998

2000

2002

2004

2005

Source: National Council of State Boards of Nursing, Inc. www.ncsbn.org

Strategies Scale and Time
High

Start Over

Complexity

Reinvent
Improve

Scramble
Low

Short

Time

Long

Source: O’Neil E, Kimball B. Health Care’s Human Crisis: Nursing. (Princeton: Robert Wood Johnson Foundation, 2002)

Reaction by Sector
• • • • Education Service Labor Policy makers

Scramble
• Focus on educational recruitment • Public relations campaigns • Staff recruitment
– – – – Signing bonus International recruitment Traveler/staffing companies Education support/loan forgiveness

• Labor organizing/actions • Market – quick grab • Policy – attention followed by rhetoric

Improve
• • • • • Improved through put in education Integration between 2Y and 4Y education programs More faculty with better preparation Standardize education through technology Realign international recruitment to two-way service

Improve
• Improve recruitment and performance of underrepresented students • Better integration with and support from practice • Transition from education to practice
– Mentoring – Structured “residency” – Better on-boarding for financial and service

Improve
• Nursing driven QI; balanced with externally driven demand for QI – Magnet, JACHO, Pay for Performance • Better use of experienced nurses • Leadership at all levels of nursing – executive, midlevel and front line • Labor providing on-boarding, mentoring • Policy makers creating context or framework for action

Reinvent
• Forget 2 year – 4 year rivalry; claim all of nursing, declare victory and work to make competitive • Push radical integration between education and practice including:
– faculty - clinician – classroom - facility – student – professional

• Regional common market for education and practice
– – – – simulation facility recruitment quality standards

Reinvent

• Create new breakthrough practice models in in-patient settings
– Position new technology by placing with new practice model – Provide process to assist in developing new practice models – Address work environment issues by repositioning practice – Create new markets that respond to failure of old practice models

Reinvent
• Labor -Move beyond old industrial model to service sector models
– Quality – Life long development – Individual effort

• Policy – new public-private and education-practice partnerships • Policy – focus on regional development issues

Start-Over
• Move education to new assessment, simulation, practice, improvement model; use new technology • Reorganize nurse practices around treatment of chronic populations in home and community settings; use new technologies • Move nursing professional knowledge out using new delivery models

Start-Over
• Create deep integrations among labor, management and education • Capitalize new business models for nursing service; build on new consumer demands • Reframe workforce as jobs development, access to opportunity issue; new political partnerships

…How to meet the new challenges
Regional Focus Strategic Leverage Honest Broker Performance Long haul Build on existing work

HTTP://www.healthws.com eoneil@healthws.com

HTTP://FUTUREHEALTH.UCSF.EDU eoneil@thecenter.ucsf.edu


								
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