Nursing Workforce in Hawaii: Charting our Progress

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Nursing Workforce in HawaiiCharting our Progress

• Bee Molina Kooker, DrPH, APRN
• University of Hawaii The Queens Medical Center
• Carol Winters-Moorhead, PhD, RN
• Hawaii Pacific University

March 5, 2005
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Funded by
Funded by the Robert Wood Johnson Foundation
Co-sponsored by the State Board of Nursing
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Purpose of the study

• Describe characteristics of our current nursing
  workforce
• Compare data trends

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Statement of the Problem

• Worldwide shortage
• Aging population with increasing health care
  needs
• Aging workforce with decreased capacity to work
• Experience drain

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Study Significance

• Impact on health care for the state, nation,
  world
• increased need
• decreased capacity
• Hawaiis geographic isolation
• unable to borrow

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Methodology

• Descriptive design
• Stratified, random sample
• 3600 nurses
• Survey instrument, 2003
• Response rate 36
• Data analysis - SPSS

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Demographics

• Age
• 2001 2003
• Mean 48.7 yrs 49.3 yrs
• 18-29 5.2 4.6
• 30-39 15.3 14.1
• 40-49 32.7 30.5
• 50-59 30.5 33.6
• 60 16.0 17.2

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Demographics

• Gender
• 2001 2003
• Female 93.8 93.4
• Male 5.9 6.5

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Demographics

• Ethnicity 2001
  2003

White, not Hispanic 48.3 48.5 Asian/Pa
c Islander 24.3 22.8 Filipino 13.4 12.5 Ha
waiian/Part Hawaiian 5.1 5.1 Hispanic
1.9 1.8 Black, not Hispanic
0.6 0.3 American Indian/AlaskNative
0.2 0.2 Multiple Responses 4.7 5.8 Other
(write in) 0.1 2.5 Blank 1.3 0.2
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Distribution

• Geographic distribution

Island 2001 2003 Oahu 39.9 40.8 Hawaii
25.6 25.4 Maui 21.9 21.8 Kauai 10.9 1
1.2 Other/missing 1.6 0.9
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Educational Preparation - Nursing

• 2003
• Diploma 29.0
• Associate degree 44.0
• Baccalaureate degree 41.8
• Masters degree 9.8
• Doctorate nursing 0.7

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Licensure/Certification

• APRN 5.8
• NP 3.5
• CNS 1.8
• CRNA 0.5
• CNM 0.5
• Multiple 0.1

• Certification 24.5
• Matern/Women 3.2
• Adult 1.0
• Psych 1.9
• Peds 1.1
• Community 0.2
• Admin 0.8
• Multiple 1.0
• Other 16.2

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Employment

• Employed in nursing
• 2001 2003
• Yes 80.0 83.6
• No 19.5 15.8

• More than one job
• 2001 2003
• Yes 12.4 16.7

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Employment

• Primary setting 2001 2003
• Hospital 44.5 44.8
• Ambulatory 7.5 6.9
• Public/community 7.1 5.5
• Long term care/nsg home 7.4 6.1
• Home care 4.3 3.6
• Education 3.2 4.0
• Insurance -- 1.1
• Multiple 2.7 3.6
• Other 11.8 13.8

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Employment

• Primary nursing job 2001 2003
• Staff/General 38.7 37.5
• TL/Charge/Manager 12.5 10.3
• Multiple 10.0 12.6
• Facility Admin/Superv 4.3 5.5
• UR/UM/CM/QA/IC 3.9 4.2
• Educator (SON, inserv) 3.2 2.8
• NP/CNM/CRNA 2.2 2.6
• Research/Consult/CNS 1.3 1.4
• Other 9.8 10.1

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Retirement Plans

• Years to retirement
• 2001 2003
• - Mean 14.6 yrs 13.6 yrs
• - 0-5 yrs 17.4 21.0
• - 6-10 25.8 26.8
• - 11-15 19.2 19.4
• - 16-20 19.2 20.3
• - gt20 18.4 12.5

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New RN Graduates
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Discussion

• Preparation of adequate numbers, levels, and
  specialties of nurses to replace
• retiring
• reservists
• relocations
• leaving the profession

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Discussion

• Improved recruitment
• targeted
• purposeful
• Improved retention
• valuing current
• workplace enhancement

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Proposed Solutions

• Increase capacity to educate nurses
• Scholarships and loans
• Design new models for nursing preparation and
  internships
• Recruit younger and more diverse
• students, faculty, staff
• establish retention strategies

Hawaii State Center for Nursing June 2003
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Proposed Solutions

• Entice licensed nurses back
• Improve the image of nursing as a career choice
• Create workplace accommodations to keep aging
  nurses at work
• redesign units (safety ergonomics)
• restructure schedules
• respect wisdom expertise

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Charting our Progress

• Capacity building
• Recruitment and retention
• Career development
• Management of the profession
• Workforce analysis and development

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Capacity Building Strategies

• Increased faculty, students, clinical sites
• Enrollment and resource management
• New models for nurse preparation
• Supportive legislation

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Achievements

• New models for enrollment management established.
  
• Nursing faculty preparation models in development
• Funds for additional faculty positions is a
  priority in the UH biennium budget

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Recruitment and Retention Strategies

• Scholarships and loans
• Efforts targeted for diversity (students
  faculty)
• Improve the image of a nursing as a career
• Recognize and value nurses in facilities
• Autonomy in practice
• NDNQI (ANA Report Card)
• www.nursingworld.org/quality/database.htm

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Achievements

• Legislation for scholarships in progress
• HB281 and SB116
• Targeted recruitment actively pursued for faculty
  and students
• State and national advertising for faculty
• Enhanced electronic recruitment activities
• Incentives for preceptors and adjunct/clinical
  faculty

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Career Development Strategies

• Career planning and options
• Educational mobility for career advancement
• Preceptorship/mentorship activities

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Achievements

• LPN to BS(N), RN to BS(N), RN to MS(N), and PhD
  in nursing programs available
• On-line PhD program at UHM
• Nursing education courses/programs available at
  HPU, UHM, UOP
• Mentorship activities for new faculty
• Career development opportunities for current
  faculty

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Management of the Profession Strategies

• Recruitment and retention of nurses in
  professional organizations
• Adoption of new roles, e.g. CNL
• Federal legislation and funding for training
  grants
• Entry into practice, e.g. Pharm.D.

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Achievements

• Close monitoring of AACN clinical nurse leaders
  (CNL) role, and practice doctorate (DNP)
• UHM submitted three training grant proposals for
  additional nursing programs
• Development of leaders through professional
  organizations

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Workforce Analysis Development Strategies

• Data, data, data accurate, timely, complete
• Analysis of data and trends
• Report generation and dissemination
• Optimal utilization of staff
• Hawaii State Center for Nursing

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Achievements

• On-going surveying of RNs via CINH
• Analysis and reports in progress
• Staff turnover and flyer rates captured
• Hawaii State Center for Nursing established
• Promoting partnerships to advance nursing
• HAH Nursing Shortage Task Force
• Hawaiis Health in the Balance A Report of the
  Nursing Workforce, October 2004
• Fact Sheet on Hawaiis Nursing Workforce
  Shortage Education Capacity, Fall 2004
• http//www.nursing.hawaii.edu/nursingshortage.html

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Report Card of Achievements

• Capacity building
• Recruitment and retention
• Career development
• Management of the profession
• Workforce analysis and development

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Report Card of Achievements

• Report card development
• Reach consensus on criteria
• State and National
• Establish scoring mechanism
• Monitor progress regularly
• Disseminate findings
• Make recommendations

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The saga continues . . .
Discussion?
Questions?
Mahalo to our CINH survey team Marla Acosta Steve
Hobbs Janne Yoshinaga