Forecasting Progress Toward the National Academy of Medicine’s Registered Nurse Education Recommendations Joanne Spetz, PhD Professor, Philip R. Lee Institute for Health Policy Studies Associate Director for Research, Healthforce Center University of California, San Francisco June 2017
IOM Committee on the Future of Nursing What is the role of nursing in delivering care to all Americans in a rapidly-changing health care system? 2011 report with 8 recommendations Robert Wood Johnson Foundation launched Campaign for Action to implement the IOM Recommendations • Multi-pronged approach • Center to Champion Nursing in America is key partner • State “Action Coalitions” for local -level work
80% of RNs should have a bachelor’s or higher degree by 2020 3
Percent of RNs in the US with BS in Nursing or Higher Degree in Any Field 100% 80% 53% 60% 51% 51% 51% 50% 49% 48% 40% 20% 0% 2009 2010 2011 2012 2013 2014 2015 Source: American Community Survey, 2009-2015 Source: American Community Survey, 2009-2015
Number of employed RNs, by education (thousands) 3,500 3,000 2,500 1,720 1,615 1,522 1,515 1,448 1,371 1,327 2,000 BSN+ 1,500 Not BSN+ 1,000 1,552 1,516 1,456 1,463 1,438 1,448 1,427 500 0 2009 2010 2011 2012 2013 2014 2015 Source: American Community Survey, 2009-2015 5
RN graduations / first-time NCLEX takers 100,000 90,000 80,000 New BSN+ NCLEX 70,000 exams 60,000 50,000 New non-BSN+ exams 40,000 30,000 RN-to-BSN graduates 20,000 10,000 - 2010 2011 2012 2013 2014 2015 Source: National Council of State Boards of Nursing & AACN 6
Is 80% BSN+ by 2020 feasible? If not, then can 80% BSN+ be reached? Approach: • Gather data on nursing workforce and education • Develop forecasting model to project BSN+ share over 10 years • Test scenarios that might speed progress 7
A model of RN supply: 2-year transitions ADs <=30 years BSNs <=30 years RN- 40% move 40% move to- New AD/ New BSN diploma BSN+ ADs 31-40 years BSNs 31-40 years graduates graduates RN- 20% move to- 20% move BSN ADs 41-50 years BSNs 41-50 years RN- to- 20% move 20% move BSN ADs 51-60 years BSNs 51-60 years RN- 20% move to- 20% move BSN ADs >60 years BSNs >60 years 30% out per 2 yrs 30% out per 2 yrs 8
Data sources Current RN workforce (American Community Survey) – numbers, age distribution, & education by age group Entry-level RN graduates (National Council of State Boards of Nursing first-time NCLEX test-takers) – by degree type • Age distribution of entry-level RN graduates (California Board of Registered Nursing Annual Schools Report) – by degree type RN-to-BSN graduates (American Association of Colleges of Nursing) • Age distribution of RN-to-BSN graduates (California Board of Registered Nursing Survey of RN Education Experiences) 9
Data entry Enter your own data, or hypothetical data, in the green cells. Pink cells are fixed values Total number of employed nurses from known data Model value Your value # employed RNs 3,235,374 3,235,374 Green cells can be edited to Source: American Community Survey, 2015 compare scenarios Age distribution of employed nurses (percentages) Sources are clearly Model value Your value <31 years 17.98% 17.98% indicated 31-40 years 24.00% 24.00% A state-level version has 3 41-50 years 23.78% 23.78% 51-60 years 23.67% 23.67% columns 61 years and older 10.57% 10.57% Source: American Community Survey, 2015 • Fixed national values • Column for state values Total number of employed BSN+ nurses Model value Your value • Column for state # employed BSN+ 1,719,742 1,719,742 Source: American Community Survey, 2015 scenarios 10
Age distribution of employed BSN+ nurses Model value Your value Age distribution of BSN+ graduates <31 years 20.16% 20.16% Model value Your value 31-40 years 24.42% 24.42% <31 years 75.3% 75.3% 41-50 years 23.69% 23.69% 31-40 years 17.8% 17.8% 51-60 years 22.21% 22.21% 41-50 years 5.1% 5.1% 61 years and older 9.52% 9.52% 51-60 years 1.5% 1.5% Source: American Community Survey, 2015 61 years and older 0.1% 0.1% Source: California BRN Annual Schools Report, 2014-15 Annual numbers of entry-level program graduates Model value Your value Annual numbers of RN-to-BSN program graduates AD & Diploma 86,986 80,986 Model value Your value BSN & Master's 70,863 76,863 # RN-to-BSN grads 56,059 120,000 Source: NCSBN, 2015 Source: AACN, 2015 Age distribution of AD & Diploma graduates Age distribution of RN-to-BSN graduates Model value Your value Model value Your value <31 years 53.6% 53.6% <31 years 19.2% 19.2% 31-40 years 30.8% 30.8% 31-40 years 36.4% 36.4% 41-50 years 13.1% 13.1% 41-50 years 26.7% 26.7% 51-60 years 2.5% 2.5% 51-60 years 17.8% 17.8% 61 years and older 0.1% 0.1% 61 years and older 0.0% 0.0% Source: California BRN Annual Schools Report, 2014-15 Source: California BRN Survey of RN Education Experiences 11
Forecasted Percent of Nurses with a BSN+ 100% 80% 60% 63.8% 62.1% 60.3% 58.2% 55.8% 53.2% 40% 20% 0% 2015 2017 2019 2021 2023 2025 12
What if 75% of entry graduates are BSN+? 13
What if we graduate 100K RN-to-BSN? 14
What if we do both? 15 Presentation Title and/or Sub Brand Name Here 6/25/2017
Why is progress slow? Inflow of new RN-to-BSN graduates is a trickle into a very large bucket Incumbent RNs who are not interested in going back to school Continued reliance on AD programs to ensure an adequate number of RNs • Especially in rural areas Mixed messages from employers • Preference for BSN may fade as the labor market tightens 16
The trickle, illustrated 0 1,000,000 2,000,000 3,000,000 Number of employed RNs Number of new BSN grads per year Number of new non-BSN grads per year Number of RN-to-BSN grads per year 17
Conclusions & Policy Recommendations Greater effort needed to attain IOM goal by 2025 • Can the goal be reached by 2025??? Increasing RN-to-BSN graduations has bigger impact • Also more plausible Educators: • Facilitate a culture of life-long learning • Expand flexible programs (including online) Employers: • Support education with tuition and flexible schedules • Reward educational progress with pay and title 18
Download the tools! http://rnworkforce.ucsf.edu/ BSNforecast Questions: joanne.spetz@ucsf.edu 19 6/25/2017
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