Forecasting Progress Toward the National Academy of Medicines - - PowerPoint PPT Presentation

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

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Percent of RNs in the US with BS in Nursing or Higher Degree in Any Field

48% 49% 50% 51% 51% 51% 53% 0% 20% 40% 60% 80% 100% 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)

1,438 1,427 1,448 1,456 1,463 1,552 1,516 1,327 1,371 1,448 1,515 1,522 1,615 1,720 500 1,000 1,500 2,000 2,500 3,000 3,500 2009 2010 2011 2012 2013 2014 2015 BSN+ Not BSN+

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Source: American Community Survey, 2009-2015

RN graduations / first-time NCLEX takers

• 10,000

20,000 30,000 40,000 50,000 60,000 70,000 80,000 90,000 100,000 2010 2011 2012 2013 2014 2015 New BSN+ NCLEX exams New non-BSN+ exams RN-to-BSN graduates

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Source: National Council of State Boards of Nursing & AACN

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

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A model of RN supply: 2-year transitions

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ADs <=30 years

New AD/ diploma graduates

ADs 31-40 years ADs 41-50 years ADs 51-60 years ADs >60 years

40% move 20% move 20% move 20% move 30% out per 2 yrs

BSNs <=30 years BSNs 31-40 years BSNs 41-50 years BSNs 51-60 years BSNs >60 years

40% move 20% move 20% move 20% move 30% out per 2 yrs

New BSN+ graduates

RN- to- BSN RN- to- BSN RN- to- BSN RN- to- BSN

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)

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Data entry

• Pink cells are fixed values

from known data

• Green cells can be edited to

compare scenarios

• Sources are clearly

indicated

• A state-level version has 3

columns

• Fixed national values
• Column for state values
• Column for state

scenarios

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Enter your own data, or hypothetical data, in the green cells. Total number of employed nurses Model value Your value # employed RNs 3,235,374 3,235,374 Source: American Community Survey, 2015 Age distribution of employed nurses (percentages) Model value Your value <31 years 17.98% 17.98% 31-40 years 24.00% 24.00% 41-50 years 23.78% 23.78% 51-60 years 23.67% 23.67% 61 years and older 10.57% 10.57% Source: American Community Survey, 2015 Total number of employed BSN+ nurses Model value Your value # employed BSN+ 1,719,742 1,719,742 Source: American Community Survey, 2015

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Age distribution of BSN+ graduates Model value Your value <31 years 75.3% 75.3% 31-40 years 17.8% 17.8% 41-50 years 5.1% 5.1% 51-60 years 1.5% 1.5% 61 years and older 0.1% 0.1% Source: California BRN Annual Schools Report, 2014-15 Annual numbers of RN-to-BSN program graduates Model value Your value # RN-to-BSN grads 56,059 120,000 Source: AACN, 2015 Age distribution of RN-to-BSN graduates Model value Your value <31 years 19.2% 19.2% 31-40 years 36.4% 36.4% 41-50 years 26.7% 26.7% 51-60 years 17.8% 17.8% 61 years and older 0.0% 0.0% Source: California BRN Survey of RN Education Experiences Age distribution of employed BSN+ nurses Model value Your value <31 years 20.16% 20.16% 31-40 years 24.42% 24.42% 41-50 years 23.69% 23.69% 51-60 years 22.21% 22.21% 61 years and older 9.52% 9.52% Source: American Community Survey, 2015 Annual numbers of entry-level program graduates Model value Your value AD & Diploma 86,986 80,986 BSN & Master's 70,863 76,863 Source: NCSBN, 2015 Age distribution of AD & Diploma graduates Model value Your value <31 years 53.6% 53.6% 31-40 years 30.8% 30.8% 41-50 years 13.1% 13.1% 51-60 years 2.5% 2.5% 61 years and older 0.1% 0.1% Source: California BRN Annual Schools Report, 2014-15

Forecasted Percent of Nurses with a BSN+

53.2% 55.8% 58.2% 60.3% 62.1% 63.8% 0% 20% 40% 60% 80% 100% 2015 2017 2019 2021 2023 2025

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What if 75% of entry graduates are BSN+?

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What if we graduate 100K RN-to-BSN?

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What if we do both?

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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
• f RNs
• Especially in rural areas
• Mixed messages from employers
• Preference for BSN may fade as the labor market tightens

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The trickle, illustrated

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

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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

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Download the tools! http://rnworkforce.ucsf.edu/ BSNforecast

Questions: joanne.spetz@ucsf.edu

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