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Nursing Workforce Planning. Mariel S. Lavieri Sandra Regan Martin L. Puterman Pamela A. Ratner. Outline. Introduction. Model Description. Final Remarks. Background Our Approach Model Overview. Model Inputs Formulation Outputs. Background.

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Nursing workforce planning l.jpg

Nursing Workforce Planning

Mariel S. Lavieri

Sandra Regan

Martin L. Puterman Pamela A. Ratner


Outline l.jpg

Outline

Introduction

Model

Description

Final Remarks

  • Background

  • Our Approach

  • Model Overview

  • Model

  • Inputs

  • Formulation

  • Outputs


Background l.jpg

Background

  • Workforce planning, training and regulation is thedominant immediate and long term issue for policy makers, managers, and clinical organizations.

    Listening for Direction: A national consultation on health services and policy issues

  • Registered nurses account for just over one-third of the health workforce.

  • Today’s decision have long term implications.

  • Decisions in the 1990’s:

    • decrease education seats,

    • increase casualization of the workforce

    • decrease nurse leadership

  • In 2001, the CNA president noted “Canada should be graduating about 10,000 nurses annually to replenish the workforce in the next 10 years”.


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Background

Source: Canadian Institute for Health Information. (2006).

Workforce Trends of Registered Nurses in Canada, 2005.


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Background

Source: Canadian Institute for Health Information. (2006).

Workforce Trends of Registered Nurses in Canada, 2005.


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Background

Source: Canadian Institute for Health Information. (2006).

Workforce Trends of Registered Nurses in Canada, 2005.


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Background

Source: Canadian Institute for Health Information. (2006).

Workforce Trends of Registered Nurses in Canada, 2005.


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Background

w

Source: Canadian Institute for Health Information. (2006).

Workforce Trends of Registered Nurses in Canada, 2005.


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Background

Source: Canadian Institute for Health Information. (2006).

Workforce Trends of Registered Nurses in Canada, 2005.


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Supply and Demand Balance (or Imbalance)


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Estimating Requirements of Providers

  • Utilization-based

    • Current utilization patterns

  • Needs-based

    • Population-health needs

  • Effective demand-based

    • Economic constraints


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Planners Need

  • Precise short and long term plans that provide:

    • Nursing education seats

    • The number of nurses to recruit and at what level

    • The number of nurses and managers to promote

  • Models:

    • Inputs and assumptions can be varied and implications seen

  • Flexible unified frameworks that apply to any workforce:

    • Regional

    • Provincial

    • National

    • Sub-specialty


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Our Approach

A flexible computer-basedoptimization model that provides a minimum cost human resource plan subject to workforce targets and high quality service delivery standards.


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A Sample Plan


Model overview l.jpg

  • Data:

  • Nurse

    workforce

    size

  • Student

    body

  • Population

    projection

  • Outputs:

  • Optimum costs

  • Yearly student

    population

  • Yearly

    workforce size

  • Run model:

  • Minimum

    cost plan

Model Overview

  • Assumptions:

  • Attrition rates

  • Nurse/Pop.

  • Costs


Model overview16 l.jpg

  • Data:

  • Nurse

    workforce

    size

  • Student

    body

  • Population

    projection

  • Outputs:

  • Optimum costs

  • Yearly student

    population

  • Yearly

    workforce size

  • Run model:

  • Minimum

    cost plan

Model Overview

  • Assumptions:

  • Attrition rates

  • Nurse/Pop.

  • Costs


Model overview17 l.jpg

  • Data:

  • Nurse

    workforce

    size

  • Student

    body

  • Population

    projection

  • Outputs:

  • Optimum costs

  • Yearly student

    population

  • Yearly

    workforce size

  • Run model:

  • Minimum

    cost plan

Model Overview

  • Assumptions:

  • Attrition rates

  • Nurse/Pop.

  • Costs


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Scope

  • Registered Nurses in British Columbia

  • 20 year planning horizon

  • Decisions made once each year

  • Ages 17 – 65+

  • 7 levels

  • Full time equivalent basis


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Cost of education

Do other work/retire

New students/recruits

Workforce Flowchart

Student(year 1)

Student(year 2)

Student(year 3)

Student(year 4)

Direct Care Nurse

Entry Level Management

Senior Level Management


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Model

  • Decision Variables:

    In each year

    • How many to admit

    • How many to recruit

    • How many to promote

Students(year 1) Students(year 3)

Direct care nurses Entry level management

Direct care nurses Entry level management


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Model

  • This model tracks the number of:

    of age i that are in the system in year j

Students(year 1) Students(year 2) Students(year 3) Students(year 4) Direct care nurses Entry level management Senior level management


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Model

Minimize:

Cost of training + Recruitment cost + Salary

In order to:

  • Have sufficient resources (FTEs) to achieve quality of care targets.

  • Achieve balance of “recruit” and BC nurses.

  • Only promote nurses after they have been in their position a specified number of years.


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Variable Inputs

  • Costs:

    • Education:

      • Student (annual) (1)

      • Management training (one shot) (1)

    • Recruitment and turnover cost(2)

    • Salaries (by level) (3)

  • Continuation and attrition rates:

    • Attrition rates (4), (5)

    • Age distribution (6), (7), (8)

    • Probability of continuing the degree (6), (9)

    • Probability of passing the RN exam (7)

    • Probability of leaving BC after graduation (7)

    • FTE per full time person per age per experience time in position (7)

  • Initial Conditions:

    • Distribution of current workforce by position (8)

    • Ratio of RN to population (8)

    • BC population projections (11)

(1)Ministry of Advanced Education

(2)Weber (2005)

(3)BCNU

(4) Kazanjian (1986)

(5) O’Brien-Pallas et al. (2003)

(6) UBC School of Nursing (2006)

(7) CRNBC (2005)

(8) CIHI (2005)

(9) Pringle and Green (2005)

(10) CIHI (2005)

(11) BC STATS (2006)


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Cost of training

Recruitment cost

Annual salary

Necessary resources

Balance students

Recruit vs

Canadian nurses

Promotion rules


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Scenarios

  • Proportion of students that continue the program after each year of study

  • Nurse to manager ratios and nurse attrition rates

  • Changes in maternity leaves

  • Changes in the minimum number of nurses needed to satisfy the demand


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Outputs – Initial Scenario


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Outputs – Initial Scenario


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Outputs – Initial Scenario


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Outputs – Comparing Scenarios


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Final Remarks

  • Challenges with data and future considerations for data collection

  • Attrition rates from nursing education programs as well as from the profession have a big impact on our decision making process

  • Benefits of bringing together nursing researchers and operational researchers


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Thank you


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