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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

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

  • 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”.


Background

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

Workforce Trends of Registered Nurses in Canada, 2005.


Background

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

Workforce Trends of Registered Nurses in Canada, 2005.


Background

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

Workforce Trends of Registered Nurses in Canada, 2005.


Background

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

Workforce Trends of Registered Nurses in Canada, 2005.


Background

w

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

Workforce Trends of Registered Nurses in Canada, 2005.


Background

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

Workforce Trends of Registered Nurses in Canada, 2005.


Supply and Demand Balance (or Imbalance)


Estimating Requirements of Providers

  • Utilization-based

    • Current utilization patterns

  • Needs-based

    • Population-health needs

  • Effective demand-based

    • Economic constraints


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


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.


A Sample Plan


  • 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


  • 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


  • 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


Scope

  • Registered Nurses in British Columbia

  • 20 year planning horizon

  • Decisions made once each year

  • Ages 17 – 65+

  • 7 levels

  • Full time equivalent basis


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


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


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


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.


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)


Cost of training

Recruitment cost

Annual salary

Necessary resources

Balance students

Recruit vs

Canadian nurses

Promotion rules


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


Outputs – Initial Scenario


Outputs – Initial Scenario


Outputs – Initial Scenario


Outputs – Comparing Scenarios


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


Thank you


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