Building Education-Service Partnerships: The Service Perspective

1. 2005 Report Building Education/Service Partnerships: The Service Perspective California Institute for Nursing & Health Care Optimizing the Health of Californians through Nursing Excellence c i n h c

2. 2005 Chief Nursing Officer (CNO) Survey Background 2005 Sample size: 156 data submissions received • Data represents 172 acute care facilities • 375 surveys sent; 46% response rate • Data represents the period of January 1, 2005 through September 30, 2005 • Reporting period was December 2005

3. Background Information California’s Nursing Shortage • In 2004, California ranked 50th in supply of nurses per capita • Nearly 45% of the current California RN workforce was educated outside the state or country • Over 70% of current graduates are educated in associate degree programs • California faces a shortfall of up to 116,000 RNs by 2020 Careforce Consulting Group 2003

4. CINHC & HASCHistory of Initiatives • Initiated in 2001 by the Hospital Association of Southern California, a regional healthcare association • Primary Objective: Increasing local nursing school enrollments by 400 in 2 years • HASC outcomes have resulted in an increase of over 1400 slots over a 5 year period • Bay Area Survey conducted in 2003

5. Survey Sample by California Region (10) (70) (76)

6. Survey Sample - Northern CA(HCNCC Areas) (9) (10) (6) (16) (14) (11) (4)

7. Survey Sample - Southern CA (HASC Areas – including San Diego) (10) (12) (11) (7) (5) (8) (13) (9) (11)

8. Participation by Economic Regions

9. CNO’s Perception of Shortage

10. Response to the Shortage

11. Costly Expenses for Temporary Solutions

12. Foreign Nurse Recruitment (Statewide) • 43% of hospitals have engaged in foreign nurse recruitment in last 2 years (68 respondents) • 30% are actively recruiting (47 respondents) • 35% of hospitals are considering in the future (54 respondents) • 25% are considering and have rejected (39 respondents) • Recruitment cost per foreign nurse averages $19,914 ($2,500 – $80,000)

13. Foreign Nurse Recruitment by Economic Region

14. RN Vacancy Trends(Statewide) • Most report a decline in vacancy rate over the last year • The average vacancy rate is 12% (Range: 2% - 10% - 46%) • 76% define vacancy as unfilled budgeted positions that are currently being recruited for even if filled by traveler staff or other temporary staff • 105 facilities reported 9,304 vacancy positions

15. Average Vacancy Rate by Economic Region

16. Improving New Graduate Retention (Statewide) • 94% of respondents monitor turnover/retention of nursing staff and 86% monitors why nurses leave • 133 respondents reported an average RN turnover rate of 9.4% New Graduate Retention Rates

17. New Graduate Retention Rates by Economic Region

18. Average Turnover Rate by Economic Region

19. New Graduate Recruitment • 94% of respondents hire new graduate RNs • Number of new graduates hired/plan to hire:

20. New Graduate RN Orientation • Average number of days of usual orientation: - 41 days for new graduate hires (131 respondents) • Average cost of usual orientation per nurse: - $15,600 for new graduate hires and range from $1,726 - $50,000 (65 respondents)

21. Experienced RN Orientation • Average number of days for orientation is 13 days (136 respondents) • Average cost per orientation per experienced nurse is $5,600 and range from $400 - $40,000 (60 respondents)

22. New Graduate Clinical Internship • 74% (116 respondents) provide a new graduate clinical internship program that extends beyond regular nursing orientation • These programs extend beyond the regular nursing orientation an average of 41 days (103 respondents)

23. Hiring New Graduates into Specialties • 76% hire new graduates into specialty areas and require a specialty training program (119 respondents) • Program lengths vary widely depending on area

24. Specialty Training Programs • Top reported specialty areas hospitals require a specialty training program: - Intensive Care - 66% (103) - Emergency Room - 56% (87) - Labor and Delivery - 53% (83) - Step Down/Telemetry - 51% (80) - Operating Room - 47% (74)

25. Specialty Program Orientation and Cost

26. Faculty/Resource Commitment to Education • 58% of hospitals have internal resources assigned to assist or facilitate student rotations (91 respondents) • 42% of hospitals have staff functioning in a joint appointment (faculty/practice) (66 respondents) - A total of 386 staff serving in this role • 36% of hospitals have additional masters prepared staff who are interested and willing to serve as clinical faculty (56 respondents) • 70% reported that schools pay for the staff time for adjunct faculty (45 respondents)

27. Faculty/Resource Commitment to Education

28. Hospitals Capacity for Students (Statewide) • 58% of reported hospitals feel they can absorb more students for clinical rotation (90 respondents) • 55% of respondents contribute additional support to schools. (86 respondents) • No significant difference in preference for Bachelor’s or AD students • 39% of hospitals will take LVN students

29. Hospital Capacity for Clinical Students by Economic Regions

30. Clinical Capacity for Student Rotations % of Hospitals with Space Available by Specialty & Time

31. What Kind of Students Can Hospitals Take? (Statewide)

32. What Kind of Students Can Hospitals Take? (Economic Regions)

33. Hospitals Financial Support to Students (Statewide)

34. Hospitals Financial Support to Students (Economic Region)

35. Hospitals Financial Support to Schools • 55% of respondents provide financial subsidies or support local nursing educational programs. • Financial support range between $500 - $2.1 million.

36. Questions?