nursing in california: recent policy developments · sacramento & northern ca san francisco bay...
TRANSCRIPT
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The Nursing Labor Market in California: Still in Surplus?
May 2013
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Today’s presenters
• Joanne Spetz
– Professor at the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
• Teri Hollingsworth
– Vice President, Human Resources Services, Hospital Association of Southern California
• Judee Berg
– Executive Director of the California Institute for Nursing & Health Care
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Goals for this webinar
• Learn how Chief Nursing Officers perceive the current RN labor market
• Track the latest hospital vacancy and turnover data
• Understand how recently-graduated nurses are faring
• Link employer and nurse perceptions with recent data on RN employment and education
• Measure the impact of enrollment trends on forecasts of future supply and demand
• Identify next steps for ensuring an adequate nurse supply
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The collaboration
• Betty Irene Moore Nursing Initiative
• Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
• California Institute for Nursing & Health Care
• Hospital Association of Southern California
Acknowledgements & thanks to…
– California Hospital Association
– Hospital Council of Northern & Central California
– Hospital Association of San Diego & Imperial Counties
– UCSF Staff & Interns: Tim Bates, Lela Chu, Jessica Lin, Dennis Keane, Fletcher Munksgard, Glenda Tam
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What is going on in our RN labor market?
• More than a decade of severe shortage, 1998-2008
• Reports of nurse surplus 2009-now
Context: Ongoing recession, high unemployment, severe regional differences
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Goals for this webinar
• Learn how Chief Nursing Officers perceive the current RN labor market
• Track the latest hospital vacancy and turnover data
• Understand how recently-graduated nurses are faring
• Link employer and nurse perceptions with recent data on RN employment and education
• Measure the impact of enrollment trends on forecasts of future supply and demand
• Identify next steps for ensuring an adequate nurse supply
6
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Survey of Chief Nursing Officers
• Fielded by UCSF
• Funded by Gordon & Betty Moore Foundation
• Web-based survey with option to return paper survey via fax or email
• Questions based on previous CINHC survey and National Forum of State Nursing Centers “Minimum Demand Data Set” recommendations
• Five surveys conducted
– Fall 2010, Spring 2011, Fall 2011, Spring 2012, Fall 2012
– Spring surveys & Fall 2012 conducted solely for CNOs
– Fall 2010 and 2011 included HR data
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Perceptions of employers
5.5%
4.6%
5.0%
45.0%
43.0%
29.4%
19.7%
6.6%
11.3%
17.0%
23.2%
25.6%
12.4%
20.5%
23.8%
0.5%
2.0%
5.0%
0% 20% 40% 60% 80% 100%
2012
2011
2010
High demand: difficult to fill open positionsModerate demand: some difficulty filling open positionsDemand is in balance with supplyDemand is less than supply availableDemand is much less than supply availableOther
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Differences across regions
9Lower number = more shortage
2.9
3.9
3.1
3.2
3.3
3.5
3.4
3.2
3.7
2.7
3.1
3.0
3.1
3.2
3.0
3.2
2.6
2.8
2.2
3.0
2.9
1 2 3 4 5
Sacramento & Northern CA
San Francisco Bay Area
Central California
Los Angeles
Inland Empire
Southern Border
California2012
2011
2010
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Rural versus urban perceptions
10Lower number = more shortage
2.71
3.33
2.82
3.15
2.6
2.9
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
Rural Non-rural
2010 2011 2012
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Differences by hospital size
11Lower number = more shortage
2.88
3.28
3.50 3.50
4.00
3.48
2.71
3.00
2.62
3.04 3.03
2.83
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
Lessthan100
100 -149
150 -199
200 -299
300 -399
400 ormore
Avera
ge r
an
kin
g
# of Licensed Beds
2010 2011 2012
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Change in difficulty recruiting, compared to last year, Fall 2012
10.4%26.2%
0.6%4.6%
61.6%
62.1%
72.1%71.6%
28.0%11.7%
27.3% 23.7%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Less difficult
About the same
More difficult
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Change in RN employment in the past year
27.3% 22.5%14.1% 11.5%
34.3%
49.1% 55.4%
48.8%59.9%
47.0%
23.6% 22.1%33.7%
23.0% 28.3%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Decreasedemployment
No change
Increasedemployment
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Changes experienced in past year
14
0 20 40 60 80 100 120 140
Budget constraints
Fewer RN retirements than…
Reduction in census
Less turnover of staff
Decrease in use of…
Current staff working more shifts
Current staff converting PT to…
Hiring freeze
Increase in use of…
Less foreign recruitment
Number of responses (217 maximum possible)
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Foreign recruitment, 2010-2012
6.7%
4.0%
1.9%
0%
1%
2%
3%
4%
5%
6%
7%
8%
2010 2011 2012
15
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Hiring of newly graduated RNs, Fall 2012
16
84.6% 82.6% 77.6%
6.7% 9.4%12.6%
8.7% 8.0% 9.8%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2010 2011 2012
Do not hire ever
Normally hire, butnot this year
Hired this year
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Hiring requirements and preferences, Fall 2011 & 2012
52.3%
4.6%
69.5%
52.3%
21.2%
53.7%
7.3%
67.9%
55.5%
21.6%
0% 20% 40% 60% 80%
Minimum experiencerequirement
Baccalaureate degreerequired
Baccalaureate degreepreferred
Specific type of experience
No experience required
2012 2011
17
Care experience most often needed in critical care, OR, ED, L&D
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New graduate training programs, Fall 2012
• 71% had a residency in 2012
• 82% developed program internally
• Most common capacity is 20-30 new grads
• Most common length is 12 weeks
67.4%61.4%
70.7%
32.6%38.6%
29.3%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2010 2011 2012
Residency No residency
18
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Hiring expectations
19
31.4%23.5%
31.2%
18.6%
8.7%
17.2%
50.0%
67.8%
51.6%
0%
25%
50%
75%
100%
2010-2011 2011-2012 2012-2013
No change
Hire fewer than lastyear
Hire more than lastyear
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Reasons for expected increasing employment
20
0 10 20 30 40 50 60
Increase in census
Increase in bed capacity
Decrease in use oftraveler/contract RNs
More RN retirements thanexpected
Care model redesign
Number of responses (67 maximum possible)
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Reasons for expected decreasing employment
21
0 5 10 15 20 25 30 35
Reduction in census
Less turnover of staff
Hiring freeze
Fewer RN retirements thanexpected
Budget constraints
Current staff working moreshifts
Number of responses (37 maximum possible)
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Hiring expectations for new graduates
22
21.6% 22.3%
18.7% 22.3%
59.7% 55.4%
0%
25%
50%
75%
100%
2011-2012 2012-2013
No change
Decrease hiring
Increase hiring
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Goals for this webinar
• Learn how Chief Nursing Officers perceive the current RN labor market
• Track the latest hospital vacancy and turnover data
• Understand how recently-graduated nurses are faring
• Link employer and nurse perceptions with recent data on RN employment and education
• Measure the impact of enrollment trends on forecasts of future supply and demand
• Identify next steps for ensuring an adequate nurse supply
23
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Turnover & hiring of full-time personnel, Fall 2012
2.5%
2.9%
2.4%
2.1%
3.8%3.7%
1.5%
3.5%3.7%
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
3.5%
4.0%
Separations Hiring
Staff RNs
Other RNs
New RN grads
LVNs
Aides
24
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Percent of new hires that were new graduates, Fall 2012
32.0%
6.0%
26.0%
0%
5%
10%
15%
20%
25%
30%
35%
Full-time Part-time Overall
25
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Per diem, traveler, and agency use
0%
5%
10%
15%
20%
Per diem Traveler Agency
RNs 2010
RNs 2011
RNs 2012
LVNs 2010
LVNs 2011
LVNs 2012
26
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RN Vacancies, 2010-2012
3.4%
4.0%3.8%
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
3.5%
4.0%
4.5%
All RNs
Fall 2010
Fall 2011
Fall 2012
27
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Vacancy rates by position, Fall 2012
2.9%
7.1%
5.9%
3.7%
4.9%
0%
1%
2%
3%
4%
5%
6%
7%
8%
Staff RNs Other RNs New RNGrads
LVNs Aides
28
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Vacancy rates by part-time and full-time status, Fall 2012
3.5%
6.7%
5.8%
4.1%4.7%
2.1% 1.9%
9.5%
8.0%
2.6%
0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
10%
StaffRNs
OtherRNs
New RNGrads
LVNs Aides
Full-time
Part-time
29
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Goals for this webinar
• Learn how Chief Nursing Officers perceive the current RN labor market
• Track the latest hospital vacancy and turnover data
• Understand how recently-graduated nurses are faring
• Link employer and nurse perceptions with recent data on RN employment and education
• Measure the impact of enrollment trends on forecasts of future supply and demand
• Identify next steps for ensuring an adequate nurse supply
30
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New RN Graduate Hiring Survey
• Statewide survey of new grads conducted in fall of 2012
• Collaborators:
– CINHC
– UCLA School of Nursing
– Board of Registered Nursing
– Association of California Nurse Leaders
– California Student Nurses Association
• Random selection of >5,000 newly licensed RNs in CA between September 2011-August 2012
– Sample was mailed letters with invitation to complete web-based survey
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Findings from the 2012 New RN Graduate Hiring Survey
• 46% were not yet employed as an RN
– Consistent with survey from National Student Nurses Association in Sept 2011 – 45% unemployed
– American Association of Colleges of Nursing survey in 2012 (BSN degree only) – 43% unemployed
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Regional variation in unemployment
33
42%
57%
52%
41%45%
33%
44%41%
0%
10%
20%
30%
40%
50%
60%
Not Working Rates
LA/Ventura
SF Bay
Orange/Inland
N CA
San Diego/Imperial
Central Valley
Sacramento
Central Coast
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Unemployment varies by education
47%45%
41%
0%
10%
20%
30%
40%
50%
AD BSN ELM
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Why are they not employed?
• 92% no experience
• 55% no position available
• 35% not having BSN
• 7% out of school too long
35
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For those employed…
• 53% employed within 3 months
• 65% reported working in “job of choice”
• 76% are working full time
• Employment settings:
– 66% hospitals
– 11% long-term care
– 8% community-based facilities
– 15% other
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What are unemployed nurses doing?
• Working in non-RN position
• Returning to school
• Volunteering
37
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Goals for this webinar
• Learn how Chief Nursing Officers perceive the current RN labor market
• Track the latest hospital vacancy and turnover data
• Understand how recently-graduated nurses are faring
• Link employer and nurse perceptions with recent data on RN employment and education
• Measure the impact of enrollment trends on forecasts of future supply and demand
• Identify next steps for ensuring an adequate nurse supply
38
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What does the 2012 RN survey tell us about employment?
82.6%89.3% 84.2% 87.5% 86.7% 86.9% 87.4% 85.1%
17.4%10.7% 15.8% 12.5% 13.3% 13.1% 12.6% 14.9%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1990 1993 1997 2004 2006 2008 2010 2012
Employed in nursing Not employed in nursing
15.5% of working nurses have more than one RN job.Source: California Board of Registered Nursing Survey of RNs, 2012
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Share of RNs employed in nursing by age
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
< 30 years 35-39 years 45-49 years 55-59 years 65 + years
2004
2006
2008
2010
2012
Source: California Board of Registered Nursing Survey of RNs, 2012
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Reasons for not having RN job
2008 2010 2012Under 55
years
55 years
and older
Retired 32.4% 34.9% 35.9% 8.0% 52.2%
Childcare responsibilities 25.8% 21.9% 18.5% 36.9% 7.8%
Other family responsibilities 33.8% 29.7% 23.8% 34.0% 17.8%
Stress on the job 47.5% 35.7% 32.2% 35.3% 30.4%
Salary 27.8% 20.1% 20.1% 26.0% 16.6%
Inconvenient schedules in
nursing jobs26.9% 19.9% 23.6% 29.3% 20.3%
Difficult to find a nursing
position8.1% 19.3%
Cannot find any RN work 20.8% 35.5% 12.2%
Difficult to find desired RN
job28.3% 40.6% 21.2%
Laid Off * 15.7% 7.8% 7.0% 8.2%
(% reporting important or very important)
Source: California Board of Registered Nursing Survey of RNs, 2012
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Average income from all nursing positions
$31,504
$42,163 $45,073
$59,937
$73,542
$81,428 $82,134 $78,236
$0
$10,000
$20,000
$30,000
$40,000
$50,000
$60,000
$70,000
$80,000
$90,000
1990 1993 1997 2004 2006 2008 2010 2012
Source: California Board of Registered Nursing Survey of RNs, 2012
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Plans for next 5 years for working RNs
14.6% 9.8% 9.7% 14.0% 15.8% 15.5% 11.5% 14.2%
6.7%8.4% 8.5%
7.2% 9.5% 10.1% 13.1% 11.4%
32.7%
21.8% 24.7% 22.1%21.6% 19.8%
15.2%21.2%
46.1%60.1% 57.1% 56.7% 53.1% 54.6% 60.2%
53.2%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1990 1993 1997 2004 2006 2008 2010 2012
Leave nursing/retire Increase hours
Reduce hours Work as much as now
Source: California Board of Registered Nursing Survey of RNs, 2012
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What do Deans & Directors think is happening?
Type of degree 2008-
2009
2009-
2010
2010-
2011
2011-
2012
Hospital 71.4% 59.0% 54.4% 61.1%
Long-term care 8.4% 9.7% 7.8% 8.3%
Comm/public
health
5.4% 3.9% 4.5% 3.6%
Employed in CA 83.4% 81.1% 68.0% 69.6%
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Deans’ estimates of the percent of grads from
the past year in each employment setting
Source: California Board of Registered Annual Schools Report, 2011-2012
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Goals for this webinar
• Learn how Chief Nursing Officers perceive the current RN labor market
• Track the latest hospital vacancy and turnover data
• Understand how recently-graduated nurses are faring
• Link employer and nurse perceptions with recent data on RN employment and education
• Measure the impact of enrollment trends on forecasts of future supply and demand
• Identify next steps for ensuring an adequate nurse supply
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Board of Registered Nursing Forecasts of Supply
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Nurses with Active
Licenses
Living in California
Outflow of nursesInflow of nurses
Full-time equivalent supply of RNs
Share of nurses who work,
and how much they work
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Changes to the model
• New data
– Numbers of RNs
– Employment patterns (2012 survey)
– Graduations (2011-2012 Annual Schools Report)
– Endorsement, inactive transitions, lapsed license data 2011-2012
• More reliance on BRN data
– State-to-state migration data from 2008 NSSRN is too old
• Adding “high” and “low” estimates for employment rates
– High = highest rate for each age group in 2008, 2010, or 2012
– Low = lowest rate for each age group in 2008, 2010, or 2012
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How do the numbers compare with the 2011 forecasts?
• Graduations are expected to drop in 2015-2016
• Fewer graduates projected than in the 2011 forecast
New
enrollment
Projected
enrollment
from 1 yr
Projected
enrollment
from 2 yrs
Graduations
2010-2011 14,228 13,141 14,835 10,666
2011-2012 13,691 13,895 13,340 10,814
2012-2013 12,948 13,867 11,009
2013-2014 12,601 11,176
2014-2015 11,617
2015-2016 10,55748Source: California Board of Registered Nursing Annual Schools Reports
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The range of supply forecasts (RN FTEs)
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0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
Best Supply Forecast
Low Employment Rate Forecast
High Employment Rate Forecast
2011 Forecast
Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2013
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Forecast of Full-time Equivalent RNs per 100,000 population
50
0
100
200
300
400
500
600
700
800
900
Best Supply Forecast
U.S. average
US 25th percentile
Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2013
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What is demand?
• National benchmarks: Employed RNs per 100,000
– California was ranked 48th in 2008, 589 per 100,000
– 25th percentile: 799.5 per 100,000
– National average: 854 per 100,000
– 50th percentile: 890 per 100,000
– These were adjusted to FTEs for the supply-demand comparison
• Bureau of Labor Statistics, forecast of 2020 demand
– 275,782 FTEs (was 236,400 FTEs for 2018)
• RNs per patient day, 2011-2012 fiscal year
– Estimate growth in patient days based on population growth
– Predict hospital RN demand from patient days forecast
– Estimate overall demand as function of hospital demand51
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Forecasts of RN demand
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0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
National 25th percentile FTE RNs/population
National average FTE RNs/population
California Employment Development Dept. forecast
Maintain 2013 FTE RNs/Population
OSHPD hours per patient day-based forecast, BRN calibration
OSHPD hours per patient day-based forecast, EDD calibration
Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2013
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Best supply and demand forecasts for RNs, 2013-2030
53
0
100,000
200,000
300,000
400,000
Best Supply Forecast
National 25th percentile FTE RNs/population
National average FTE RNs/population
OSHPD hours per patient day-based forecast, BRN calibration
Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2013
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Goals for this webinar
• Learn how Chief Nursing Officers perceive the current RN labor market
• Track the latest hospital vacancy and turnover data
• Understand how recently-graduated nurses are faring
• Link employer and nurse perceptions with recent data on RN employment and education
• Measure the impact of enrollment trends on forecasts of future supply and demand
• Identify next steps for ensuring an adequate nurse supply
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Implications for policy
• How do we define shortage?
– Are current employment levels adequate?
– Should California be at the national average? 25th percentile? Bottom?
– Economic demand vs. need-based demand
• In this economy…
– Demand is starting to ramp up again
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Concerns for workforce policy
• If RN education contracts, our supply will fall far short of demand
• Will recent graduates who can’t find work leave California permanently?
• Can we foster opportunities to gain on-the-job skills and to pursue additional education?
• What do we need to do?
– Stop the expected declines in RN school sizes
– Consider growing our RN programs a bit more
– Identify strategies to retain new graduates’ skills and employ them quickly
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Check out our website!• http://futurehealth.ucsf.edu/SupplyDemand/Das
hboard.html
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Also go to the BRN website• Forms Publications
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Available from the BRN website
• Annual Schools Report
– Public-use Excel workbook to summarize data by region, type of program…
• RN Surveys (every 2 years)
– Full reports
– Link to a webpage with summary data, and ability to get regional and other cuts of the data
• RN Forecasts
– Full reports
– Regional reports when we have them
• Other studies
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What is happening next?
• UCSF and HASC are continuing our collaboration
– HASC does quarterly surveys of HR directors
– UCSF does annual CNO surveys
• The 2012 BRN Survey of RNs report will be published soon
• The 2012-2013 BRN Annual Schools Survey will be sent in October
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Questions?
Thoughts?
Ideas?
Perspectives?
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