This document summarizes new research on California's nursing workforce. It finds that after over a decade of nurse shortages, employers are now reporting an oversupply of nurses due to the recession. While shortages still exist in some rural areas, surveys of employers in 2010 and 2011 found overall surpluses across the state. The number of new nursing graduates is also expected to decline in the next few years. The document analyzes factors like nurse employment rates, earnings, and forecasts of future supply and demand to understand trends in California's nursing labor market.

1. California’s Nursing
Workforce:
New Research
Joanne Spetz, Ph.D.
University of California, San Francisco
February 7, 2012

2. What is going on in our RN labor
market?
• More than a decade of severe shortage,
1998-2008
• Reports that new graduates cannot find
jobs 2009-now
• Stories that nurses are not retiring when
expected
• Shortages in some regions
Context: Ongoing recession, high
unemployment, severe regional
differences
2

3. Survey of Nurse Employers,
Fall 2010
• Collaboration between UCSF, CINHC, and HASC
• Email 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
• Follow-up short survey conducted Spring 2011
3

4. Perceptions of employers, fall 2010
4

5. Differences across regions,
Fall 2010 & Spring 2011
Lower number = more shortage 5

6. Rural versus urban perceptions
Lower number = more shortage 6

7. Staff RN Vacancies,
Fall 2010 & Spring 2011
Estimated 1,772 vacancies for new RN graduates in
Fall 2010 7

8. Planned employment growth for
2011 & 2012, from Fall 2010
These data are for respondents, not all California hospitals 8

9. BRN surveys
• Survey of RNs, 2010
– 10,000 RNs sampled, ~65% response rate
– Paper survey with option to do online survey
• Annual Schools Survey, 2010-11
– Online survey of all nursing programs
– 100% response rate
9

10. Employment rates by age, 2008 &
2010
Source: California Board of Registered Nursing Survey of RNs, 2010
10

11. Reasons for not working in nursing
% important or very important
Laid off
Difficult to find a nursing position
Inconvenient schedules in nursing jobs
Wanted to try another occupation 2010
Dissatisfaction with the nursing… 2008
Other dissatisfaction with your job
Dissatisfied with benefits
Salary
Job-related illness/injury
Stress on the job
Childcare responsibilities
Retired
0% 20% 40% 60%
Source: California Board of Registered Nursing Survey of RNs, 2010
11

12. Nurse earnings over time
Source: California Board of Registered Nursing Survey of RNs, 2010
12

13. Future plans of RNs
100%
90% Plan to retire
80%
70% Plan to leave
60% nursing entirely, but
not retire
50%
Plan to increase
40% hours of nursing
30% work
20% Plan to reduce
hours of nursing
10% work
0% Plan to work
Under Under 65+, 65+, approximately as
35, 35, 2008 2010 much as now
2008 2010
Source: California Board of Registered Nursing Survey of RNs, 2010
13

14. RN Graduations are expected to drop in
2012-2013
New Projected Projected Graduations
enrollment enrollment enrollment
from 1 yr from 2 yrs
2008-2009 13,988 14,621 13,692 10,526
2009-2010 14,228 14,917 14,216 11,512
2010-2011 13,055 14,835 12,447*
2011-2012 13,223 13,273*
2012-2013 11,616*
2013-2014 11,766*
Source: California Board of Registered Nursing Annual Schools Report,
2009-2010
14

15. Board of Registered Nursing
Forecasts of Supply
Nurses with Active
Inflow of nurses Licenses Outflow of nurses
Living in California
Share of nurses who work,
and how much they work
Full-time equivalent supply of RNs
15

16. The range of supply forecasts
(RNs living in California)
2,500,000
2,000,000
Best Supply Forecast
Low Supply Forecast
1,500,000 High Supply Forecast
2009 Forecast
1,000,000
500,000
0
Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2011
16

17. Variation in FTE employment with
assumptions about work and
retirement
500,000
450,000
400,000
350,000
300,000
250,000
200,000 Best Supply Forecast
150,000 Low Employment Rate Forecast
High Employment Rate Forecast
100,000 2009 Forecast
50,000
0
Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2011
17

18. Forecast of Full-time Equivalent RNs
per 100,000 population
1,000
900
800
700
600
500
Best Supply Forecast
400
U.S. average
300
US 25th percentile
200
100
0
Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2011
18

19. What is demand?
• National benchmarks: Employed RNs per 100,000
• Bureau of Labor Statistics, forecast of 2018
demand
• Growth based on current hospital employment &
expected growth in patient days
• Potential impact of PPACA
19

20. Forecasts of RN demand
400,000
350,000
300,000
250,000
200,000
National 25th percentile FTE RNs/population
150,000 National average FTE RNs/population
California Employment Development Dept. forecast
100,000 Maintain 2011 FTE RNs/Population
OSHPD hours per patient day-based forecast, BRN calibration
50,000 OSHPD hours per patient day-based forecast, EDD calibration
0
Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2011
20

21. Best supply and demand forecasts
for RNs, 2009-2030
450,000
400,000
350,000
300,000
250,000
200,000
150,000 Best Supply Forecast
National 25th percentile FTE RNs/population
100,000 OSHPD hours per patient day-based forecast, BRN calibration
Low Supply Forecast (low count & employment)
50,000 National average FTE RNs/population
0
Source: California Board of Registered Nursing Forecasts of the RN Workforce, 2011 21

22. 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 estimates have dropped and supply is high
22

23. What is happening next?
• UCSF, CINHC, and the Hospital
Associations is analyzing Year 2 of the
employer survey
• UCSF & BRN are nearly done with the
2011-12 Annual Schools Survey
• 2012 BRN Survey of RNs (mailed in
spring)
23

24. Questions?
Thoughts?
Ideas?
Perspectives?
24