NEW YORK S GROWING DEMAND

Nurses and Allied Health Professionals

Results from

the 2011

Health Care

Professionals

Workforce

Survey

NEW YORK’S GROWING DEMAND

The 2011 Health Care Professionals Workforce Survey was conducted by

in collaboration with

WNYHA

Western New York Healthcare Association

T

he demand for nurses and allied health professionals in New York is on the rise as the state begins to emerge from the recession and new health care reform initiatives take hold. During 2010 (the period covered by this report), 40% of the hospitals that responded said they anticipated over-all growth in demand for staff and in particular for registered nurses (RNs), physician assistants (PAs), and nurse practitioners (NPs). They also reported higher vacancy rates for these and other allied professionals. Survey re-spondents indicated that many of these types of professionals were very difficult to recruit, either because of shortages or competition.

This contrasts with last year’s survey, when respondents saw lower vacancy and turnover rates due presumably to the economic recession, and 40% re-ported reducing staff, 32% were im-plementing hiring freezes, and 25% were planning layoffs.

Nurses and Allied Health Professionals: New York’s Growing Demand includes responses received from a 2011 survey of New York State hospitals to assess the staffing levels of nurses and allied health professionals in 2010. The sur-vey covered 2010 vacancy and turnover rates; recruitment and reten-tion challenges; nursing degree distri-bution; and hospital subsidies of nursing education. The findings re-ported represent 105 hospitals/health systems, a 58% response rate.

fessionals Workforce Survey in collab-oration with the State University of New York (SUNY) Center for Health Workforce Studies (CHWS) with sup-port from Western New York Health-care Association (WNYHA), Rochester Regional Healthcare Association (RRHA), Iroquois Healthcare Alliance (IHA), Northern Metropolitan Health-care Association (NorMet), and Nas-sau-Suffolk Hospital Council (NSHC). The report provides statewide and re-gional data. The Western New York and Rochester regions were com-bined due to their smaller response rates.

The relatively higher turnover rates in this year’s survey results suggest that an improvement in the overall health care workforce job market is prompt-ing nurses and allied health profession-als to change jobs. According to the U.S. Bureau of Labor Statistics, the re-cession resulted in a loss of 8.4 million jobs, but health care gained 732,000 jobs over the same period. As the na-tion recovers from the recession, the health care and social assistance sec-tor seems to be proving more resilient than other industries, with more than 19,000 jobs added over the past year in New York, according to the New York State Department of Labor (DOL). Nursing and allied health pro-fessionals are among the fastest grow-ing segment for jobs, with a reported addition of 5,000 private sector jobs in March 2011 alone. DOL considers employment prospects for nursing

Certified Nurse’s

Aides

In a CHWS April 2010 report, The Health Care Workforce in New York 2008, the number of professional licensees

regis-tered with the state grew as follows be-tween 2003 and 2008:

GROWTH IN NUMBER OF LICENSEES BY PROFESSION, 2003 - 2008

30%

21%

14%

_13%

10%

7%

Physician Assistants Nurse Practitioners Physical Therapists Social Workers Occupational Therapists Licensed Practical Nurses

In that same report, all regions of the state showed health sector job growth between 2003 and 2008. Similarly, this Survey found that 40% of responding hospitals

antici-pated an overall job growth in coming months. The percentage of respondents anticipating growth by type of health care staff was as follows:

ANTICIPATED GROWTH, 2011

46.7%

34.3%

31.4%

25.7%

23.8%

14.3%

RNs Physician Assistants Nurse Practitioners Coders Pharmacists

H

ospitals reported much higher nurse vacancy and turnover rates for 2010 than in 2009. Nearly 50% of respondents expected their nursing staff to grow over the next few months and 47% reported that experienced nurses are very difficult to recruit. De-mand for nurses is likely to grow for sev-eral reasons. As has been the case for more than a decade, the average age of a nurse is on the rise, with more than 50% of RNs in the state being 50 years or older. Simultaneously, there is a growing popu-lation of elderly people with multiple chronic conditions, along with an in-creased overall complexity of disease, cre-ating an increased demand on health care

resources. Further, implementation of the federal Affordable Care Act (ACA) and re-lated activities is expected to expand the scope of practice for nursing and allied health professionals and increase demand for them.

According to another recent CHWS re-port, 12% of currently active nurses in New York expect to leave their current po-sition in the coming year. Of those, 24% said they will retire (about 4% of all active nurses). This represents a loss of about 8,100 RNs in the coming year. The retire-ment rate reported in the 2011 Health Care Professionals Workforce Survey was 4.2% for the same period.

N U R S E S

Responses from the 2010 nursing and al-lied workforce survey report suggest that the economy played a major role in keep-ing vacancy and turnover rates unusually low over the last year and declining over the last two years. Older nurses were re-luctant to retire and nurses who had left

the nursing profession were returning. As reported in last year’s workforce survey report, what resulted was a large number of newly graduating nurses who were un-able to find jobs, giving a temporary indi-cation that the nursing shortage had receded.

RN VACANCY AND TURNOVER IN NEW YORK HOSPITALS, 2006 - 2010

The above chart shows that the New York State RN vacancy rate increased to 6.1% in 2010 from 3.6% in 2009, mirrored by significant growth in turnover. Consistent with responses on vacancy rates, hospi-tals described recruitment of experienced RNs as “very difficult.” While nearly 47% of responding facilities statewide ported recruitment difficulties, some

re-gions reported even greater challenges, with 62% of the Northern Metropolitan (Hudson Valley) region indicating recruit-ment difficulties, followed by New York City (58%) and the Northeastern regions (53%). However, once recruited, only 11% of respondents indicated that nurses were difficult to retain.

The chart on the right shows the specific reasons respondents cited for their re-cruitment difficulties.

Percent Reporting Recruitment Difficulty

HOSPITAL-REPORTED REASONS FOR

DIFFICULTIES RECRUITING EXPERIENCED RNS, 2010

47%

Shortage of Workers Competition for Experienced RNs Salary Levels

41%

73%

29%

HOSPITALS REPORTING RECRUITMENT DIFFICULTY

FOR EXPERIENCED RNS BY REGION, 2010

While 71% of respondents in the Central New York region attributed the recruit-ment difficulties to the nursing shortage,

other regions responded in greater num-bers to competition for experienced nurses.

Of this 47%, the following reasons were noted:

Regional differences in competition for ex-perienced RNs were reported as listed on the right.

Western NY/Rochester

PERCENT REPORTING COMPETITION FOR EXPERIENCED RNS, 2010

79%

Central NY Northeastern NY Northern Metropolitan

71%

59%

85%

Long Island

87%

New York City

63%

Anticipated Growth in Demand for RNs

in the Coming Year

As the chart below indicates, nearly half of responding hospitals anticipate growth in the demand for nurses in the coming

year. This number is much higher on Long Island, where nearly 80% of respondents anticipate a growth in demand.

PERCENT OF RESPONDING HOSPITALS THAT ANTICIPATE GROWTH

IN DEMAND FOR RNS, 2011

Nursing Education Levels

The Institute of Medicine’s (IOM) 2010 re-port, The Future of Nursing: Leading Change, Advancing Health, made several health care reform recommendations, in-cluding improving nursing education and collecting data for workforce planning and policy making. IOM recommended in-creasing the proportion of nurses with a Bachelor of Science in Nursing (BSN) de-gree to 80% of the workforce by 2020. According to CHWS , across the state, only 33% of RNs have a BSN . Of these,

only 19.2% are in upstate New York and 18% are in northeastern New York, com-pared to 48.3% in the downstate region. These disparities could likely be attributed to a lack of access to BSN programs, as more of these nursing education programs are located downstate.

Further, while approximately 9,800 new nurses graduated in the past year in New York State, only 13% (about 1,200 nurses) of these graduates completed their BSN .

STATEWIDE DISTRIBUTION OF NURSING DEGREES

MSN, 5.2% PhD, 0.2%

Associate, 43.7% BSN, 33.0%

Diploma, 6.3%

STATEWIDE DISTRIBUTION OF NURSING DEGREES, 2010

Statewide Associate Degree

43.7%

Western NY/Rochester Central NY Northeastern NY

47.9%

69.0%

52.8%

Northern Metropolitan

39.6%

Long Island

35.4%

6.3%

7.3%

4.6%

13.9%

5.0%

5.8%

33.0%

21.3%

23.2%

18.8%

20.1%

41.7%

5.2%

1.9%

2.9%

4.5%

1.9%

8.5%

REGIONAL DISTRIBUTION OF NURSING DEGREES, 2010

Diploma BSN MSN PhD

0.2%

0.3%

0.3%

0.3%

0.0%

0.1%

New York City

30.0%

2.7%

54.5%

7.6%

0.2%

Certified Nurse’s Aide to Licensed Practical Nurse (LPN)

NUMBER OF NURSES PURSUING HIGHER EDUCATION , 2010

88

LPN to RN Associate to BSN BSN to MSN

301

1,889

1,631

MSN to PhD

62

The 2011 survey also asked how many hospital nurses were pursuing a higher level of education in 2010, and while the numbers are encouraging, they again re-veal regional disparities. Of those pursu-ing a BSN , 34% are on Long Island and 26% are in New York City. Of those pur-suing an MSN , 30% are located on Long Island and 47% are in New York City; and, of those pursuing a doctoral de-gree, 50% are located in New York City and 24% are on Long Island. The per-centages of those pursuing degrees up-state are much smaller.

Statewide

89%

76%

62%

25%

20%

93%

64%

71%

21%

21%

86%

64%

79%

21%

14%

88%

65%

88%

29%

12%

BARRIERS TO PURSUING HIGHER NURSING DEGREES BY REGION, 2010

Western NY/ Rochester Central NY Northeastern NY Northern Metropolitan

77%

92%

54%

77%

39%

Long Island

87%

87%

17%

13%

9%

New York City

96%

79%

75%

8%

29%

Family Responsibilities

Courses Conflict with Work Schedule

Need for Financial Assistance

Lack of Reasonable Proximity to RN Program

Prerequisite Requirements

When asked about strategies that hospi-tals employ to encourage further nursing education, 43% of responding hospitals indicated that they provide on- or off-site RN to BSN programs, and 27% provide on- or off-site BSN to MSN programs. Con-sistent with other findings related to higher education, these percentages are

higher in the Long Island and New York City regions. This is reflected in the chart below, where, unlike in other regions, most hospitals in the Long Island and New York City regions did not indicate that proximity to a nursing program is a barrier to nurses pursuing higher degrees.

Statewide

96%

85%

43%

37%

93%

86%

43%

64%

100%

50%

29%

29%

94%

88%

47%

59%

STRATEGIES TO ASSIST NURSES IN FURTHERING THEIR EDUCATION BY REGION, 2010

Western NY/ Rochester Central NY Northeastern NY Northern Metropolitan

100%

92%

23%

31%

Long Island

100%

87%

57%

17%

New York City

92%

96%

46%

33%

Tuition Reimbursement Scheduling Changes

Providing On- or Off-site RN to BSN

Scholarships

Hospitals are well aware of the barriers to nurse education and are responding ac-cordingly. For example, nearly all hospitals provide tuition reimbursement to nurses and a substantial majority work with

nurses’ schedules to accommodate their continuing education efforts. The various strategies that hospitals have employed are listed by their rate of use and region below.

R

esponses to the survey indicate the strong need for allied health pro-fessionals will likely grow as more New Yorkers become insured through ACA and aging “baby boomers” continue to place a growing demand on the health

care system. The 2011 survey collected in-formation from hospitals on vacancy, turnover, recruitment, and retention for a large subset of health care professionals. What follows is a summary of these re-sponses by the various professions.

ALLIED HEALTH

PROFESSIONALS

Nurse Practitioners and Physician Assistants

With a growing shortage of primary care physicians and increasing demand for pri-mary and preventive health services across the nation, the role that nurse prac-titioners (NPs) and physician assistants (PAs) perform in health care delivery will continue to expand and evolve. A recent Robert Wood Johnson Foundation report on the health care workforce found that team-based care and an expanded role for advance practice nurses could mitigate the shortage of primary care providers. Additionally, IOM’s report, The Future of Nursing: Leading Change, Advancing Health recommended that nurses be al-lowed to practice to the full extent of their education and training. Legislation was in-troduced in New York to increase the scope of practice of NPs. Seventeen states across the country have already passed legislation to increase NP scope of practice, specifically by allowing NPs to practice without a collaborative

agree-ment so that they can provide much-needed services in areas with severe physician shortages.

Responses to the 2011 Health Care Profes-sionals Workforce Survey reflect the rec-ommendations in these reports and legislation and reflect an increased de-mand for NPs and PAs in New York State. Thirty-one percent of survey respondents indicated a growth in demand for NPs and 34% indicated growth in demand for PAs in 2010.

Vacancy rates have increased significantly since last year’s survey based on 2009 data for both of these professions. Last year’s report showed a 7.8% vacancy rate for NPs and a 4.5% vacancy rate for PAs. This year, those rates are 11.8% and 9.7%, respectively. While turnover rates for PAs remained stable compared to last year, NP turnover more than doubled, suggesting that NPs are indeed in increased demand.

Consistent with this year’s hospital survey results, a recent study by CHWS on the supply and demand of health care work-ers found that the number of licensed NPs grew by 21% over a five-year period (2004-2008), and the number of licensed PAs grew 30% over the same period. According to DOL, the employment prospects for PAs in New York are favor-able. DOL does not include NPs as a spe-cific category for its analysis. Nearly one-third of survey respondents indicate that NPs are very difficult to recruit, and 22% indicate that PAs are very difficult to

recruit. In the CHWS 2010 report, The Healthcare Workforce in New York, 2008, recruitment difficulty for NPs and PAs in the hospital setting scored 3 on a scale of 1 to 5 (where 5 was most difficult). When these same data are broken down by region, Central New York emerges as the region where recruiting these professionals is most difficult, with 71% of Central New York hospitals reporting that NPs were very difficult to recruit and 64% indicating that PAs were very difficult to recruit. Central New York also is an area with a growing physician shortage.

VACANCY AND TURNOVER FOR NURSE PRACTITIONERS

AND PHYSICIAN ASSISTANTS, 2009 - 2010

For every allied health care profession, ex-cept radiologic technicians, vacancy rates rose relative to last year’s survey. This year’s survey added new categories, in-cluding clinical laboratory technologists and several health information technology (HIT) categories. While we cannot com-pare these new categories to past years, the vacancy rates reported for those cat-egories in 2010 are listed at right.

Notably, hospitals anticipated growth in several categories of professionals in which they also indicated challenges with recruitment. This was the case for medical coders, pharmacists, physical therapists, and clinical laboratory technologists. The highest vacancy rates across the state

were also seen in some of these same pro-fessions. These higher turnover rates could probably be attributed to the in-creased demand for these health care professionals and greater choice of avail-able jobs.

VACANCY RATES FOR ALLIED HEALTH PROFESSIONALS, 2009 - 2010

Clinical Lab Technologist

VACANCY RATES BY PROFESSION , 2010

7.5%

HIT Analyst

HIT Technical Support HIT Program Manager

6.5%

6.4%

4.8%

TURNOVER RATES FOR ALLIED HEALTH PROFESSIONALS, 2009 - 2010

The percentage of respondents indicating anticipated growth for the allied health professions (excluding RNs, PAs, and NPs discussed earlier in this report) is shown in the chart to the right.

Hospital responses to questions about an-ticipated growth in clinical lab technolo-gists varied by New York State region, with 35% in the Northeastern region and 70% in the Long Island region anticipating growth over the next year. Sixty-five per-cent of respondents on Long Island also predicted growth for medical coders and HIT program managers.

Clinical Lab Technologists

PERCENT OF RESPONDENTS INDICATING GROWTH, 2010

29%

Certified Nurse’s Aides Physical Therapists Medical Coders

26%

27%

24%

Pharmacists

14%

Anticipated Growth in Allied Health

Professions

This year, the most difficult professions to recruit are noted to the right:

Additionally, respondents were asked to cite reasons for recruitment difficulty and were given the following choices: short-age of workers, competition for workers, and salary levels. They were asked to check all that apply. Fifty-eight percent of respondents believe that there is a short-age of medical coders, and 49% believe there is a shortage of clinical laboratory technologists. Twenty-nine percent of hos-pitals cited competition as the reason for difficulty in recruiting PAs, and 45% stated that competition was the reason for diffi-culty in recruiting pharmacists. Thirty-nine percent of respondents cited competitive salary levels as the barrier to pharmacist recruitment. Retention of allied health care professionals does not appear to be a problem for respondents, with the excep-tion of certified nurse’s aides.

Medical Coders

PERCENT REPORTING DIFFICULTY RECRUITING, 2010

55%

Clinical Lab Technologists Physical Therapists Pharmacists

47%

44%

39%

Respiratory Therapists HIT Analysts

33%

33%

Medical Coders Pharmacists Clinical Lab Technologists Physical Therapists HIT Program

Man-57%

50%

50%

57%

41%

59%

47%

RECRUITMENT DIFFICULTIES OF SPECIFIED PROFESSIONALS BY REGION, 2010

Western NY/ Rochester Central NY Northeastern NY Northern Metropolitan

69%

69%

77%

Long Island

87%

61%

New York City

63%

42%

Conclusion

Implementation of ACA, along with the nu-merous reports related to the state of health care and the health care workforce including IOM’s Future of Nursing report, all denote increasing demands on the health care workforce and an expansion of nursing and allied workforce scopes of practice. Nurses and allied health profes-sionals are in demand nationally and, as in-dicated in this year’s survey responses, in New York State. There is a corresponding shortage in many of the nursing and allied health care professions, as many experi-enced workers retire and the demands on the health care system increase.

Additionally, for certain allied health pro-fessionals, including medical coders, clin-ical laboratory technologists, and pharmacists, there is not only a projected growth in demand, but recruitment chal-lenges as well. It is difficult to know if these are issues specific to hospitals or are being experienced by other parts of the health care sector.

More data are needed to better under-stand the nature of the workforce short-ages New York State and the national health care industry are facing, as well as to develop appropriate strategies in ad-dressing these supply and demand gaps.

To this end, ACA established a National Health Care Workforce Commission, but the appointed members have not yet met, due in large part to a lack of funding. New York State was one of the first five national pilot states in which the Robert Wood Johnson Foundation is sponsoring the development of a Regional Action Coalition (RAC) to advance the recom-mendations put forth in the IOM Future of Nursing report. One of the goals of the New York State RAC is a focus to improve the data collection and information gath-ering infrastructure.

HANYS, GNYHA, and the other allied as-sociations will continue to advocate for and support both state and federal legis-lation that addresses workforce shortages for nurses and allied health professionals. Further, the associations will continue to work with the Governor’s office, the State Legislature, and all relevant stakeholders in expanding the health workforce capac-ity to meet the growing demands of New York State’s patients. We will work to en-sure that any workforce expansion and re-design activities do not place unfunded burdens on facilities. Lastly, we will con-tinue to advocate against any harmful workforce legislation.