by the
VERMONT ORGANIZATION OF NURSE LEADERS
STATE OF NURSING IN VERMONT
IMPACT ON HOSPITALS
August 2, 2000
Katherine Anderson, RN, MA, Vice President
of Patient Care Services,
Brattleboro Memorial Hospital
Jill Lord, RN, Director of Patient Care Services,
Mt. Ascutney Hospital and Health Center, Inc.
Susan Nicholls, RN, Nurse Coordinator, Ambulatory
Services & Emergency Department,
Gifford Medical Center
Roseanne Palmer, RN, Director of Inpatient
Services,
Central Vermont Hospital
Purpose
To provide a status report on the nursing workforce and outline concerns as they relate to hospital functioning and budgets.
Background
Report on Nursing, Toni Keading for the Vermont Association of Hospitals and Health Systems, Inc. and the Vermont Organization of Nurse Leaders, December 1998.
In Vermont - 1997
- Average age of nurses – 45
- 72% of nurses over 40
- 36% fewer graduating nurses than 1994
- No growth in inflation-adjusted RN wages over past 5 years
- Majority of nurses prepared in 2 rather than 3 years
- More complex practice environment
- All licensed nurses active due to practice requirement
- 39% of RN’s in VT hospitals work full time, down from 60% a decade ago
- 45.9% of VT RN’s work in VT hospitals
- RN’s represent 22% of total hospital staff, compared to 24% in 1993
National Trends
Demand Factors:
- U.S. population growing 1% annually
- Chronic illness, risky teen behavior
- Technology
- Economic climate
- Consumer demand
- High patient acuity
- Productivity and efficiency
- Competition for high quality outcome measures
- Increased regulation
- Elderly population increases in U.S. population from 39 Million in 2010 to 79 Million in 2050 as baby boomers retire
Supply Factors:
- Social preference for nursing as a career
- Strong economy –spousal income
- Smaller cohort younger nurses
- RN’s caregivers of older adults at home
- RN’s most rapidly aging occupation. In ten years, more than 50% will be over 50
- Over age 53, nurses retire or decrease hours worked.
- Wages flat; down compared to other college graduates
- Tuition costs/loans
- Supply of faculty
- Capacity of Nursing Education programs
- Enrollment in educational programs
- Shift of RNs into Nurse Practitioner programs
- Declining work satisfaction and health of nurses due to increased job demands, decreased job control and decreased workplace support
SALARIES AFTER
COLLEGE
Job |
’98 Salary |
Change from ’97 |
| Chemical Engineering | $44,557 | 4.2% |
| Electrical Engineering | $41,167 | 3.4% |
| Mechanical Engineering | $39,857 | 0.1% |
| Industrial Engineering | $39,842 | 5.6% |
| Computer Science | $38,741 | 4.8% |
| Physics | $36,692 | 14.8% |
| Materials Logistics | $36,190 | 4.8% |
| Packaging Engineering | $36,089 | 2.1% |
| Chemistry | $35,227 | 12.6% |
| Civil Engineering | $34,385 | 6.9% |
| Mathematics | $33,180 | 3.5% |
| Nursing | $31,802 | -3.4% |
| Financial Administration | $32,430 | 7.9% |
| Geology | $31,273 | -1.1% |
| Accounting | $31,209 | 2.6% |
| Business Administration | $30,373 | 6.5% |
| Advertising | $25,485 | 2.9% |
| Journalism | $24,588 | 11.2% |
| Liberal Arts | $24,578 | 2.1% |
| Telecommunications | $22,563 | 0.5% |
- Average starting salaries for 1997-98 college graduates, by academic degree.
| Degree | ’98 Salary | Change from ’97 |
| Computer Engineering | $39,593 | 6.3% |
| Computer Science | $38,475 | 6.3% |
| Liberal Arts | $28,875 | 6.5% |
Source: Unpublished Results (Buerhaus, Staiger & Auerbach) based on data from the Current Population Merged Files, 1998
QUALITY - INDICATORS FROM NATIONAL RESEARCH
Relationship between RN availability and quality:
- Mortality – inverse, negative
- Complications – urinary and lung infections, blood
clots – inverse, negative
- Adverse Events – pressure sores, medication errors, failure to rescue – inverse, negative
Relationship to Nurse Satisfaction:
- Patient Satisfaction – direct, positive
% Skill Mix and Vacancy Rate – 1/00 VAHHS Survey
Overall Vacancy Rate in Health Care Organizations
RN 7.4%
LPN 11.3%
LNA 13.3%
Hospitals Home Health Nursing Homes
|
RN LPN LNA |
Skill Mix | Vacancy Rate | Skill Mix | Vacancy Rate | Skill Mix | Vacancy Rate |
79.4 10.9 9.7 |
7.0 8.8 16.2 |
46.6 3.1 50.3 |
3.1 20.4 6.0 |
17.5 16.0 66.5 |
16.8 15.8 17.2 |
January 2000 VAHHS Survey of Hospitals, 10/99-3/00 (6 mos)
- 11 of 14 hospitals reporting
- 9 hospitals spent $3,974,000 above salary budget on travelers
- Highest vacancies – medical/surgical;
Second highest – critical care
Budgetary Impact on Hospitals is greater than POC Guidelines
Salary and benefit increases
- Wage increases due to regional and national competition; i.e., 15% higher salaries in New Hampshire
- Increased use of travelers as vacancies increase (2X base salary)
- Increased overtime required as fewer nurses work harder to meet the demands (1.5X base salary)
- Incentives – i.e., Baylor plans, bonus for working extra shifts
Increased recruitment costs
- Sign-on bonus (2-5k per nurse recruited)
- Training costs
Increased costs for retention
- Internships – orientation and mentor costs over several months
- Clinical ladders – staff development, continuing education
- Support staff FTE’s, i.e. secretaries
- Nursing FTE’s to reduce overtime
Quality – when quality is compromised, costs increase
IMPACT OF NURSING SHORTAGE ON PUBLIC HEALTH
- Potential of decreased quality of care
- Lack of staffing in tertiary care and nursing homes increases patient LOS in hospitals
- Intermittent closing of beds and transfer of patients to other hospitals due to staffing shortages
Study – ER transfers out of one small VT hospital 11/99-6/00 (8 mo.)
67 patients transferred out
37 required specialty services not available at hospital
30 required services provided by the hospital but were transferred
4 patient request
6 VA patients
10 specialist not available (subsequently recruited coverage)
10 inadequate nurse staffing in critical care and inpatient serv.
- Public perception of local hospital letting down the community.
Market Trends – Salary Budgets
- 4.4% for salaried exempt employees
- American Compensation Association’s comprehensive survey of U.S. employers.
(Compliments of Fletcher Allen Health Care)
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