Home Health Nursing Pilot Study 2003

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Vermont Health Workforce Assessment Survey

PREPARED BY: OFFICE OF NURSING WORKFORCE RESEARCH, PLANNING, AND DEVELOPMENT

University of Vermont, College of Nursing and Health Sciences
(802) 656-0023 e-mail: marypalumbo@uvm.edu

 

 

 

 

 

 

 

 

 

 

Notes and References:

1. HWAT members are from the UVM College of Nursing and Health Sciences, School of Business Administration, Community and Economic Development, Bioinformatics, College of Medicine Area Health Education Center and Fletcher Allen Health Care. The project was funded by the VT Health Dpt, Office of Rural Health.

2. Vacancy rates were calculated as follows: 1 – (Total actual FTEs employed from all responding institutions divided by the total budgeted FTEs from all responding institutions) on 2/15/03.

3. Turnover rates were calculated as follows: Total # workers leaving institution between 2/15/02 – 2/15/03 divided by total # part-time + full-time workers employed as of 2/15/03.

4. American Association of Colleges of Nursing. (2002) Nursing Shortage Fact Sheet. http://www.aacn.nche.edu/Media/ Backgrounders/shortagefacts.htm (Sept. 30, 2002).

WHY WAS THIS SURVEY DONE?

One factor in assuring access to quality health care for all Vermonters is an ongoing and current knowledge of the state’s health workforce resources. To this end, the Office of Nursing Workforce Research, Planning and Development created the Health Workforce Assessment Team (HWAT)1. This team was charged to develop a new system to assess Vermont’s healthcare workforce, including new ways to measure the state’s need for various healthcare positions. The following is a report of the 2003 pilot survey of home health agencies.

WHO WAS SURVEYED?

In February 2003, the Vermont Health Workforce Survey was sent to home health agency executive directors. This contact person was asked to participate in the data collection with assistance from human resources and other department heads. Follow up postcards, letters, telephone calls, and replacement surveys were used to assure a high response rate. The response rate was 92% (11 of 12 home health agencies responded).

WHAT WAS LEARNED?

Vacancy rates2 vary according to nursing position in the home health setting.

Statewide Vacancy Rate % (Range)

LPN

 24% (0-56%)*

RN

 12% (0-40%)

LNA

 8% (0-31%)

Clinical Nurse Specialist

 3% (0-5%)*

Clinical Managers

 0% (0-5%)
*Only 7 agencies reported employing LPNs and CNSs

Turnover rates3 vary according to nursing position in the home health setting.

Statewide Turnover Rate % (Range)
Clinical Nurse Specialist 43% (0-120%)*
LPN 38% (0-100%)*
LNA 32% (13-63%)
RN 24% (0-73%)
Clinical Managers 5% (0-14%)

 

RECRUITMENT INCENTIVES:

  • 45% of VT home health agencies report a positive impact from starting salaries on recruitment.
  • 64% of VT home health agencies report a pay differential for RN educational preparation.
  • 64% of VT home health agencies report a pay differential for credentialed RNs.

Hardest positions to fill:
  • The LNA position was reported to be difficult to fill by 60% of the agencies but was filled in an average of 5.3 weeks with a range of 3.5 to 8 weeks.
  • The CNS position had the highest turnover rate and a maximum time of 30 weeks to fill this position was reported. However, no vacancies for CNSs were reported by 78% of the agencies.

 

 

 

 
IMPACT OF SHORTAGES

Never

Several times a year

Monwthly

Weekly

Daily

Missing or n/a

Curtailed plans for acquiring new technology

82%

9%

9%

Delayed or diverted admissions

64%

18%

9%

9%

Reduced service hours

55%

27%

9%

9%

Mandatory staff overtime

64%

 

9%
9%

 

18%

Decreased patient satisfaction

64%

18%

9%
9%

Increased patient complaints

55%

27%

9%

9%

Decreased staff satisfaction

36%

45%

9%

9%

Curtailed plans for facility expansion

No 91%

9%

Discontinued clinical programs

No 91%

9%

CONSEQUENCE OF THE AGING WORKFORCE:

Percent Fulltime Home Health Nursing Positions

As the RN workforce ages, more nurses may be cutting back their hours per week.

Most needed unavailable specialists*
  1. Psychiatric nursing
  2. High tech specialist
  3. Pediatric high tech nurse
  4. IV specialist
  5. Diabetic educator

(*in 40% of agencies who reported needing nurses with specialized skills)

 

CONCLUSIONS:

Vermont is having a nursing shortage similar to other areas of the United States. In September 2002, the AACN reported that the annual nurse vacancy rate an U.S. hospitals was 13%, and that one in seven hospitals has an RN vacancy rate over 20%4. No similar national statistics are available for home health agency vacancy rates. Fewer RNs are working fulltime, which may decrease agency cost for benefits but may create more underinsured workers. Turnover rates greater than 25% in 4 of 5 nursing positions will mean that valuable health care dollars will be spent on recruitment and orientation. Continuity of care is also at greater risk with increased turnover. At this time, the largest impact of the nursing shortage is in the areas of staff satisfaction and patient complaints.

(C) 2002, Office of Nursing Workforce Research, Planning and Development
School of Nursing, University of Vermont
Burlington, VT 05405, phone 802-656-0023