Hospital Nursing Pilot Study 2003

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WHY WAS THIS SURVEY DONE?

One factor in assuring access to quality health care for all Vermonters is an ongoing understanding 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 the state’s 16 hospitals. Adjustments will be made to the survey instrument based on this pilot study.

WHO WAS SURVEYED?

In February 2003, the Vermont Health Workforce Survey was sent to hospital nurse executives. 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 94% (15 of 16 hospitals responded).

WHAT WAS LEARNED?

Vacancy rates² vary according to nursing position in the hospital setting.

RECRUITMENT INCENTIVES:

• 53% of VT hospitals report a positive impact of salaries on recruitment.
• 26% of VT hospitals report a pay differential for RN educational preparation (ADN vs. BSN).
• 26% of VT hospitals report a pay differential for credentialed RNs (e.g. RNC).

Traveling nurses were used by 8 hospitals for a total cost of $9.4 million and they occupied 7% of the budgeted staff nurse and CRNA positions.

 

IMPACT OF SHORTAGES	Never	Several times a year	Monthly	Weekly	Daily	Missing or n/a
Curtailed plans for acquiring new technology	93%					7%
Reduced number of staffed beds	33%	33%	7%	7%		20%
Emergency department overcrowding	20%	33%	20%	13%		13%
Diverted emergency department patients	40%	47%				13%
Delayed or diverted admissions	20%	40%	20%	7%		13%
Reduced service hours	67%	20%	7%			7%
Increased wait times to surgery	47%	27%	7%			20%
Cancelled surgeries	53%	27%				20%
Delayed hospital discharges	47%	7%	13%	13%		20%
Shortened lengths of stay	67%					33%
Mandatory staff overtime	73%	7%		13%		7%
Decreased patient satisfaction		60%	20%			20%
Increased patient complaints	20%	40%	20%			20%
Decreased staff satisfaction		53%	7%	20%	7%	13%
Curtailed plans for facility expansion	Yes 7%	No 73%				20%
Discontinued clinical programs		No 93%				7%

CONSEQUENCE OF THE AGING WORKFORCE:

Percent Fulltime by Nurse Position

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

CONCLUSIONS:

In September 2002, the AACN reported that the annual nurse vacancy rate an U.S. hospitals is 13%, and that one in seven hospitals has an RN vacancy rate over 20%⁴. The range of vacancy rates at Vermont’s hospitals (0-24%) indicates that the nursing shortage is significant in some Vermont hospitals. In addition, only 57% of hospital RNs are working full time. This may decrease hospital cost for benefits, but may create more underinsured workers. High turnover rates lead to increased expenditures on recruitment, orientation, and traveling nurses to fill the gaps. Continued attention must be paid to the preparation of nurses with specialized skills. At this time, the largest impact of the nursing shortage is in the areas of staff satisfaction, patient satisfaction and complaints, diverted emergency room patients and overcrowding, and delayed or diverted admissions. Ongoing assessment of the impact of the shortage on quality of care is also necessary.