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 health care workforce, including new ways to measure the state’s need for various health care 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* Psychiatric nursing High tech specialist Pediatric high tech nurse IV specialist 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.