1. VT. Nurse Workforce Background Information for the Blue Ribbon Commission on Nursing October 6, 2011 Mary Val Palumbo DNP, APRN University of Vermont AHEC Nursing Workforce Initiatives

2. Members of the Nursing Workforce Licensed Nursing Assistant (LNA) 6 wks Licensed Practice Nurse (LPN) 1 yr Registered Nurse Diploma – 3 yr ADN – 2yr

3. Members of the Nursing Workforce Registered Nurse BS or BSN – 4 years

4. Members of the Nursing Workforce – Advanced Practice MSN – Nurse Practitioner, Nurse Anesthetist, Nurse Midwife, Administrator or Educator DNP – Doctor of Nursing Practice PhD – Nurse Scientist/Educator

5. Recent History Blue Ribbon Nursing Commission January, 2001 “Vermont is in the midst of a crisis. The number of nursing students has declined at the same time the number of working nurses who are retiring is increasing. The confluence of these two dynamics has created unacceptably high nursing vacancy rates in hospitals, nursing homes, and home health agencies.” Vermont Association of Hospital and Health Systems Vacancy rates has high as 19% reported in 2003

7. Recommendations of the Blue Ribbon Nursing Commission January 2001  Create an Office on Nursing Workforce  Increase salaries  Establish a marketing partnership  and X Develop a Scholarship Program  Fund a Loan Forgiveness Program  Increase capacity of nursing schools  Expand continuing education programs

8. Age of RN’s Working in VT Board of Nursing Relicensure Surveys in 2001 n = 6,008 (85% response rate) 2009 n = 3,627 (54% response rate)

9. The Nurse Age Dilemma 2009 RN Relicensure Survey completed in March, 2009 by 3,627 VT employed nurses (54% response rate)

10. 2001- 2003 Focus on Recruitment

11. Educational change over decade Five Vermont schools of nursing VTC – online re-entry, LPN, ADN expanded Southern VT college – ADN, RN to BSN UVM – BS, RN to BSN expanded, MS Castleton – ADN, new BSN, RN to BSN Norwich – BSN, MSN nursing admin/education Plans: VTC - BSN, UVM - DNP

12. Educational Level of Vermont Nurses From re-licensure survey was completed in March, 2009 by 3,627 VT employed nurses (54% response rate) 17% completed a Diploma program in nursing 40% completed an Associate’s Degree in nursing 35% completed a Bachelor’s Degree in nursing 5% completed a Master’s Degree in nursing <1% completed a Doctoral degree

13. Vermont Nurse Graduates 1999-2011 301 169

14. Vermont Nurse Graduate by Type/Degree 2011 *Does not count – RN to BSN graduates in 2011

15. 2011 RN Graduates in Vermont

16. Applications to UVM Masters Program in Nursing 2000 to 2011

17. Nursing Masters' Degrees in Vermont 1999 to 2011

18. 2005-2009 Policy Work In Collaboration with AHEC and other stakeholders: – Nurse Faculty Loan Repayment – October Designated as Health Care Career Awareness Month – Workforce Development Partners (grant and policy work)

19. Infrastructure to collect and analyze health care workforce data Office of Nursing Workforce collected 10 years of Vermont Supply and Demand data which is available at http://www.choosenursingvermont.org/ http://www.choosenursingvermont.org/ Vermont Board of Nursing is now working with the National Council of State Boards of Nursing to collect a “Minimum Data Set” electronically with relicensure of RNs, LPNs, and APRNs. Office of Nursing Workforce (now AHEC)has published studies on educational determinants of satisfaction and retention, intention to leave, emergency preparedness, youth perceptions of a nursing career, nurse perceptions of their health and safety and their employers attention to same. (2004-11)

20. Implement nurse residency programs Vermont Nurses In Partnership, Inc. (VNIP) provides an international forum for nurse leaders from academia, regulation and various practice settings that are working to improve transition to practice for direct care providers. The forum has grown from the initial 45 Vermont-based members, to a coalition of over 500 nurse leaders from across the nation and around the world. http://www.vnip.org/

21. Remove scope-of-practice barriers As of June 1, 2011, experienced nurse practitioners are no longer required to have a written “collaborative agreement” with an MD. Scope of practice barriers remain for APRNs and RNs

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23. Magnet Hospitals Southwestern Vermont Medical Center (X3) Rutland Regional Medical Center Dartmouth Hitchcock Medical Center (X2) A hospital where nursing delivers excellent patient outcomes, where nurses have a high level of job satisfaction, and where there is a low staff nurse turnover rate and appropriate grievance resolution. Magnet status is also said to indicate nursing involvement in data collection and decision-making in patient care delivery. Segen's Medical Dictionary. © 2011

24. New challenges for Nurses Vermont Blue Print for Health requires attention to health promotion and population health Transition to Electronic Medical Records requiring nurse input Health care reform and primary care provider shortage.

25. Old Challenges Nursing faculty shortage Availability of clinical placement sites for nursing programs Nurse health and safety (older and younger) Pending retirement of half the workforce Interest in caring for elders

26. Why you? Why us? Why now? Add value while slowing costs Quality Access - +200,000 IOM Future of Nursing Report Vermont Healthcare reform - Blueprint for Health and Act 48 Blue Ribbon Commission on Nursing – A chance to transform system to improve care