Linda Flynn, PhD, RN, FAAN Associate Dean & Professor University of Colorado College of Nursing

Michael Yedidia, PhD Rutgers Center for State Health Policy Principal Investigator Project Director, Evaluating Innovations in Nursing Education

 Increase of million people insured (34 million by 2016) (Congressional Budget Office, 2012)  By 2019 increase of million primary care visits per year (Hofer, Abraham, & Moscovice, 2011)  Shortage of approximately 12,000 – 41,000 primary care physicians by 2025 (AAMC)

 According to HRSA 2012….NO.  HRSA estimates that supply of NP will increase 30% by 2020 and PA supply will increase by 58% by  The increase in NP and PA supply will reduce PCP shortage from 20,000 PCPs to 6,000 PCPs.

 In Colorado….. ◦ State graduates 125 new NPs per year ◦ A total of 140 NPs retire each year ….(CCNE). ◦ Supply not keeping up with demand from retirement NOT counting population growth nor impact of ACA.

◦ Only 18% of NPs practice in rural areas (American Academy of Nurse Practitioners) ◦ Yet, 20-25% of residents live in rural areas ◦ An additional 4,000 primary care providers needed in rural areas (National Conference of State Legislators).

 BLS estimates RN demand up 26% (1 million RN increase) by  1/3 of increase in RN demand will come from ACA (333,333 RNs).  RNs needed in home health care will increase 55% between  RNs needed for Primary Care Practices / Medical Homes = more training / education.

 Increase in NP demand expected, especially for rural areas.  Demand for RNs will increase, particularly in outpatient settings and home health care.  RNs increasingly need skills as care coordinators, case managers, patient educators, and chronic care specialists.  Increased pressure on educational pipeline.

 Total of 78,089 qualified applicants turned away in  Total of 1,358 existing faculty positions unfilled in 2013; an additional 98 new positions needed.  Faculty vacancy rates of over 8% nationwide.  Wave of faculty retirements expected.

 Inadequate doctoral-prepared pool and pipeline.  Non-competitive salaries.  Aging faculty workforce.  Attrition of existing faculty for other than retirement (Fang & Bednash, 2014).

Environment Practice Environment AdequacyResource Adequacy RN/MD Relationships Foundations for Quality Input Into Affairs Supportive Manager Environment Practice Environment AdequacyResource Adequacy RN/MD Relationships Foundations for Quality Input Into Affairs Supportive Manager NurseOutcomes Outcomes Patient Outcomes Patient Outcomes Processes Processes of Care Nurse StaffingNurse SurveillanceSurveillance Facility CharacteristicsFacility (Aiken, et al., 1998; 2001)

 Nurse Burnout ◦ Aiken, Clarke, Sloane (2002); Aiken et al. (2008); Lang et al. (2012); Flynn, Thomas-Hawkins, Clarke, 2009 Van Bogaert et al. (2010).  Job Satisfaction / Intent-to-Leave / Attrition ◦ Choi, Flynn, Aiken (2011); Flynn (2007); Flynn, Thomas-Hawkins, Clarke (2009); Van Bogaert, et al. (2010).  Poor Patient Outcomes ◦ Kutney-Lee, et al. (2009); Flynn, et al., (2012); Flynn, Liang, Dickson, & Aiken, 2010; Jarrin, Flynn, Lake, Aiken (2014).

What are the modifiable aspects of work-life that are associated with burnout and intent-to-leave among nurse faculty?

 Stratified random sample of full-time faculty.  Sample proportionately representative of all US programs by prelicensure offered (BS, AD); urban/rural; research intensity.  Total of 3,975 faculty invited to participate in survey; 78.5% response rate!  Final Sample = 3,120 faculty from 269 schools of nursing.

CharacteristicMean (SD)Percent Age51.4 (9.38) Within 5 years of retirement 15.8% Female95% White88% Education Master’s70.6% Doctorate19.7% Research Institution25% Rank Professor16.7% Associate Professor19.4% Assistant Professor30.8% Instructor28.8%

 76% taught in Pre-Licensure Program  24% taught in Graduate Programs  46.2% taught in schools offering ADN  53.8% taught in schools offering BSN or >  21.4% taught in schools in rural areas  28.6% were tenured  20.8% on tenure track  24.4% NOT on tenure track  26.2% school does not offer tenure

 Burnout (Emotional Exhaustion) ◦ Maslach Burnout Inventory EE Subscale  Intent-to-Leave Academic Nursing ◦ How likely to leave in next 5 years (4-point scale)  Demographics ◦ Age, gender, race/ethnicity, highest degree ◦ Health Status

 Institutional Characteristics ◦ Degree Programs Offered ◦ Research Intensity ◦ Urban/Rural Locale  Job Characteristics ◦ Years in current institution ◦ Rank ◦ Tenure Status / Tenure Track/ Non-Tenure Track / Tenure Opportunity ◦ Teaching post-BSN students

 Administrative Responsibilities  Salary Range  Certified APRN

 Hours spent per week on…. ◦ Didactic Teaching / Prep ◦ Clinical Teaching / Prep ◦ Committees / Meetings ◦ Advising / Mentoring Students ◦ All Work Activities ◦ Developed 1 Course / 1 Major Course Revision ◦ Developed 2 Courses/ 2 Major Course Revisions ◦ Converted 1 or more courses to online format ◦ Published 1 or more articles in p-r journal ◦ Prepared 1 or more grant proposals

 Conditions of Work ◦ Workload ◦ Salary ◦ Benefits ◦ Job Security ◦ Resource Availability  Content of Work ◦ Flexibility to balance work/family ◦ Autonomy/Independence ◦ Relationship with Adm ◦ Relationships with Students ◦ Relationships with Colleagues ◦ Meaningfulness of Work ◦ Rewards for Innovations ◦ Visibility in Job

 Mean hours worked = 48.3 hrs / week.  34.2% Major revision of 2 or more courses  19.8% Published 1 or more p-r articles  28.3% Submitted 1 or more grants  67.7% >61 plan to retire in 5 years  85% Very – Somewhat Satisfied with their  work

 39% High Levels of Burnout! Higher than staff nurses in hospitals and nursing homes!  20% Younger faculty intended to leave Academic Nursing within 5 years  31% yrs old intended to leave Academic Nursing within 5 years

PredictorORCIp Within 5 years of retirement age6.41(4.77,8.62)<.001 Highest Degree BSN2.70(1.58,4.62)<.001 Highest Degree Master’s1.91(1.42,2.56)<.001 On Tenure Track but not Tenured1.50(1.08,2.08)<.05 Not on Tenure Track1.49(1.02,2.16)<.05 High Burnout (EE)1.27(1.00,1.61)<.05 Dissatisfied with Workload1.26(1.08,1.47)<.01 Dissatisfaction w/Teaching Support1.19(1.01,1.40)<.05 Dissatisfaction with Salary1.18(1.02,1.35)<.05 Dissatisfaction with Reward for Innovation 1.16(1.04,1.29)<.01

PredictorORCIp Dissatisfaction with Workload1.82(1.55,2.13)<.001 >50% Administrative Role1.73(1.32,2.27)<.01 Dissatisfaction with Flexibility to Balance Work and Family Life 1.58(1.37,1.82)<.001 Poor Health1.46(1.28,1.67)<.001 Dissatisfaction with Meaningfulness of Work 1.36(1.14,1.63)<.01 Dissatisfaction with Direction of Department / School 1.27(1.09,1.48)<.01 Hours Worked per Week*1.02(1.10,1.03)<.001 Race / Ethnicity Non-White0.68(0.49,0.93)<.05 *Increase from 40 hrs – 50 hours of work per week associated with 22% higher odds of burnout.

 Constellation of Work-Life factors equal to retirement age in predicting intent-to-leave academic nursing! ◦ Burnout  Workload / Hours per week worked  Lack of flexibility to balance work / family life ◦ Dissatisfaction with Workload ◦ Dissatisfaction with Salary / Reward for Innovation ◦ Dissatisfaction with Teaching Support

 Monitor faculty workload / perceptions  Implement strategies to increase flexibility of schedules  Implement strategies to increase teaching support 

 Explore needs of APRN faculty  Explore needs of Non-Tenure Track Faculty  Explore needs of Academic Leaders

 Planning grant funded by RWJF  Schools invited to join as Members  Annual Faculty / Student Survey (electronic) for Member Schools / Outcome Driven  Large Database of De-identified Data / Schools own their data  Benchmarking Capabilities  www. NNERN.org (Under Construction)