1. Nurses Leading the IOM Report in Wisconsin: Pathways, Progress, & Potential Judith M. Hansen, MS, BSN WCN Executive Director Taking the LEAD for Nursing in Wisconsin RWJF State Implementation Program Grant #70696 July, 2014

2. Objectives Present nursing workforce data from the Wisconsin Center for Nursing, Inc. Share overview of Wisconsin Action Coalition Provide updates on RWJF (SiP) Taking the LEAD for Nursing in WI grant focus areas Present concepts for RWJF (SiP) Round 2 Identify key regional issues & strategies to prevent workforce shortages, advance grant initiatives

3. WCN Mission Assure an adequate, well- prepared and diverse nurse workforce to meet the needs of the people of Wisconsin

4. Data Driven Process Three surveys: RN, LPN, & Educational Survey designs; based on National Minimum Dataset: Supply, Demand & Education from National Forum of State Nursing Workforce Centers DSPS - Distribution of surveys DWD – Data security & initial analysis, forecasting tools WCN – analyses by nursing researchers & dissemination w/ recommendations Benchmark data from national reports

5. Data Model Workforce Report Education RN and LPN Diversity DWD ModelIOM Report

6. Trends impacting nursing workforce Growing elderly population Increasing diversity Aging healthcare workforce Faculty shortage & age Potential impact of healthcare reform, changing delivery systems Economy, postponed retirements

7. Table 1. Wisconsin Projected Population by Age Group, 2000-2035 Age Group Census 2000Projected 2015 Projected 2035Percent Change 0-171,368,7561,349,0901,448,2005.8 18-643,292,4063,739,1603,720,20013.0 18-24520,629553,530577,80011.0 25-441,581,7241,547,3801,570,350-0.7 45-641,190,0531,638,2501,572,05032.1 65 & over702,553900,1701,485,570111.5 65-84606,928764,7101,263,020108.1 85 & over95,625135,460222,550132.7 Source: Egan-Robertson, D., Harrier, D. & Wells, P. (2008). Wisconsin projected population growth 2000-2035

8. 2012 Wisconsin RN Survey Findings n = 78,159 83.9% actively working as nurse in WI healthcare settings 3.1% working in healthcare non-nurse 1.8% working in another field 45,821 working in direct patient care in WI 5,664 APRNs with Masters or higher 5.7% APRNs in Wisconsin vs 8.7% nationally

9. 2013 Wisconsin LPN Survey Findings n=11,195 75.2% actively working as nurse in healthcare 6.5% working in healthcare non-nurse 4.2% working in another field 8,402 (87.3%) working in direct patient care 98.3% LPN Diploma, 4.5% ADN, 0.7% Bachelors 4,025 (36%) enrolled to further education

10. Wisconsin Nursing Employment 2012 RNs: 53.6% hospitals 17.3% ambulatory care 10.7 % nursing home/extended care 5.7% home health Average age: 48 Average experience: 15 years 2013 LPNs: 10.7% hospitals 29.1 % ambulatory care 42.1% nursing home/extended care 6.8% home health Average age: 50 Average experience: 20 years

11. Wisconsin RNs 55 & older by work setting

12. Wisconsin LPNs 55 & older by work setting

13. Gender in Wisconsin Nurses Assembly of Men in Nursing Goal: 20% Men by 2020 Wisconsin Nurses by Gender % Female % Male WI 2010 RN93.26.8 WI 2012 RN93.16.9 WI 2011 LPN95.44.6 WI 2013 LPN95.64.4 Source: WCN DWD 2010-2012-2013 Wisconsin Nurse Survey Summaries

14. Race/Ethnicity In Wisconsin Nurses Source: 2012 RN & 2013 WI LPN At-a-Glance Caucasian African American HispanicOther WI RN 93.52.01.43.0 WI LPN 91.06.31.93.8 WI Population 85.06.0 3.0 US Population 78.113.116.76.4

15. RNs – Plan to Leave Direct Patient Care

16. LPNs – Plan to Leave Direct Patient Care Source: 2013 Wisconsin LPN Survey

17. DWD Forecasting Tool Developed by economists Projections include a variety of scenarios All show similar results Potential gap: 34% - 36% by 2035 Potential gap of 15-20,000 direct care nurses Source: Walsh, T., Udalova, V. & Winters, D. (2011). Wisconsin Registered Nurse Supply and Demand Forecasting: Results Report 2010-2035. Wisconsin Department of Workforce Development, Office of Economic Advisors. Retrieved from http://worknet.wisconsin.gov/worknet_info/projects/rn_forecasting/results_report_printer_friendly.pdf

18. DWD 2013 Updated Workforce Projections Source: Wisconsin Registered Nurse Supply and Demand Forecasting Update:2012-2035 Wisconsin Department of Workforce development Office of Economic Advisors Feb 2014

19. Closing the RN Gap New graduates needed annually to close the projected demand 2010 Observation2,700 2015 Scenario Estimate4,500 2020 Scenario Estimate7,500 2025 Scenario Estimate11,300 2030 Scenario Estimate14,100 2035 Scenario Estimate15,500 Source: DWD, OEA, 2010 RN Forecasting Model, Broad Nursing Workforce - Head Count

20. 2013 Strategic Workforce Report The Wisconsin Nursing Workforce: Status & Recommendations Landmark, historical report Aligned w/ IOM Report – The Future of Nursing: Leading Change, Advancing Health Identified issues in Wisconsin http://www.wisconsincenterfornursing.org/workforce_report.html

21. Wisconsin Challenges 43.7% BSN 25,292 ADNs to advance Mean age for MSN completion is age 41; “degree a decade” 67% RN’s no immediate plans to return to school 0.6% Doctorates (includes PhDs & DNPs) 48% faculty are over age 55 59.9% nurses plan to leave workforce within 10 years Only 5% of nurses from under-represented populations APRNs are not completely independent

22. Wisconsin Regional Differences WI RNsSouthSENEWestNorth Median age48 49 % Female93.394 91.993.1 % White96.892.797.998.198.5 % Unemployed 1.82.52.3 1.9 % ADN35.832.236.645.846.1 % BSN43.348.944.734.736

23. Overarching Recommendations Triple the number of ADNs returning to school for BSN or higher, expand educational capacity Double # APRNs graduating by 2020 Remove Scope of Practice barriers Double # doctoral degrees graduating by 2020 Increase diversity in nurses to reflect the population Expand participation of nurses as full partners in redesign of care models Enhance healthcare workforce data collection

24. Multi-prong approach Retention of the workforce w/in new models of care Recruitment & successful transition of new nurses to double the pipeline, but “keep the wisdom” Recruitment of faculty; curricular redesign Academic progression in partnership w/employers & schools Innovative partnerships w/adoption & spread of best practices

25. Wisconsin Action Coalition Wisconsin Center for Nursing, Inc. Rural Wisconsin Health Cooperative Future of Nursing™ Campaign for Action national partners: Center to Champion Nursing in America Robert Wood Johnson Foundation® AARP

26. Wisconsin IOM Report ‘Inventory’ National Summit Feb. 2013 – Washington DC; developed Wisconsin ‘gameplan’ – course of action Formal launch Wisconsin AC – May, 2013 Inventory questionnaire based on IOM Report recommendations. WHA, ANEW, WI Nurses Coalition, WALHDAB, WI School Nurses, WI Health & Homecare Assn, WI Longterm Care Assn, RWHC, WMS, Wisconsin Medical Group Management Assn, WI Minority Nurses Assns. & more! 100+ responses, 500+ comments Report being developed by WCN (Fall 2014) Receiving national attention

27. Taking the LEAD for Nursing in Wisconsin RWJF State Implementation Program (SiP) grant 2/1/13- 1/31/15 FOCUS AREAS: Leadership - WONE, leadership development (20%), assess nurses on boards (10%), leadership tool kits Educational Advancement – Increase BSN completion (15% - 10%), WHA website, CNO Tool kit, push-pull models, rural/urban partnerships Diversity – inclusive excellence organizations, outreach to increase numbers of minority, male nurses, WI Diversity Assessment Tool

28. Wisconsin Funders Network Integrated into grant proposal Linking CNOs, Health system foundation directors, deans Regional meetings– Madison, Green Bay (to date) Next outreach; beyond healthcare, i.e., business, private foundations, etc. Faye McBeath Foundation – grant to assess nursing funding in Wisconsin being compiled by Public Policy Forum Philanthropy - Need assistance making connections throughout state

29. NEXT: RWJF SiP Grants Round 2 Proposals: October 1, 2014. Grant period 2/1/15-1/31/17 $150,000 over 2 years/$75,000 match by 10/1/14 Continue: BSN completion, leadership, diversity New focus areas for consideration: Interprofessional education/practice Employer/Educator partnerships Enhanced BSN completion programs Team & community-based care models Repository, mentorship for boards Pilot Wisconsin Diversity Assessment Tool

30. Thank you! Questions?

31. Group Discussion What is currently going on in this region to implement recommendations from: IOM Future of Nursing Report ? WCN 2013 Nursing Workforce Report? What are the greatest needs in this region? What might be possible strategies to address these needs? Where would you like to see activities in the next grant round?

32. Websites & Contact Info Wisconsin Center for Nursing www.wicenterfornursing.org Judith Hansen, Executive Director judi@wicenterfornursing.org Future of Nursing™ Campaign for Action www.campaignforaction.org