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
Members of the Nursing Workforce
Licensed Nursing Assistant (LNA) 6 wks
Licensed Practice Nurse (LPN) 1 yr
Registered Nurse
Diploma – 3 yr
ADN – 2yr
Members of the Nursing Workforce
Registered Nurse BS or BSN – 4 years
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
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
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
Age of RN’s Working in VT
42%
38%
26%
24%
20%
19%
14%
7%
7% 6%
20-30
31-40
41-50
51-60
61+
Years of Age
Board of Nursing Relicensure Surveys in 2001 n = 6,008 (85% response rate)
2009 n = 3,627 (54% response rate)
2001
2009
The Nurse Age Dilemma
30%
25%
19%19%
20%
Employed
Vermont 15%
nurses
10%
5%
14%
10%
12%
7% 7%
4%
7%
2%
<2
5
25
-2
9
30
-3
4
35
-3
9
40
-4
4
45
-4
9
50
-5
4
55
-5
9
60
-6
4
65
+
0%
Years of Age
2009 RN Relicensure Survey completed in March, 2009 by 3,627 VT
employed nurses (54% response rate)
2001- 2003 Focus on Recruitment
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
Educational Level of Vermont Nurses
• 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
From re-licensure survey was completed in March, 2009
by 3,627 VT employed nurses (54% response rate)
Vermont Nurse Graduates
1999-2011
350
301
300
250
200
150
129
169
100
50
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
0
Total RN
VTC LPN
UVM
CSC
S.VT.C
VTC AD
Norwich
Vermont Nurse Graduate by
Type/Degree 2011
LPN, 36%
BS or BSN,
23%
BS or BSN
Associates,
41%
*Does not count – RN to BSN graduates in 2011
Associates
LPN
2011 RN Graduates in Vermont
VTC, CSC, SVC
Associate
Degree,
65%
BS or BSN
Associate Degree
BS or BSN,
35%
UVM, Norwich
Applications to UVM Masters Program
in Nursing 2000 to 2011
180
160
154
140
131
120
137
147
134
100
80
77
86
60
40
20
0
17
26
10
13
25
00 001 002 003 004 005 006 007 008 009 010 011
0
2 2 2 2 2 2 2 2 2 2 2 2
Applicants to
Graduate Nursing
Program
Nursing Masters' Degrees in Vermont
1999 to 2011
55
50
45
40
35
30
25
20
15
10
5
0
1
2
27
27
4
21
10 6 12 10 7 12 8
8
1
4
3
5
18
UVM Clinical Systems
Management
Norwich
Administration/Educator
UVM Psych/Mental Health
1
12
99 000 001 002 003 004 005 006 007 008 009 010 011
9
1 2 2 2 2 2 2 2 2 2 2 2 2
UVM NP
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)
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/
• 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)
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/
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
22
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
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.
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
Why you? Why us? Why now?
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
Access +200,000
Quality
Add value
while slowing
costs