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
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Increase of 16-34 million people insured
(34 million by 2016) (Congressional Budget Office, 2012)
By 2019 increase of 15-25 million primary
care visits per year (Hofer, Abraham, & Moscovice, 2011)
Shortage of approximately 12,000 – 41,000
primary care physicians by 2025 (AAMC)
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According to HRSA 2012….NO.
HRSA estimates that supply of NP will
increase 30% by 2020 and PA supply will
increase by 58% by 2020.
The increase in NP and PA supply will reduce
PCP shortage from 20,000 PCPs to 6,000
PCPs.
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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).
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BLS estimates RN demand up 26% (1 million
RN increase) by 2020.
1/3 of increase in RN demand will come from
ACA (333,333 RNs).
RNs needed in home health care will increase
55% between 2010-2020.
RNs needed for Primary Care Practices /
Medical Homes = more training / education.
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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.
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Total of 78,089 qualified applicants turned
away in 2013.
Total of 1,358 existing faculty positions
unfilled in 2013; an additional 98 new
positions needed.
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Faculty vacancy rates of over 8% nationwide.
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Wave of faculty retirements expected.
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Inadequate doctoral-prepared pool and
pipeline.
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Non-competitive salaries.
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Aging faculty workforce.
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Attrition of existing faculty for other than
retirement (Fang & Bednash, 2014).
Nurse
Staffing
Practice Environment
•Resource Adequacy
•RN/MD Relationships
•Foundations for Quality
•Input Into Affairs
•Supportive Manager
Surveillance
Processes of Care
Facility
Characteristics
(Aiken, et al., 1998; 2001)
Nurse
Outcomes
Patient
Outcomes
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Nurse Burnout
◦ Aiken, Clarke, Sloane (2002); Aiken et al. (2008); Lang et al. (2012); Flynn,
Thomas-Hawkins, Clarke, 2009 Van Bogaert et al. (2010).
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Job Satisfaction / Intent-to-Leave / Attrition
◦ Choi, Flynn, Aiken (2011); Flynn (2007); Flynn, Thomas-Hawkins, Clarke
(2009); Van Bogaert, et al. (2010).
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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?
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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.
Characteristic
Mean (SD)
Age
51.4 (9.38)
Percent
Within 5 years of
retirement
15.8%
Female
95%
White
88%
Education
Master’s
70.6%
Doctorate
19.7%
Research Institution
25%
Rank
Professor
16.7%
Associate Professor
19.4%
Assistant Professor
30.8%
Instructor
28.8%
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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%
20.8%
24.4%
26.2%
were tenured
on tenure track
NOT on tenure track
school does not offer tenure
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Burnout (Emotional Exhaustion)
◦ Maslach Burnout Inventory EE Subscale
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Intent-to-Leave Academic Nursing
◦ How likely to leave in next 5 years (4-point scale)
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Demographics
◦ Age, gender, race/ethnicity, highest degree
◦ Health Status
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Institutional Characteristics
◦ Degree Programs Offered
◦ Research Intensity
◦ Urban/Rural Locale
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Job Characteristics
◦ Years in current institution
◦ Rank
◦ Tenure Status / Tenure Track/ Non-Tenure Track /
Tenure Opportunity
◦ Teaching post-BSN students
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Administrative Responsibilities
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Salary Range
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Certified APRN
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Hours spent per week on….
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Didactic Teaching / Prep
Clinical Teaching / Prep
Committees / Meetings
Advising / Mentoring Students
All Work Activities
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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
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Conditions of Work
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Workload
Salary
Benefits
Job Security
Resource Availability
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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
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Mean hours worked = 48.3 hrs / week.
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34.2%
Major revision of 2 or more courses
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19.8%
Published 1 or more p-r articles
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28.3%
Submitted 1 or more grants
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67.7%
>61 plan to retire in 5 years
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85%
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Very – Somewhat Satisfied with their
work
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39%
High Levels of Burnout! Higher than
staff nurses in hospitals and nursing
homes!
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20%
Younger faculty intended to leave
Academic Nursing within 5 years
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31%
51-60 yrs old intended to leave
Academic Nursing within 5 years
Predictor
OR
CI
p
Within 5 years of retirement age
6.41
(4.77,8.62) <.001
Highest Degree BSN
2.70
(1.58,4.62) <.001
Highest Degree Master’s
1.91
(1.42,2.56) <.001
On Tenure Track but not Tenured
1.50
(1.08,2.08) <.05
Not on Tenure Track
1.49
(1.02,2.16) <.05
High Burnout (EE)
1.27
(1.00,1.61) <.05
Dissatisfied with Workload
1.26
(1.08,1.47) <.01
Dissatisfaction w/Teaching Support
1.19
(1.01,1.40) <.05
Dissatisfaction with Salary
1.18
(1.02,1.35) <.05
Dissatisfaction with Reward for
Innovation
1.16
(1.04,1.29) <.01
Predictor
OR
CI
p
Dissatisfaction with Workload
1.82
(1.55,2.13)
<.001
>50% Administrative Role
1.73
(1.32,2.27)
<.01
Dissatisfaction with Flexibility to
Balance Work and Family Life
1.58
(1.37,1.82)
<.001
Poor Health
1.46
(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-White
0.68
(0.49,0.93)
<.05
*Increase from 40 hrs – 50 hours of work per week associated with 22%
higher odds of burnout.
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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
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Monitor faculty workload / perceptions
Implement strategies to increase flexibility of
schedules
Implement strategies to increase teaching
support
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Explore needs of APRN faculty
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Explore needs of Non-Tenure Track Faculty
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Explore needs of Academic Leaders
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Planning grant funded by RWJF
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Schools invited to join as Members
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Annual Faculty / Student Survey (electronic) for Member
Schools / Outcome Driven
Large Database of De-identified Data / Schools own their
data
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Benchmarking Capabilities
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www. NNERN.org (Under Construction)