Shortages and Recruitment Issues in Nursing and Allied Health: The Minnesota Model Where have all th

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Shortages and Recruitment Issues in Nursing and
Allied HealthThe Minnesota Model(Where have
all the health care workers gone?)

• Estelle Brouwer, Office of Rural Health Primary
  Care, MN Department of Health
• Kristin Juliar, Healthcare Education Industry,
  MN State Colleges and University
• Sally Buck, Minnesota Center for Rural Health

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Minnesota Health Professions Workforce Partnership

• Healthcare Education-Industry Partnership,
  MNSCU
• Minnesota Center for Rural Health
• Minnesota Colleagues in Caring
• Minnesota Department of Economic Security
• Minnesota Hospital Healthcare Partnership
• Office of Rural Health Primary Care, MDH

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What is Driving the Current (and Future) Shortage
of Workers?
Historical Trends
Strong Economic Growth High Levels of Workforce
Participation
Current Conditions
Tightening Labor Market Strong Demand for Workers

• Continued Economic Growth
• Slower Workforce Growth
• Strong Employment Growth

Future Forecast
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Why Is Minnesota Facing a Worker Shortage?
Historical Trends
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Historical Trends Why Is Minnesota Facing a
Worker Shortage?
Employment growth has outpaced workforce growth.
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Historical Trends Why Is Minnesota Facing a
Worker Shortage?
During the 1980s and 1990s, the health care
industry had above average job growth.
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Historical Trends Why Is Minnesota Facing a
Worker Shortage?
During the past two decades, workforce growth has
been dependent on increased workforce
participation.
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Historical Trends Why Is Minnesota Facing a
Worker Shortage?
Figure 4
Overall, the number of workers able to fill new
jobs has decreased since 1980.
Source Governors Workforce Development Plan
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Historical Trends Why Is Minnesota Facing a
Worker Shortage?
Is there a pool of workers currently not working
who could meet the current demands of Minnesotas
employers?
Older and younger workers are already working at
historically high levels. While the number of
migrants to our state has grown and remained
steady in the 1990s (10,000 migrants in 1997),
net migration may not be as strong in the future.
Immigrants? Older Workers? Younger Workers?
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What About The Current Situation?
Current Conditions
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Current Conditions The Supply of Health Care
Workers
Health Care Completers in Minnesota (1997)

• 36 colleges and universities in 48 cities
• 16 private colleges and universities
• 2 University of Minnesota campuses with health
  care fields

Source Minnesota Higher Education Services Office
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Current Conditions The Supply of Health Care
Workers
Health Care Completers by Type Career Path
(1997) (All nurses including advanced practice
included in nursing data primary care includes
medicine, dentistry, pharmacy allied health
includes over 100 occupations)
Source Minnesota Higher Education Services Office
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Current Conditions The Supply of Health Care
Workers
Recent Trends

• Overall decline in graduation rates in MN in
  health related programs.
• Increase in graduation rates in MN in health
  programs with advanced degrees Pharmacy, Nurse
  Practitioners, Family Physicians.
• Increase in percentage of women and minority
  students in pharmacy and medical educational
  programs.
• Admission slots per year Family Physicians -
  98, Nurse Practitioners 120, Physician
  Assistants 25, Pharmacy - 90, Registered Nurses
  - 1,671.

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Current Conditions A Strong Demand for Health
Care Workers
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Current Conditions A Strong Demand for Health
Care Workers

• The number of RN and LPN graduates from Minnesota
  schools may not be keeping pace with employers
  demand for workers.
• Minnesota RNs and LPNs have a high rate of
  part-time employment.
• Average Minnesota RN is 3 years older than
  national average.
• Rural RNs are older than urban RNs.

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What Does The Future Hold?
Future Forecast
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Future Forecast EMPLOYMENT

• An increase in total employment of 416,000 jobs.

Employment Projections 1996 to
2006 (Minnesota Department of Economic Security)

• Health care is expected be one of the
  fastest-growing major industries.

• Health care industry employment is projected to
  increase by 21, above the overall Minnesota
  average of 16.

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Future Forecast WORKFORCE

• A similar increase in the number of people age 16
  and older.

Workforce Projections 1996 to 2006 (State
Demographers Office, MN Planning )

• Not all of the potential workers will be added to
  the workforce. In fact only 294,000 new workers
  are projected to be added to the workforce.

• In other words, there will be about seven new
  workers for every 10 new jobs by 2006.

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Future Forecast WORKFORCE

• The states population is growing older.

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Future Forecast WORKFORCE
Growth in the working age population will slow.
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Future Forecast WORKFORCE
More elderly citizens will be supported by fewer
workers, especially outside of urban areas.
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What Do The Numbers Mean?
The aging of the population combined with the
current (and future) shortage of workers has a
number of implications

• As the labor market continues to tighten, the
  competition for qualified workers will heighten.

• Health care will increasingly compete with other
  industries for workers.

• As boomers retire, the demand for health care
  services will increase.

• The aging population and decline in working age
  population will be felt strongest in rural
  Minnesota. Consequently, the demand for health
  care services may become more acute in rural
  areas.

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Can We Resolve the Crisis?
Is demography destiny?
Can we change the future?
STATEWIDE POLICY RESEARCH ACTIVITES

• Office of Rural Health and Primary Care, MDH
• Minnesota Nurses Association
• Minnesota Department of Economic Security
• National Institute of Health Policy
• Healthcare Education-Industry Partnership, MnSCU

• Minnesota Hospital and Healthcare Partnership
• Colleagues in Caring
• Minnesota Center for Rural Health
• University of Minnesota
• Health plans and Health systems
• Long term care trade associations
• Others

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Current Statewide ActivitiesOffice of Rural
Health Primary Care

• Health professions loan forgiveness newly
  expanded state programs NHSC
• Health professions database maintains
  practice-related data on 11 professions.
• HPSA/MUA designation
• Health workforce analysis
• Policy development, planning in partnership with
  other workforce efforts

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Current Statewide ActivitiesMinnesota Nurses
Association

• Active nursing lobby at state legislature also
  represents organized nurses in contract
  negotiations
• This year, proposed new scholarship, grant and
  loan forgiveness programs, prohibition on
  mandatory overtime
• Convened Coalition to Retain Nurses in 1999
• Involved in policy development, planning in
  partnership with other workforce efforts

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Current Statewide Activities Minnesota
Department of Economic Security

• Conducts a multi-sector job vacancy survey twice
  a year
• Random sample of 8,800 employers in all regions
  of the state
• 65 response rate for fall 2000 survey
• The health care industry accounts for 20 of
  total job vacancies in Greater Minnesota.

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Current Statewide Activities National Institute
of Health Policy

• Partnership between U of Minnesota and U of St.
  Thomas (in St. Paul)
• Headed by former U.S. Senator Dave Durenberger
• Focusing on health system redesign as a key to
  resolving workforce problems
• Targets the year 2013

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Current Statewide ActivitiesHealthcare
Education-Industry Partnership

• Strategic initiatives
• Joint strategic planning with healthcare
  industry, higher education and state agencies
• Expanding capacity in higher education
• Emerging workers immigrants and refugees
• Core healthcare curriculum
• E-learning
• K-12

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Current Statewide ActivitiesColleagues in Caring

• Robert Wood Johnson Foundation national program
  around nursing workforce issues
• Improving the workplace environment
• Developing a policy framework for nursing issues
• Promoting nursing careers addressing educational
  capacity issues
• Bringing diverse nursing interests together
  collaboratively

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Current Statewide ActivitiesMN Hospital
Healthcare Partnership

• Established Workforce Task Force
  Recommendations
• Improve workforce data
• Legislative policies in partnership with HEIP and
  others
• Increase labor pool
• Cut red tape
• Connect with community
• Promote best practices

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Current Statewide ActivitiesMinnesota Center
for Rural Health

• Physician Placement and Retention Program
• Annual Minnesota Advanced Practice Nursing,
  Physician, and Physician Assistant Demand
  Assessment Survey
• Minnesota Practice Opportunities Directory
• Education and technical assistance for networks
  and regional groups addressing workforce issues

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Current Statewide ActivitiesRegional Healthcare
Workforce Groups

• Planning town meeting to have a public
  discussion with legislators on health care worker
  shortages
• Exploring recruitment of non-traditional students
  into healthcare careers
• Submitted grant to help hire a telecommunications
  coordinator for healthcare-education initiatives
• Formed videoconferencing taskforce to look at new
  applications of delivering healthcare education
  onsite

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Current Statewide ActivitiesRegional Healthcare
Workforce Groups

• Conducted regional labor workforce study
• Coordinated a conference Maximizing the
  Potential of the Aging Workforce in Healthcare
• Facilitating regional dialogue between
  educational institutions and healthcare providers
  on recruitment, continuing education, and types
  of vacancies
• Educating the public about the magnitude of
  worker shortages
• Advocating for healthcare workforce legislation

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Minnesota Health Professions Workforce Partnership
Healthcare Education-Industry Partnership,
MNSCU www.tip.mnscu.edu/healthcare_facts.htm Minn
esota Center for Rural Health www.ruralcenter.org/
mcrh Minnesota Colleagues in Caring www.mnnursing
.org Minnesota Department of Economic
Security www.MNWorkforceCenter.org Minnesota
Hospital Healthcare Partnership www.mhhp.com Of
fice of Rural Health Primary Care,
MDH www.health.state.mn.us/divs/chs/orh_home.htm
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Forum Objectives

• Present regional and statewide workforce data.
• Discuss regional issues and strategies.
• Provide regional networking.
• Identify regional responses to worker shortages.
• Gather information from various regions for Final
  Report and Statewide Forum (State Rural Health
  Conference) in 2001.
• Initiate policy recommendations.

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Regional Minnesota Health Professions Workforce
Forums
Forum Participation Bemidji
45 Biwabik 51 Brainerd
52 Fergus Falls 45
Hutchinson 70 Mankato
75 Marshall
22 Rochester 80 St. Cloud
68 Thief River Falls
43 Willmar 40
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Regional Workforce Strategies for Rural Minnesota
? Recruitment

• Improve the publics perception of health care
  work.
• Expand the presence of health care at career
  fairs, in K-12 curriculum, and in high school and
  college counseling.
• Network with other employers to find employment
  for spouse of health care worker.
• Explore ways of recruiting trained workers for
  second career in health care.

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Regional Workforce Strategies for Rural Minnesota
? Retention

• Provide a positive work environment, encourage
  team approach to health care delivery.
• Allow for greater use of flexible work hours.
• Mentor current staff about opportunities to move
  up the career ladder.
• Develop resources for supervisors working with a
  variety of ages, culture and ethnic groups.
• Gather information about why people leave health
  careers.

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Regional Workforce Strategies for Rural Minnesota
? Regulatory and Reimbursement Reform

• Remove regulatory obstacles and legal mandates
  that discourage additional family involvement in
  patient care.
• Equalize urban and rural reimbursement rates.
• Increase the level of reimbursement for
  facilities and service providers.
• Promote greater collaboration between providers
  and regulatory agencies to streamline reporting
  and improve compliance.

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Regional Workforce Strategies for Rural Minnesota
? Improve Wages and Employee Benefits

• Increase wages for health care worker, especially
  for those in long term care facilities.
• Reimburse employees for work related travel.
• Create comprehensive and flexible benefit
  packages that are competitive with non health
  care jobs.
• Explore creative staffing solutions that allow
  workers to balance family and work.

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Regional Workforce Strategies for Rural Minnesota
? Increase Educational Capacity

• Increase class sizes in health care programs.
• Offer distance learning and increased access to
  post secondary health care education.
• Increase the number of clinical sites and
  rotations in rural settings and expand MRHS.
• Incorporate school to work curriculum in K-12
  expand mentoring and job shadowing.
• Increase the number of rural loan forgiveness and
  scholarship programs available to health care
  students.

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Regional Workforce Strategies for Rural Minnesota
? Develop Regional Alliances

• Develop and retain a local workforce with a
  commitment to the community.
• Reduce the reliance on temporary agencies through
  the development of a employer-supported nursing
  pool.
• Encourage sharing of best practices between
  facilities.
• Cooperate in a regional marketing campaign to
  promote the value of health care to regional
  economic development and the growing elderly
  population.

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Regional Workforce Strategies for Rural Minnesota
? Increase Productivity and Efficiency

• Utilize staff more efficiently.
• Increase the use of technology to improve
  productivity (pagers, computers, monitoring
  devices).
• Expand the use of telecommunications for
  radiology and pharmacy.

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HEIP Policy Group

• HEIP convened a policy discussion with Mn.
  Hospital and Healthcare Partnership, Mn. Nurses
  Association, Colleagues in Caring, Mn. Dept. of
  Health, Mn. Dept. of Human Services, University
  of MN, Mn. State Colleges and Universities, and
  long term care, MCRH
• Purpose to create a consensus document
  outlining healthcare workforce policy initiatives
  in advance of the legislative session

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Policy Collaborative

• Created a grid to track legislation related to
  policy statement
• Met throughout session to track progress
• Will begin working immediately following session
  on issues unresolved
• Relating the regional forum strategies to the
  next legislative session

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Can We Resolve the Crisis?
POLICY RECOMMENDATIONS FOR THE HEALTHCARE
WORKFORCE ENDORSED BY MN Hospital and Healthcare
Partnership MN Nurses Association Healthcare
Education-Industry Partnership MN Colleagues in
Caring MN Center for Rural Health
1. To increase the capacity of the higher
educational system to produce more healthcare
professionals for the State of Minnesota.
2. Healthcare Workforce Data, Analysis and
Planning.
3. Improve K-12 Linkages to the Healthcare
Industry and to Post-Secondary Education.
4. Education and Training for the Emerging
Workforce.
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2001 Health Workforce Related Legislative Outcomes

• Loan forgiveness expansion for nurses in nursing
  homes new professions
• COLAs for nursing home workers
• Expansion of summer health care internship
  program
• Grants to encourage middle and high school
  students to work in health/long term care
  settings
• Other?

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Working Together To Resolve the Crisis

• Regional and local collaboration between
  educational institutions and employers.
• Partnerships within communities to address local
  needs.
• Support for collaborative, community-based
  solutions.
• Collection and analysis of statewide health care
  workforce data and issues.
• Further discussion of strategies and sharing of
  best practices.