Healthcare Workforce Trends in Minnesota

The Minnesota Hospital Association Board of Directors felt it was important to have current information about current and future workforce needs for the hospitals and healthcare systems across the state. The MHA has developed a workforce planning tool that is available for member organizations. This workforce planning information is available to all member organizations that participate in providing their workforce data into the tool each year. MHA also uses this valuable information to advocate on behalf of member organizations and advise and educate others about the Healthcare Workforce needs throughout the state.

Minnesota’s healthcare industry, in both the private and public sector, provided 13.4 percent of our state’s total employment. Labor market information indicates that from 2007-2009 general medical and surgical hospitals saw growth of 1.4 percent, and all other hospitals saw growth of 10.8 percent. Growth in the healthcare workforce is predicted by the Department of Employment and Economic Development (DEED), to increase across almost all occupations. Using these statistics, which are provided on the Minnesota Hospital Workforce website, individual facilities can project needed hires and benchmark their own data against the MHA member population as a whole, across 38 different job classifications (from Nursing Assistant to Specialty Physicians). The MHA WF Tool can provide statewide analysis or be as detailed as helping one hospital analyze its current workforce demographics and model projections of turnover and future hiring needs. For example, Registered Nurses are the largest group of health care providers in hospitals and hospital systems; using MHA workforce data we can scan the RN population and look at future and model various growth scenarios. Chart A below provides a scan of the present RN workforce data (as of January 2010) and gives a snap shot by facility type and age.

This snapshot based on the current downturn in the economy would seem to indicate that Minnesota’s healthcare facilities currently are not in imminent danger of losing all of their nurses this year. However, as the economy improves and as baby boomers who delayed retirement prepare to exit the workforce, this is expected to change as is the demand to hire additional RNs to fill vacancies from retirement and growth will likely outpace new graduates. Facilities can look at their own employees’ age and service profiles and get comparisons to the MHA benchmarks to assess their relative amount of risk compared to other MN health service providers.

Chart A January 2010 RN Age Distribution

1

As the baby boomer generation, those born between the years 1946-1964, currently the largest population in the workforce, begin to exit, several issues will need to be addressed. These employees will no longer be part of the labor force but as they age will be demanding more health care. The tool has the ability to drill down by job class which can guide an organization in forecasting future staffing needs critical to optimum health care services. See the summary of changing age makeup of the workforce below (Chart B&C).

Chart B Projected Age Distribution of RN’s

Chart C Projected Average Change in Age of RN’s

The MHA WF Tool also has projection capabilities. Table 1 below shows projections of the RN workforce, based on the assumption of 0% growth in workforce demand. Even given this conservative assumption, the projection is

2

that approximately 750-850 RN’s will need to be hired each year for the next 10 years. These new RN’s will be needed to replace those who have exited the workforce from retirement, death or disability. Projections like this can be done for each of the 38 job classes in the tool to assist in staff planning exercises.

Table 1 RN Source of Change in Supply

Projected Exits from MN RN Workforce

The tool is flexible enough to allow for changes to the baseline assumption of 0% demand growth (or any other assumption).. This allows user friendly modeling to see how an increase or decrease in projected headcount would change the need to hire or reduce staffing levels. The Department of Employment and Economic Development projects a statewide increase in employment of RN’s by approximately 23.8% over the next 10 years (DEED). To compensate healthcare employers would have to increase hiring rates each year for the next ten years. Users can change the headcount assumption in the tool to represent this growth. Table 2 below shows the new projected numbers based on this 23.8% growth assumption. This would have a profound effect on the need for additional RN graduates in the coming years. Also, having this many new employees in the workforce would put additional demands on clinical rotation spaces and the need to hire and onboard new staff. Effective strategies linked to employee retention and engagement will positively impact the present and future state of health care facilities. See

3

the MHA Retention Tool Kit (http://www.mnhospitals.org/inc/data/pdfs/employee-retention-booklet.pdf) for ideas and resources facilities can use.

Table 2 RN Dashboard Increased Headcount Growth

For most patient care job (see appendix with list of current included job classes), the tool can provide a projection of the workforce mix over the next ten years. In Table 3 below, the assumption of 0% growth was changed to reflect projected growth values taken from a report Simply Minnesota. The following Table indicates growth for all of MHA members who submitted data this year, but these assumptions can be increased or decreased for each individual facility or business unit. Looking to the future and the projected growth can help guide action planning so that potential human capital/workforce solutions can be proactively designed, instead of reacting to shortages. Employee retention, knowledge retention, employee development programs and/or alternative sourcing methods can be researched based on organizational data and projections in order to close expected gaps.Table 3 Dashboard for all Job Classes with Projected Headcount Growth

4

The turnover risk zone category, “employees with less than five years of service”, is an important element in predicting potential turnover. Turnover costs can significantly impact the financial health of an organization. Costs for the recruitment, selection and training of new employees can be magnified when these same functions need to be repeated due to turnover. Indirectly, increased workload for existing employees, overtime costs, decreased productivity, and employee morale can potentially adversely affect the organization. Projection of our future workforce shows an increase of employees at the front end of the distribution/years of service. In conjunction with the number of baby boomers exiting the workforce this information is critical to identifying gaps where there could be undesired turnover or larger than expected number of retirements. The tool also has the ability to split statistical data by region, metro versus non-metro, allowing facilities to benchmark their data on the surrounding region in question.

The workforce tool can drill down into the data and segregate one group of employees, for example physician group. The nation is expected to experience a physician shortage that could negatively impact access and quality of care. That coupled with an aging population will very likely change healthcare practice and utilization patterns. An aging population may result in a need for more primary care doctors and/or increase need for specialties such as oncology or geriatrics. The tool provides users with the ability to scan their present workforce and change assumption patterns based on present supply and future demand. A scan of physicians for 2009, split by job category, indicates that the largest percentages of physicians throughout the next ten years are between the ages of 25-34. Taking into consideration that medical training takes at least seven years to complete, an assumption can be made, that there is a high percentage of this age group who also have less than three years of service (a period of time with high turnover). The second diagram scans the distribution of physicians by service and job class (Chart E). This provides users with a snap shot of where their physician workforce is presently concentrated. Taking into consideration the changes in the future of healthcare, strategic initiatives can help fill specialty workforce gaps.

5

Chart D Scan of Physician Headcount by Job Class Split by Age

Chart E Scan of Physician Headcount by Job Class Split Years of Service

Digging a bit deeper, the tool can pull data for just one specialty group, primary care physicians. Rural Minnesota is going to be more adversely affected by the physician shortage, although across the board a shortage of primary care physicians is being experienced. The tool forecasts that almost one third of primary care physicians will have worked less than two years in this discipline (Chart F). Educational and health care facilities can use this information in determining incentives and programs linked to increasing primary care physician numbers, ensuring Minnesotans continue to have access to quality health care. Users can also scan the present and projected

6

Nurse Practitioner and/or Physician Assistants’ headcount, and/or other positions that play a major role in patient care.

Chart F Projection of Primary Care Physicians Split by Service

Using the tool, employers can also look at projected retirement when examining turnover possibilities (Chart G). Based on historical data, the rate at which employees in these age groups retire increases from 5% at age 55-59 to 80% at age 65. The tool allows users to look at their present supply of employees/physicians and change retirement assumptions based on internal retirement information; physician age, gender and personal retirement age preference. These changes in projected supply and demand can aide HR in shifting recruitment efforts.

Chart G Primary Care Physicians at Risk of Retirement

Projections from the workforce tool can also significantly affect the need for quality retention programs and will have a dramatic impact on the healthcare workforce as baby boomers exit. For example, there are a large number

7

of physicians expected to exit the workforce within the next ten years. A potential physician shortage will require health care providers, educational institutions and the state to look for potential solutions. A scan of the projected statistics can guide hiring efforts, and alert our education system to the need for increased availability of slots in medical doctor, nurse practitioner, physician’s assistant and other allied health professionals.

The following diagram (Chart H) is a scan of the present physician, nurse practitioner and physician assistant supplies broken down by region (metro versus non metro) and benchmarked against all MHA member data. Using the Workforce tool, MHA can examine headcount or FTE’s by job types and by region which allows us to view the supply of specific health care providers and get a handle on issues such as maldistribution. This can determine recruitment efforts for medical education organizations focusing on the need for health care workers in rural MN.

Chart H Scan of Physician, Physicians Assistant and Nurse Practitioner Headcount

Table 3 provides organizations with a snap shot of the current and projected percentage of physician (broken down by specialty) at risk of turnover due to low service and retirement. Understanding turnover risk zone patterns allows users to define strategies that will fill workforce vacancies. For example, if hospitals who serve a disproportionate share of the older population have a high percent of potential retirees, strategies will need to be designed to maintain healthcare professionals who care for this specific age group. MHA can also advocate for additional capacity in the education system for more Medical Education graduates.

Table 3 Retirement/New Entrant Risk Zone Matrix

8

The workforce projection tool is also set up to be able to identify the source of change in supply of our health care employees. Using this information, facilities or business units can identify factors in which they have control over, anticipate future needs, and assess strengths and weaknesses of their present retention programs. This will aide in designing programs geared towards making the necessary changes in reducing turnover which will assist in better managing their workforce.

Table 4 Source of Change in Supply

The MHA has collected over 53,000 data points this year across 38 job classes, valuable demographic information and financial statistics. Although the workforce tool isn’t a salary survey, it can be used to benchmark facility pay rates to MHA’s member population. Labor costs, pay distribution and all other key demographic edits can be benchmarked to all MHA member facilities and/or filtered to include metro versus non metro statistics.

9

Table 5 Demographic Mix of all 38 Job Classes

10

Appendix

MHA Workforce Assessment Tool Job Types

1) RN-Emergency Room: this group includes emergency nursing care for a diversified population of all age distributions and all problem types. Includes assessment, care planning, interventions, and teaching. Responsible for performing duties in accordance with all policy, procedure, and professional practice guidelines. This RN coordinates care with other members of the health care team and delegates responsibilities to others as appropriate.

2) RN Operating Room: this group includes the Operating Room RN who is responsible for the assessment, planning, delivery, and evaluation of nursing care intraoperatively for the patient undergoing surgical procedures in the operating room. Responsible for performing duties in accordance with all policy, procedure, and professional practice guidelines. This RN coordinates care with other members of the health care team and delegates responsibilities to others as appropriate during the patient’s surgical experience.

3) RN-Peri-Operative (Perianesthesia): this group includes the perianesthesia RN who is responsible for the assessment, planning, delivery, and evaluation of nursing care by preparing the patient for surgery in the pre-op area, and, caring for the patient recovering from anesthesia in the PACU. Responsible for performing duties in accordance with all policy, procedure, and professional practice guidelines. This RN coordinates care with other members of the health care team and delegates responsibilities to others as appropriate immediately before and immediately after the patient’s surgical experience.

4) RN-Labor & Delivery: this group includes, RNs responsible for assessment, planning, delivery and evaluation of care to patients in Labor and Delivery and postpartum care to mom and baby. Responsible for performing duties in accordance with all policy, procedure, and professional practice guidelines. This RN coordinates care with other members of the health care team and delegates responsibilities to others as appropriate.

5) RN-Med/Surg: this group includes, an RN who is responsible for the assessment, planning, delivery, and evaluation of nursing care for all assigned patient populations. Responsible for performing duties in accordance with all policy, procedure, and professional practice guidelines. The RN coordinates care with other members of the health care team and delegates responsibilities to others as appropriate.

6) RN-ICU: this group includes an RN who is responsible for the assessment, planning, delivery, and evaluation of nursing care for all assigned patient populations in the ICU (NICU, PICU, Tele, Critical Care, etc.). Responsible for performing duties in accordance with all policy, procedure, and professional practice guidelines. This RN coordinates care with other members of the health care team and delegates responsibilities to others as appropriate.

7) RN-Pediatrics this group includes, an RN who is responsible for assessment, planning, delivery, and evaluation of nursing care for all pediatric populations. Responsible for performing duties in accordance with all policy, procedure, and professional practice guidelines. Coordinates care with other members of health care team and delegates responsibilities to others as appropriate.

8) RN-Clinic this group includes, an RN who performs both independent nursing and delegated medical functions. The independent nursing function includes assessment, planning, delivery, and evaluation of nursing care for assigned patient population(s). The delegated medical function includes participation in and coordination of delegated patient care to other health care team members.

11

9) RN-Home Health: this group includes, the Home Health RN and the Home Health Specialist RN Case Manager position and is responsible for coordinating the delivery of all care/services appropriate to the needs of the patients of all ages and their families. Complete a thorough physical and psychosocial assessment of the patient and identifies effective interventions with the patient, family under the direction of physician to address the specific care goals. Maintains complete and timely records, verify authorizations. Provide clinical supervision as appropriate.

10) RN-Rehabilitation: this group includes, an RN who is responsible for the assessment, planning, delivery and evaluation of nursing care for all assigned patients. The RN is responsible in accordance with all policy, procedure and professional practice guidelines. Coordinates care with the interdisciplinary team through strong communication and documentation skills.

11) RN-Behavioral: this group includes, RNs who are on In-patient Adult Mental Health units (Chem Dep, mental health, eating disorders/additions, etc.), responsible for assessment, planning, delivery and evaluation of assigned population. Responsible for performing duties in accordance with all policy, procedure, and professional practice guidelines. The RN coordinates care with other members of the health care team and delegates responsibilities to others as appropriate.

12) RN-Specialty: group includes, RNs who are responsible for providing acute and rehab care for people with select disorders of the gastro-intestinal, genitourinary and integumentary systems (includes Bone Marrow, Vascular, Wound, Diabetes/Chronic Care, etc.) this. Provides direct patient care to persons with abdominal stomas, wounds, fistulas, drains, pressure ulcers, incontinence and similar conditions.

13) RN-Other (Patient care that does not fit into other categories): this group includes, any staff RN position not specifically listed previously. You can use this category as a general RN category for any RN position that does not fit other categories. If your organization does not intend to do planning by specific RN subspecialty, you can report all your RN employees under this one general category.

14) Advanced Practice Nurses: this group includes all Midwives, and other Certified Nurse Specialists-CNS: Midwife: The Certified Nurse Midwife is a member of the healthcare team who works in the

independent management of women’s health care, focusing particularly on pregnancy, childbirth, the postpartum period, care of the newborn, and the family planning and gynecological needs of women. The Certified Nurse Midwife practices within the health care system that provides for consultation, collaborative management or referral as indicated by the health status of the client. Certified Nurse Midwives practice in accord with the Standards of the Practice of Nurse Midwifery, as defined by the American College of Nurse Midwives.

CNS: This individual is required to have expertise in the care of a specific population of patients or in a specialized function. This individual provides direct services to patient/families/clients and consultation and education to staff and other health care professionals. This individual establishes and monitors standards of care related to a specialty area and participates in research and other scholarly activities. This individual provides leadership in creating and promoting an environment of evidence-based practice and interdisciplinary care delivery.

15) CRNA: Certified Registered Nurse Anesthetists (CRNAs) are advanced practice registered nurses with specialized graduate level education, training, and certification in anesthesiology. The CRNA must choose the appropriate mode of anesthesia for the needs of the patient. They also oversee line operations of the anesthesia department and direct the supervision of the support staff. The CRNAs work very independently while collaborating with Anesthesiologists and Surgeons.

12

16) Nurse Practitioner: this group includes, a Nurse Practitioner who is a member of the health care team who works in collaboration with physicians and other medical staff to provide comprehensive health care to patients. The NP will obtain patient histories, perform physical and psychological health assessments, provide patient and family education and counseling, ensure continuity of health care services, and manage acute and chronic disease conditions.

17) Nursing Leadership: The nursing leader group includes “Exempt Supervisory” personnel, such as: Director of Nursing, Chief Nursing Officers, Nurse Managers or other similar “Exempt” supervisory titles. A person in this role plans, directs, controls, coordinates and evaluates patient care activities of the unit. Includes responsibility for nursing human resource management, quality assurance, regulatory compliance, educational opportunities, and financial management functions. Serves as a leader and role model to all staff. Maintains clinical competencies of staff.

18) Lab Technician: this group includes lab positions that do not require the four-year BA/BS degrees in lab technology or clinical lab sciences. The 2-yr MLT/CLT) performs waived, moderate, or high complexity testing as defined by CLIA' 88. The MLT/CLT possesses working knowledge of the clinical laboratory and performs routine clinical laboratory analyses, recognizes problems, identifies basic causes, and makes corrections using established protocols. The MLT/CLT works independently under general supervision.

19) Lab Technologist: this group includes positions requiring 4 or 5-yr Bachelor level degrees such as CLS/MT. The Lab Technologist performs a wide variety of complex diagnostic and therapeutic tests on a 24-hour rotation basis in the disciplines of chemistry, microbiology, blood banking, hematology, urinalysis, coagulation, and serology. Demonstrates self-direction, critical thinking, and customer service skills. Other duties include training and mentoring new staff/students and working closely with patient care staff.

20) Imaging-Tech: this group includes (Rad Tech, CT, MRI); these are Imaging Technologist positions that provide services to patients and physicians through the creation of various diagnostic images appropriate to the age of the patient. Provides preliminary report to the radiologist. This group does not include technologists who primary provide ultrasound services.

21) Imaging-Ultrasound: this group includes, technologists who perform ultrasound procedures in the Imaging Department producing quality images, maintaining appropriate patient care and communication with all members of the patient care team, ensuring integrity of patient data, correctly operation equipment and participation as a team member. Provides preliminary report to the radiologist.

22) Speech Therapist: this group includes therapists responsible for providing speech, language, communication evaluation and treatment to the patient population.

23) Physical Therapist: this group includes, any physical therapist who is responsible for evaluating and reassessing patient condition, determining physical therapy diagnosis and prognosis for recovery, establishing goals with patient and caregiver and implementing and/or modifying plan of care based on reassessment and patient response. Coordinates care and communicate effectively with interdisciplinary team to achieve desired outcomes.

24) Physical Therapy Assistant: The Physical Therapy Assistant provides safe and effective physical therapy care to patients, per their plan of care, under the supervision of a Physical Therapist and in collaboration with other members of the healthcare team. The Physical Therapy Assistant is responsible for performing these responsibilities in accordance with all policy, procedure and practice guidelines.

25) Certified Athletic Trainer: The Athletic Trainer specializes in the prevention, assessment, treatment, and rehabilitation of musculoskeletal injuries. The Athletic Trainer works with athletes and non-athletes. The work

13

setting can be a health care clinic; or a high school, college or professional sports team setting. The Athletic Trainer works under the direction of a physician and in collaboration with other healthcare professionals, coaches, athletes, etc.

26) Occupational Therapist: this group includes, the therapist responsible for providing quality patient interventions including assessment, interpreting, planning, and implementing therapy treatments for people with multiple sclerosis and other neurological disorders.

27) Respiratory Therapist: this group includes, the therapist who provides routine respiratory therapy modalities (including oxygen therapy, aerosol therapy, percussion and postural drainage, CPAP, BiPAP, etc.), ventilator care, EKGs and arterial blood gas punctures (ABGs).

28) LPN: The LPN performs delegated nursing and medical functions of data collection and delivery of care to an assigned group of patients, or an individual patient. The LPN works under the direction of a Registered Nurse, or physician/authorized practitioner and in collaboration with other members of the healthcare team.

29) Medical Assistant: The Medical Assistant performs delegated medical functions under the direction of a physician in the delivery of care for all assigned patient populations. The MA is responsible for performing these responsibilities in accordance with all policy, procedure and practice guidelines.

30) Pharmacist: this group includes the Pharmacist positions responsible for clinical services, drug information, medication safety, financial and formulary initiatives, medication use evaluations, education/development of staff, students and residents; and other duties as assigned by a manager.

31) Physician Assistant: this group includes, Physician Assistants who are a member of the health care team who works with the supervision of licensed physicians to provide comprehensive health care services to patients. The Physician Assistant engages in independent decision making about health care needs and provides health care services to individuals throughout their life span. The Physician Assistant provides physical and psychological health assessments, patient education and counseling, orders and interprets diagnostic procedures, and manages chronic disease conditions ensuring continuity of care for individuals in the communities served. Physician Assistants also perform minor surgical procedures within their scope and realm of their practice agreement with their supervising physician.

32) Physician-Primary Care: this group includes various primary care physicians (Family Practice, Pediatricians, Internal Medicine, OB/GYN, Urgent Care, Hospitalists) who are a member of the health care team and work in collaboration with other staff to provide comprehensive health care services to patients. The scope of practice of each physician is defined based on the training of the physician and approved through Credentialing and Privileging Committees. The role of a clinic physician is to assess, maintain, and improve the individual and collective health status of individuals in the communities served. This group also includes any hospitalist who is a member of the health care team who works in collaboration with other staff to provide comprehensive health care services to patients during the stay in the hospital.

33) Physician – Surgical Specialty Care: this group includes any of a number of surgical physician specialists (General Surgeons, Orthopedists, Neurosurgeons, Thoracic Surgeons, etc.) who are members of the health care team who work in collaboration with primary care physicians and other staff to provide surgical treatment health care services to patients. The scope of practice of each physician is defined based on the training of the physician and approved through Credentialing and Privileging Committees. The role of the surgical physician specialist is to provide consultation and manage the care of the patient within the scope of their expertise.

34) Physician- Medical Specialty Care: this group includes any of a number of medical physician specialists (Dermatology, Infectious Disease, Neurology, Cardiology, etc.) who are members of the health care team who

14

work in collaboration with primary care physicians and other staff to provide specialized health care services to patients. The scope of practice of each physician is defined based on the training of the physician and approved through Credentialing and Privileging Committees. The role of the medical specialty physician specialist is to provide consultation and manage the care of the patient within the scope of their expertise.

35) Physician- Procedural Specialty Care: this group includes any of a number of physician specialists (Interventional Radiologist, Interventional Cardiology, etc.) who are members of the health care team who work in collaboration with primary care physicians and other staff to provide specialized health care services to patients. The scope of practice of each physician is defined based on the training of the physician and approved through Credentialing and Privileging Committees. The role of the procedural physician specialist is to provide consultation and manage the care of the patient within the scope of their expertise.

36) Pharmacy Technician: this group includes those employees who assist Pharmacists in serving patients and in maintaining medication and inventory control systems. Under the general supervision of the Director and other Pharmacists, the Pharmacy Technician performs various distributive and clerical functions associated with the dispensing, delivery, and charging of medications and IV fluids.

37) Surgical Technician: this group includes employees who assist in surgical operations under the supervision of surgeons, registered nurses or other surgical personnel. Primarily responsible for preparing the operating room: setting up the equipment and sterilizing tools that are necessary for the operation. Also responsible for making sure all equipment is working properly which may involve assembly of some materials. The Surgical Technician also prepares the patient for surgery by washing, shaving and disinfecting areas for operation. In some instances they may also transport patient, observe vital signs, check charts and assist the surgical team in dressing for the surgery. During surgery, a surgical technologist or operating room technician passes instruments and other supplies to surgeons and surgeon assistants.

38) Paramedic/EMT: this group functions as a primary care provider in the pre-hospital setting. The EMT is responsible for all aspects of care provided to the sick and injured. They provide basic life support (EMT), or both basic and advanced life support (Para) including patient assessment, invasive airway management, use of the automatic defibrillator, cardiac monitoring and administration of medications. The paramedic is frequently in a leadership role working with a small team of lesser-trained prehospital care providers. The paramedic is responsible for verbal communication with the patient, other prehospital providers and hospital personnel, including physician medical directors. The paramedic completes extensive written documentation on patient condition and treatment provided, and must understand all applicable legal, moral and ethical issues surrounding emergency medical service. The EMT will work under the direction of a Paramedic and assume a support role.

15