leveraging data to make better decisions - an overview of databases webinar series webinar 4:...

Leveraging Data to Make Better Decisions - An Overview of Databases

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Webinar 4:Development of a New Graduate Nurse

Employment Database

Andrea Baumann RN, PhD

Mary Crea-Arsenio MSc.

Nursing Health Services Research Unit (NHSRU)

McMaster University


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Date: Monday January 21, 2013Time: Noon- 1:00PM (EST)


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Big Picture Thinking...

Potential for long-term context Think carefully about the development of

survey even if it is for one study (e.g. Master’s thesis)

If possible, collect data over time


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Benefits of Longitudinal Research

One-time versus annual survey– Cross-sectional study provides snapshot at one

point in time – Longitudinal surveying allows for tracking

individuals over time; change, context and trends


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Issues of Longitudinal Surveys

Survey development – establish reliability and validity – issues of comparability over time – responding to changing context– how much to change survey and re-testing


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Sources of Data for HHR* Planning

Workforce trends – historical and current employment, sector and practice

Workforce profile – demographic, education

Transition into the workforce– orientation/mentorship

Workforce stability – retention/turnover

5* Health Human Resources (HHR)


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Databases for Decisions

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PRIMARY SECONDARY

New Graduate Nurse Employment

College of Nurses Of Ontario

(CNO)

Ministry of Health and Long-Term Care (i)Health Data Branch

(ii) Health Professions Database

Healthcare Employers

Canadian Institute for Health Information

(CIHI)


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Why study nurse employment?


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A Focus for Policy

Largest health care workforce There were 150,149* nurses in 2011 Changing population needs (e.g. aging

population) Global nursing shortages Technological changes

*Source: College of Nurses of Ontario (CNO) 2011


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Historical Context

Fiscal constraints: Ontario health-care restructuring in the 1990s

Organizations reduced full-time nursing positions; hired part-time and casual positions

Result: – Loss of nurses from the workforce – Casualization nursing workforce

Source: Alameddine et al., (2006)


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A Call for Change: Policy-setting Required to collect statistics to provide

information to government Ontario Nursing Task Force (1998) Impact of SARs (2003): Walker report Variety of government committees and

presentations

Source: MOHLTC, 1999.


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Impact of Casualization

Source: CNO, 2010.

College of Nurses of Ontario: Renewal Counts for Registered Nurses, 1995-2012

19941995

19961997

19981999

20002001

20022003

20042005

20062007

20082009

20102011

201275,000

80,000

85,000

90,000

95,000

100,000

105,000

110,000

115,000

Total Workforce Employed in Nursing

Year

Cou

nt

Casualization


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Impact of Casualization on New Graduate Nurse Employment

Early indication that new graduates were least likely to obtain full-time work

There was a need to study new graduates

Source: Baumann et al. (2006). Educated and Underemployed


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Generating the Evidence Survey developed in 2004

– at graduation and six months post-graduation

First wave of data collection (2004) included new graduate RNs

Wave 2 (2005): new graduate RPNs included



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Evidence for Policy Data collected presented to the Ministry of Health

and Long-Term Care (MOHLTC) One-third (35%) of 2005 new graduates employed

full-time Policy Recommendation:

− Target investment toward increasing full-time opportunities for new graduates



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Evidence Informed Decision-Making

15Source: MOHLTC 1999, 2004, 2006, 2007.Source for photo: http://www.votethomson.ca/Document/168

Nursing Enhancement Fund

70% Full-Time Commitment

New Graduate Initiative

Nursing Graduate Guarantee (NGG)

1999 2005 2007-20122004-2006


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Nursing Graduate Guarantee 2007-2012

Policy initiative launched in 2007 Incentive funding for employers

– hire new graduate nurses

– temporary full-time supernumerary positions

– six months Evaluated annually

16Source: Ministry of Health and Long-Term Care (2011). Guidelines for participation in the Nursing Graduate Guarantee.


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Policy Evaluation

Trend study* design New graduate nurses grouped into annual cohorts and

employment status compared over time New graduate survey data validated with CNO new

member employment data

* Trend studies are a type of longitudinal research that focuses on a particular population (e.g., new graduate nurses) sampled repeatedly (Cohen, Manion, and Morrison 2000).


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Methodology

Real-time data collection– New graduate nurse employment survey was

adapted to include questions about the NGG– Revised survey was re-tested in 2007

Secondary database – CNO new members employment data*

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*early survey findings are validated with CNO new member employment data


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New Graduate Nurse Data Elements Demographic data:

– Age, sex, employment status, type of employer, position in nursing, primary area of practice, and practice location (geographic region).

Preferences data:– employment status (FT/PT/casual) – sector of employment (hospital/long-term

care/community/other) – geographical location (urban/rural)


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CNO Administrative Database

Administrative database is an annual mandatory census (total population of nurses in Ontario).

New graduates included as new members. New members are nurses who have registered with

the CNO in a given year and renew their membership for the first time


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CNO Administrative Database: Variables of Interest

Nurse category – Category of nursing registration (RN/RPN).

Location of initial nursing education – Country or province in which the nurse’s initial nursing education was obtained.

Employment status –FT/PT/casual

Sector of employment –hospital, long-term care, community and other.


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New Graduate Data Just-in-time data Data are leading Used to advise decision-

makers on effectiveness of policy

Sample (30%) representative of population

CNO Data Database composed of

total population of new graduate nurses employed in nursing

Data are lagging Historical data available

for trending

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Sample Data Validation

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Age

NG Survey

N=715CNO New Members

N=2800 Chi-square18-24 361 51% 1495 53%

χ2=4.037 p=0.4010

25-29 180 25% 725 26%30-34 63 9% 232 8%35-39 56 8% 182 7%

>40 51 7% 166 6%

Total 711 100% 2800 100%Gender

Female 653 92% 2565 92%

χ2=0.00600 p=.9383

Male 57 8% 235 8%

Total 710 100% 2800 100%

Source: Baumann et al., 2009; CNO, 2008 *significant at p< .05

Comparison of Demographic Variables of RN New Graduate Survey Respondents and CNO General Class RN New Members, 2008


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Sample Data Validation

24Source: Baumann et al., 2008; CNO, 2007 *significant at p<.05

18-24* 25-29 30-34 35-39 >400%

10%

20%

30%

40%

50%

60%

NG SurveyCNO New Members

Age

Per

cen

tage

Comparison of age categories RN New graduate Survey Respondents and CNO New Member RNs, 2007


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Key Issues in Data Integration

Timing− data collection− length of time to integrate, link and validate− report publication/data access

Lack of standardization Data quality

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Full-time Employment of New Member RNs by Location of Nursing Education

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1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100%

10%

20%

30%

40%

50%

60%

70%

80%

90%

ONIENOther Cdn

Year of first renewal

Per

cen

tage

Note. Year of first renewal reflects new graduates of previous year (e.g. new graduates in 2009 are included in first renewal for 2010.Source: CNO, unpublished data, 2012

First cohort of NGGs


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Features of Database Standardized Aligned with secondary databases Annual reports generated (employment and

preferences)


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Types of Analysis

Develop indicators (e.g. full-time employment rate)

Trend analysis of preferences over 8 cohorts of new graduates

Trend analysis of employment across 8 cohorts of new graduates


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Points to consider View survey in context of the field of study

If there is an opportunity, collect data over time

Establish validity and reliability; re-establish based on changes over time

Linking of databases enhance data quality Multiple sources of data for decision-makers

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ReferencesBaumann, A. Hunsberger, M & Crea-Arsenio, M (2012). Impact of Public

Policy on Nursing Employment: Providing the Evidence. Canadian Public Policy.

Baumann, A., Hunsberger, M., & Crea-Arsenio, M. (2011). Workforce Integration of New Graduate Nurses: Evaluation of a Health Human Resource Employment Policy. Healthcare Policy. Vol 7(2), 47-59.

Baumann, A. Hunsberger, M & Crea-Arsenio, M (2012). Full-Time Work for Nurses: Employers' Perspectives Journal of Nursing Management.

Baumann, Blythe, J., Cleverley, K., &Grinspun, G. (2006, May). Health Human Resource Series Number 2. Educated and underemployed: The paradox for nursing graduands. Hamilton, Ontario: Nursing Health Services Research Unit, McMaster University.

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Contact Information

Andrea Baumann, PhD

Scientific Director Nursing Health Services Research Unit

McMaster University

Michael DeGroote Centre for LearningMDCL 3500

(905) 525-9140 ext. [email protected]

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leveraging data to make better decisions - an overview of databases webinar series webinar 4:...

Documents

better decisions

sources of data

time change

time longitudinal surveying

ontariocnoministry of

health informationcihi

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ft employment