nursing workforce planning mariel s. lavieri sandra regan martin l. puterman pamela a. ratner
TRANSCRIPT
Nursing Workforce PlanningNursing Workforce Planning
Mariel S. LavieriMariel S. Lavieri
Sandra ReganSandra Regan
Martin L. Puterman Martin L. Puterman
Pamela A. RatnerPamela A. Ratner
OutlineOutline
ModelDescription
Model Model InputsInputs FormulationFormulation OutputsOutputs
Introduction
BackgroundBackground Our ApproachOur Approach Model OverviewModel Overview
Final Remarks
BackgroundBackground Workforce planning, training and regulation is thethe
dominant immediate and long term issue for policy makers, managers, and clinical organizations.
Listening for Direction: A national consultation on health services and policy issues
Registered nurses account for just over one-third of the health workforce.
Today’s decision have long term implications. Decisions in the 1990’s:
decrease education seats, increase casualization of the workforce decrease nurse leadership
In 2001, the CNA president noted “Canada should be graduating about 10,000 nurses annually to replenish the workforce in the next 10 years”.
B.C. RNs Employed in Nursing by Age (2001-2005)
0
1000
2000
3000
4000
5000
6000
<25 25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65+
Age groups
Nu
mb
er
of
RN
s
2001
Source: Canadian Institute for Health Information. (2006). Workforce Trends of Registered Nurses in Canada, 2005.
BackgroundBackground
B.C. RNs Employed in Nursing by Age (2001-2005)
0
1000
2000
3000
4000
5000
6000
<25 25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65+
Age groups
Nu
mb
er
of
RN
s
2002
Source: Canadian Institute for Health Information. (2006). Workforce Trends of Registered Nurses in Canada, 2005.
BackgroundBackground
B.C. RNs Employed in Nursing by Age (2001-2005)
0
1000
2000
3000
4000
5000
6000
<25 25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65+
Age groups
Nu
mb
er
of
RN
s
2003
Source: Canadian Institute for Health Information. (2006). Workforce Trends of Registered Nurses in Canada, 2005.
BackgroundBackground
B.C. RNs Employed in Nursing by Age (2001-2005)
0
1000
2000
3000
4000
5000
6000
<25 25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65+
Age groups
Nu
mb
er
of
RN
s
2004
Source: Canadian Institute for Health Information. (2006). Workforce Trends of Registered Nurses in Canada, 2005.
BackgroundBackground
B.C. RNs Employed in Nursing by Age (2001-2005)
0
1000
2000
3000
4000
5000
6000
<25 25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65+
Age groups
Nu
mb
er
of
RN
s
2005
Source: Canadian Institute for Health Information. (2006). Workforce Trends of Registered Nurses in Canada, 2005.
BackgroundBackground w
B.C. RNs Employed in Nursing by Age (2001-2005)
0
1000
2000
3000
4000
5000
6000
<25 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+
Age groups
Nu
mb
er o
f R
Ns
2001
2002
2003
2004
2005
Source: Canadian Institute for Health Information. (2006). Workforce Trends of Registered Nurses in Canada, 2005.
BackgroundBackground
Supply and Demand Balance (or Imbalance)Supply and Demand Balance (or Imbalance)
Estimating Requirements Estimating Requirements of Providersof Providers
Utilization-based Current utilization patterns
Needs-based Population-health needs
Effective demand-based Economic constraints
Planners NeedPlanners Need
PrecisePrecise short and long term plans that provide: Nursing education seats The number of nurses to recruit and at what level The number of nurses and managers to promote
Models: Inputs and assumptions can be varied and implications seen
Flexible unifiedunified frameworks that apply to any workforce: Regional Provincial National Sub-specialty
Our ApproachOur Approach
A flexible computer-basedcomputer-based optimization model that provides a minimum cost human resource planhuman resource plan subject to workforce targets and high qualityquality service delivery standards.
A Sample Plan A Sample Plan
Model OverviewModel Overview
Assumptions: Attrition rates Nurse/Pop. Costs
Run model: Minimum cost plan
Data: Nurse workforce size
Student body
Population projection
2003 RN Population
0
1000
2000
3000
4000
5000
6000
<25 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 >=65
Age
Pop
ulat
ion
Age distribution of student body
0
50
100
150
200
250
300
350
15
18
21
24
27
30
33
36
39
42
45
48
51
54
57
60
63
Age
Nu
mb
er
of s
tud
en
ts
Student(year 2) Student(year 3) Student(year 4)
BC Population projection
0.00
1,000.00
2,000.00
3,000.00
4,000.00
5,000.00
6,000.00
20
04
20
06
20
08
20
10
20
12
20
14
20
16
20
18
20
20
20
22
20
24
20
26
Year
Po
pu
latio
n
Outputs: Optimum costs
Yearly student population
Yearly workforce size
Practicing nurse population
05000
10000150002000025000300003500040000
2006
2008
2010
2012
2014
2016
2018
2020
Year
Wo
rkfo
rce
po
pu
latio
n Total practicingnurses
New immigrantpracticingnurses
Total Cost
$1,694,786,393 4%
$1,665,612,117 4%
$40,138,704,506
92%
Cost of training
Immigration cost
Annual salary
Yearly total student population
0
500
1000
1500
2000
2500
3000
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Year
Stu
de
nt p
op
ula
tion
Student(year 1)
Student(year 2)
Student(year 3)
Student(year 4)
Model OverviewModel Overview
Assumptions: Attrition rates Nurse/Pop. Costs
Run model: Minimum cost plan
Data: Nurse workforce size
Student body
Population projection
2003 RN Population
0
1000
2000
3000
4000
5000
6000
<25 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 >=65
Age
Pop
ulat
ion
Age distribution of student body
0
50
100
150
200
250
300
350
15
18
21
24
27
30
33
36
39
42
45
48
51
54
57
60
63
Age
Nu
mb
er
of s
tud
en
ts
Student(year 2) Student(year 3) Student(year 4)
BC Population projection
0.00
1,000.00
2,000.00
3,000.00
4,000.00
5,000.00
6,000.00
20
04
20
06
20
08
20
10
20
12
20
14
20
16
20
18
20
20
20
22
20
24
20
26
Year
Po
pu
latio
n
Outputs: Optimum costs
Yearly student population
Yearly workforce size
Practicing nurse population
05000
10000150002000025000300003500040000
2006
2008
2010
2012
2014
2016
2018
2020
Year
Wo
rkfo
rce
po
pu
latio
n Total practicingnurses
New immigrantpracticingnurses
Total Cost
$1,694,786,393 4%
$1,665,612,117 4%
$40,138,704,506
92%
Cost of training
Immigration cost
Annual salary
Yearly total student population
0
500
1000
1500
2000
2500
3000
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Year
Stu
de
nt p
op
ula
tion
Student(year 1)
Student(year 2)
Student(year 3)
Student(year 4)
Model OverviewModel Overview
Assumptions: Attrition rates Nurse/Pop. Costs
Run model: Minimum cost plan
Data: Nurse workforce size
Student body
Population projection
2003 RN Population
0
1000
2000
3000
4000
5000
6000
<25 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 >=65
Age
Pop
ulat
ion
Age distribution of student body
0
50
100
150
200
250
300
350
15
18
21
24
27
30
33
36
39
42
45
48
51
54
57
60
63
Age
Nu
mb
er
of s
tud
en
ts
Student(year 2) Student(year 3) Student(year 4)
BC Population projection
0.00
1,000.00
2,000.00
3,000.00
4,000.00
5,000.00
6,000.00
20
04
20
06
20
08
20
10
20
12
20
14
20
16
20
18
20
20
20
22
20
24
20
26
Year
Po
pu
latio
n
Outputs: Optimum costs
Yearly student population
Yearly workforce size
Practicing nurse population
05000
10000150002000025000300003500040000
2006
2008
2010
2012
2014
2016
2018
2020
Year
Wo
rkfo
rce
po
pu
latio
n Total practicingnurses
New immigrantpracticingnurses
Total Cost
$1,694,786,393 4%
$1,665,612,117 4%
$40,138,704,506
92%
Cost of training
Immigration cost
Annual salary
Yearly total student population
0
500
1000
1500
2000
2500
3000
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Year
Stu
de
nt p
op
ula
tion
Student(year 1)
Student(year 2)
Student(year 3)
Student(year 4)
ScopeScope Registered Nurses in British Columbia 20 year planning horizon Decisions made once each year Ages 17 – 65+ 7 levels Full time equivalent basis
Workforce FlowchartWorkforce Flowchart
Student(year 2)
Student(year 4)
Student(year 1)
Student(year 3)
Direct Care Nurse
Entry Level Management
Senior Level Management
Cost of educationDo other work/retireNew students/recruits
ModelModel Decision Variables:
In each year
How many to admit
How many to recruit
How many to promote
Students(year 1) Students(year 1) Students(year 3)Students(year 3)
Direct care nurses Direct care nurses Entry level managementEntry level management
Direct care nurses Direct care nurses Entry level managementEntry level management
ModelModel
This model tracks the number of:
of age i that are in the system in year j
Students(year 1) Students(year 1) Students(year 2) Students(year 2) Students(year 3) Students(year 3) Students(year 4) Students(year 4) Direct care nurses Direct care nurses Entry level managementEntry level management Senior level Senior level managementmanagement
ModelModelMinimize: Cost of training + Recruitment cost + Salary
In order to: Have sufficient resources (FTEs) to
achieve quality of care targets. Achieve balance of “recruit” and BC
nurses. Only promote nurses after they have been
in their position a specified number of years.
Variable InputsVariable Inputs Costs:
Education:• Student (annual) (1)• Management training (one shot) (1)
Recruitment and turnover cost (2) Salaries (by level) (3)
Continuation and attrition rates: Attrition rates (4), (5) Age distribution (6), (7), (8) Probability of continuing the degree (6), (9) Probability of passing the RN exam (7) Probability of leaving BC after graduation (7) FTE per full time person per age per experience time in position (7)
Initial Conditions: Distribution of current workforce by position (8) Ratio of RN to population (8) BC population projections (11)
(1) Ministry of Advanced Education(2) Weber (2005)(3) BCNU(4) Kazanjian (1986) (5) O’Brien-Pallas et al. (2003)(6) UBC School of Nursing (2006)(7) CRNBC (2005)(8) CIHI (2005)(9) Pringle and Green (2005)(10) CIHI (2005)(11) BC STATS (2006)
Cost of training
Recruitment cost
Annual salary
Necessary resources
Balance students
Recruit vs Canadian nurses
Promotion rules
ScenariosScenarios Proportion of students that continue the
program after each year of study Nurse to manager ratios and nurse
attrition rates Changes in maternity leaves Changes in the minimum number of
nurses needed to satisfy the demand
Outputs – Initial Scenario Outputs – Initial Scenario
Direct Care Nurse population
0
5000
10000
15000
20000
25000
30000
20
07
20
08
20
09
20
10
20
11
20
12
20
13
20
14
20
15
20
16
20
17
20
18
20
19
20
20
20
21
Year
Wo
rkfo
rce
po
pu
latio
n
Total direct carenursesNewly recruited directcare nurses
Outputs – Initial Scenario Outputs – Initial Scenario Entry level management population
0
500
1000
1500
2000
2500
20
07
20
08
20
09
20
10
20
11
20
12
20
13
20
14
20
15
20
16
20
17
20
18
20
19
20
20
20
21
Year
Wo
rkfo
rce
po
pu
latio
nTotal entry levelmanagement
Newly recruited entrylevel management
Newly promotedentry levelmanagement
Senior level management population
0
100
200
300
400
500
600
20
07
20
08
20
09
20
10
20
11
20
12
20
13
20
14
20
15
20
16
20
17
20
18
20
19
20
20
20
21
Year
Wo
rkfo
rce
po
pu
latio
n
Total senior levelmanagement
Newly promotedsenior levelmanagement
Outputs – Initial Scenario Outputs – Initial Scenario
Yearly total student population
0500
10001500200025003000350040004500
20
07
20
08
20
09
20
10
20
11
20
12
20
13
20
14
20
15
20
16
20
17
20
18
20
19
20
20
20
21
Year
Stu
de
nt p
op
ula
tion
Student(year 1)
Student(year 2)
Student(year 3)
Student(year 4)
Outputs – Comparing ScenariosOutputs – Comparing Scenarios
Number of Students Admitted per Year
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
2007 2009 2011 2013 2015 2017 2019 2021
Year
Num
ber
of S
tude
nts
Adm
itted
Student(year 1) admitted:
Scenario 1 (Baseline)
Scenario 2 (School Attrition)
Scenario 3 (Nurses to Manager Ratio)
Scenario 4 (Maternity Leave)
Scenario 5 (Nurses to Population Ratio)
Student(year 3) admitted:
Scenario 1 (Baseline)
Scenario 2 (School Attrition)
Scenario 3 (Nurses to Manager Ratio)
Scenario 4 (Maternity Leave)
Scenario 5 (Nurses to Population Ratio)
Final RemarksFinal Remarks Challenges with data and future
considerations for data collection Attrition rates from nursing education
programs as well as from the profession have a big impact on our decision making process
Benefits of bringing together nursing researchers and operational researchers
Thank you