Validating HRSA's nurse supply and demand models: a state-level perspective

In addition to federal initiatives, solutions to the nursing shortage must also be devised at the state level. Understanding the timing and severity of the nursing shortage in a particular state is paramount to devising appropriate solutions In 2005, the Health Resources and Services Administration released new versions of the Nurse Supply Model and Nurse Demand Model designed to project the supply of RNs and demand for RNs, LPNs, and nurse aides in the United States through the year 2020. The process used by two state-level analysts to project nurse supply and demand in North Carolina using the HRSA models is described. The authors conclude that the models work well for state-level forecasting but that users should carefully assess the default data provided with the model against independent data sources specific to their states.     

Business software for nurse executives

Nurse executives are encouraged to be innovative with computer applications for effective management. Business software systems useful for nurse executive are compared in this article.     

The California Nurse Mentor Project: every nurse deserves a mentor

In the rush to fill positions, newly hired and transitioning RNs are increasingly put into demanding roles without adequate clinical or organizational preparation. One approach that has shown promising preliminary success in enhancing nursing job satisfaction and increasing long-term retention is the use of trained nurse mentors who are paired with newly hired or new graduate nurses to provide ongoing support, guidance, and assistance. The California Nurse Mentor Project was a 3-year pilot project whose goal was to create a replicable program designed to improve the quality, sensitivity, and effectiveness of patient care through enhanced retention of nurses, including multicultural, multilingual, and male nurses. The pilot implementation of the California Nurse Mentor project has been extremely successful. Attrition rates are lower for nurses who are enrolled in the program than those who did not. Both mentors and mentees report that the program has impacted several areas, including their job satisfaction and professional confidence. Preceptor training, according to participant feedback, shows lasting effects on their pedagogy even a year after attending the training.     

Outsourcing issues for nurse practitioner practices

Nurse practitioner managed practices face multiple business and clinical processes. While most practice managers are prepared as clinicians, they are not well prepared to deal with the daily multiple business infrastructure issues they face. To provide for increased efficiency and effectiveness, nurse practitioner practices should consider outsourcing context business functions.     

Pay for performance: motivating the chief nurse executive

A recent membership survey of the Association of Nurse Executives indicates that an increasing number of nurse executives are receiving bonus compensation based upon the criteria of budget performance, patient satisfaction, and relations with physicians and nurses.     

Ambulatory care registered nurse performance measurement

On March 1-2, 2010, a state-of-the-science invitational conference titled "Ambulatory Care Registered Nurse Performance Measurement" was held to focus on measuring quality at the RN provider level in ambulatory care. The conference was devoted to ambulatory care RN performance measurement and quality of health care. The specific emphasis was on formulating a research agenda and developing a strategy to study the testable components of the RN role related to care coordination and care transitions, improving patient outcomes, decreasing health care costs, and promoting sustainable system change. The objectives were achieved through presentations and discussion among expert inter-professional participants from nursing, public health, managed care, research, practice, and policy. Conference speakers identified priority areas for a unified practice, policy, and research agenda. Crucial elements of the strategic dialogue focused on issues and implications for nursing and inter-professional practice, quality, and pay-for-performance.     

Internationally educated nurse hiring: geographic distribution, community, and hospital characteristics

As the largest importer of internationally educated nurses (IENs), the United States is considered to be the epicenter of global nurse migration. The purposes of this study were to examine the geographic distribution of IEN hiring and determine associations between community and hospital characteristics and IEN hiring. More community characteristics than hospital characteristics were strongly associated with IEN hiring which suggest perceived community needs and receptivity to lENs could be an important consideration in hospital administrators' decisions to hire IENs. These findings suggest that as the U.S. population ages and becomes increasingly diverse, the demand for IENs is likely to grow. Nurse leaders and faculty may face challenges with regard to the ethical recruitment of IENs from low-income countries, incorporation of IENs into U.S. health care organizations, and continued development of a diverse U.S.-educated nursing workforce. This study expands understanding of the demand side of IEN employment in U.S. hospitals by providing the first in-depth examination of the community and hospital factors related to hospitals' IEN hiring.     

California regional registered nurse workforce forecast

OBJECTIVE: To forecast the shortage of registered nurses (RNs) of the 24 Primary Metropolitan Statistical Areas (PMSA) and Metropolitan Statistical Areas (MSA) in California. BACKGROUND: A nursing shortage prevails nationally and is most serious in the state of California. Successful interventions in the alleviation of the RN shortage will require effective resource allocation and academic program development in various regions throughout the state. While various published studies have focused on nursing workforce development at the state and even regional levels, there are no studies focused on identifying RN shortages at the PMSA or MSA (P/MSA) level. In this report, a forecasting model is developed to systematically analyze the future supply and demand of the RN workforce within each California P/MSA. METHODS: Using accessible public databases, forecasting models were constructed to project the demand and supply of RN jobs in California P/MSAs. In the demand model, population age and size were used as determinants of regionally required RN jobs. In the RN jobs (supply) model, a region's supply of RNs was the net sum of factors increasing and decreasing the regional presence of RN jobs, including RN graduations, migration, and aging of the RN workforce. The combination of these supply and demand models was used to produce regional RN shortage forecasts for future years. RESULTS: Almost all regions exhibited growing shortages by 2020 at rates ranging from 3% to 600%. Using a modified version of the grading rubric of the California Regional Registered Nurse Workforce Report Card (Lin, Lee, Juraschek, & Jones, 2006), only two regions will receive a grade above "C" in 2020. The number of "F" grades will grow to nine. CONCLUSIONS: California has the lowest RN ratio in the United States (Fletcher, Guzley, Barnhill, & Philhour, 2004; Health Resources and Services Administration, 2004a) and this RN workforce forecasting model shows that over the next 15 years, the majority of P/MSAs in California will have increasing RN shortages. This analysis has significant policy implications including the need to create specific plans to mitigate the effect of the California shortage.     

Strategic considerations in developing a delivery model

Nurse executives must challenge basic assumptions about their organizations and help create visions that are feasible and applicable to the institutions' realities. Evaluative criteria and the relationship of the nurse executive to a reality-based model of care are vital to this goal.     

Patient empowerment strategies for a safety net

The Milwaukee County General Assistance Medical Program implemented strategies to improve the delivery of care to its patients that include patient education and a Nurse Telephone Line. The partnership between a county-funded program and an academic health center has been very productive and resulted in improvements to the program that benefit underserved patients. The outcomes of these educational strategies are described.     

An interview with Peter I. Buerhaus, PhD, RN, FAAN: on hopes and threats for nursing's future

Peter I. Buerhaus, PhD, RN, FAAN, reflects on several recently published studies examining workforce and nurse survey data and reveals more findings. Dr. Buerhaus identifies several policy and research priorities to accelerate progress and secure a more stable future for nursing. Dr. Buerhaus will be the recipient of the 2007 Nursing Economics/Margaret D. Sovie Writer's Award, for his collective works on nursing workforce issues in the journal, during the Nurse Faculty/Nurse Executive Summit, sponsored by Nursing Economics, in Scottsdale, AZ, November 29-December 1.     

Nurse executives: decision points in their careers

Nurse executives identified key decision points in their careers. Typical of executive women, they had a general sense of career direction but reported no overall career plan.     

Nurse managers as transformational and transactional leaders

Nurse managers demonstrating transformational leadership are more likely than transactional leaders to have committed staff nurse followers. Committed followers exert extra effort, thus improving unit performance and enhancing the organization's competitive advantage.     

Increasing resourcefulness: the key to declining resources

Nurse executives face many daily issues related to balancing scarce resources with an ever-increasing demand for high quality services and programs. Never before have nursing organizations been faced with such relentless pressure to conserve resources and control costs in the process to meet organizational missions.     

An interview with Rhonda Anderson. Interview by Connie R. Curran

Nurse executives working in a hospital system experience varied and challenging opportunities to enhance the quality of patient care as well as the success of their professional careers. In this interview, Rhonda Anderson, MPA, RN, CNAA, discusses the hospital system, the managed care environment, and the importance of developing nurse managers.     

Nurse retention: is it worth it?

Nurse turnover costs thousands of dollars and negatively affects patient outcomes. Study results indicate experienced nurses perceive decreased autonomy and task orientation, and increased work pressure in their work environments. Strategies are presented to help retain RNs, save money, and improve patient outcomes.     

Challenges for nursing in the 21st century

Nurse leaders face a myriad of challenges in the 21st century such as nursing workforce shortages, negative affectivity, generation workforce concerns, changing delivery systems, and increasing clinical practice complexity, to name a few. Visionary and strategic thinking centered on patients' well-being are needed to tackle these challenges and shape a more humane and compassionate health care system.     

Nursing and technology: a love/hate relationship

The fundamental value of information technology in clinical settings is no longer in question, as clinicians enter and retrieve information in order to deliver care and the benefit of ubiquitous availability to clinical data using computers cannot be overplayed. The question now is how to increase adoption, improve productivity, and support transformational changes in health care delivery. It is important to get the interplay between people, process, and technology right for successful implementations which support care transformation. We must lead projects with the clinical practice changes being enabled by the technology, and then ensure the technology supports the practice change. Nurse leaders must consider letting the quality improvement process drive and define when and how technology is used, running our projects as practice changes and not IT implementations, with nursing sponsors owning the projects and leading the charge.     

A critical competency: determining and communicating the number of nurses you must hire

Nurse leaders must understand and articulate critical concepts of budgeting and staffing to provide credible leadership to our nursing organizations. Determining the ideal number of nurses to hire on any given unit is as much an art as it is a science. Understanding the relationship between hiring requirements and the budget can lead your nursing organization to achieve important results for your hospital.