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.