Projected Registered Nurse Workforce
in Hawai’i 2005 - 2020January 2007 (download pdf file)

Summary & Introduction | I. Nursing Supply Model | II. Nursing Demand Model

III. Projecting RN Shortage | IV. Limitations | V. Recommendations

VI. Conclusions | VII. References

Author:
Dr. Sandra A. LeVasseur PhD, RN
Associate Director, Research
Hawai’i State Center for Nursing

Acknowledgments

The author would like to acknowledge the members of the ‘Data Collaborative Group’ of the Hawai’i State Center for Nursing for their contributions and assistance in the production of this report.

Asst. Prof. Clementina Ceria-Ulep, UHM School of Nursing and Dental Hygiene

Mr. Francisco Corpuz, Dept. of Labor & Industrial Relation, State of Hawai’i

Mr. Gary Kienbaum, American Organization of Nurse Executives

Prof. Bee Kooker, Queen Emma Nursing Institute, Queens’ Medical Centre

Prof. Patricia Lange-Otsuka, Hawai’i Pacific University

Assoc. Prof. Lois Magnussen, UHM School of Nursing and Dental Hygiene

Ms. Barbara Mathews, Director, Hawai’i State Center for Nursing

Ms. Charissa Raynor, Central Union Church

Assoc. Prof. Chen-Yen Wang, UHM School of Nursing and Dental Hygiene

Asst. Prof. Paulette Williams, UHM School of Nursing and Dental Hygiene

Dr. Kelley Withy, MD, MS, Program Director, Hawai’i / Pacific Basin Area Health Education Center

The author would like to thank Dean and Professor Mary Boland, University of Hawai’i at Manoa School of Nursing and Dental Hygiene, for editorial and constructive feedback concerning policy recommendations. The Hawai’i State Center for Nursing would also like to thank Linda Lacey with the North Carolina Center for Nursing, David Rosenbaum, with the University of Nebraska, and Gerard Russo, with the University of Hawai’i for sharing their time and experience in forecasting without which this study may not have been possible.

Executive Summary

The Hawai’i State Center for Nursing (HSCFN) was established by the Hawai’i State Legislature in 2003 to address nursing workforce issues. The Center’s functions include

1) Collect and analyze data;

2) Prepare and disseminate written reports and recommendations regarding the current and future status and trends of the nursing workforce;

3) Conduct research on best practices and quality outcomes;

4) Develop a plan for implementing strategies to recruit and retain nurses;

5) Research, analyze and report data related to the retention of the nursing workforce.

One of the primary goals of the HSCFN is to establish “an ongoing system that assists in estimating the future registered nursing workforce supply and demand needs in Hawai’i.”

In accordance with the mission, the Hawai’i State Center for Nursing is developing and modifying forecasting models utilizing data relevant to the State of Hawai’i to project future nursing needs. Such detailed analysis will:

• Identify and refine elements predictive of nursing supply and demand.

• Evaluate supply-and-demand forecast model options.

• Report on projected supply and demand.

• Identify and suggest data driven policy solutions.

This report: 1) describes the national Nursing Supply Model (NSM) ¹ and Nursing Demand Model (NDM); ² 2) describes the procedures used in updating and adjusting the two independent models to reflect the current Hawaiian workforce environment; 3) provides Hawai’i specific estimates of current supply and demand; and 4) lists model limitations and 5) potential policy initiatives to reduce the impact of the shortage.

Long range forecasting is described as ‘an estimate or prediction of the future’. Forecast data are a best estimate of likely trends and are an essential component of nursing workforce planning. In order to plan future workforce needs, workforce demand requirements and supply availability need to be adequately estimated, and workforce shortages or oversupply conditions need to be predicted. Forecasting requires that past and current trends in the demand for and supply of nursing workforce are carefully assessed. Predictors of levels and trends in demand and supply must be identified and models created that weigh these factors and use them to project future demand and supply. Whether these projections prove to be close to the values observed in the future depends on the degree to which historical trends provide a guide to the future and the influences of unforeseen external factors.

Forecasting workforce demand and supply is a complex endeavor with many factors potentially influencing current and future levels. An adequate forecasting model must take into consideration as many of these factors as possible, and must accurately estimate trends in the factors and the effect they will have on supply and demand in the future. In addition, good forecasting models allow for different future scenarios, since factors such as the economy (affecting supply and demand), the nation’s health (affecting demand), funding for nursing education (affecting supply), and retirement rates (affecting supply), can singularly or collectively change direction over time.

In this study, the National Center for Health Workforce Analysis (NCHWA) models are used to forecast the supply and demand of registered nurses (RN) in Hawai’i from 2005 - 2020. Preliminary estimates suggest that demand will grow from a current need for about 8,411 FTE RNs to more than 10,955 over the next 15 years. However, supply is projected to increase from an estimated 7,553 FTE RNs in 2005 to an estimated 8,286 by 2020. The models indicate that by the year 2020, Hawai’i will have a shortage of approximately 2,669 FTE RNs, or about 24 percent demand shortfall.

Both immediate and long-term policy development is required to address this growing nursing shortage. We need to address the limited educational capacity issues faced by our nursing programs; to attract and ensure educational opportunities for people to the nursing profession. The advantage of such policies is that they add new nurses year after year. Thus, while the increase in any one year may be modest, the cumulative effect can be significant. Other factors such as reducing net annual out-migration and turnover rates; and attracting more people to nursing will have an accumulative effect.

Policies that affect participation within the existing pool of nurses may have a limited long-term impact while increasing the supply of nurses in the short term. Delaying time until retirement, reducing career changes and increasing the percentage of nurses working full time as opposed to part time are examples of such policies.

Data suggests that no individual policy is likely to alleviate the nursing shortage. Rather, eliminating the nursing shortage requires a series of policy initiatives targeted to ensuring nursing supply. The most effective strategy may be one that stimulates supply among existing nursing workforce to address the current shortage and simultaneously increase supply through nursing education to minimize future shortages.

Introduction

In order to plan future workforce needs, workforce demand requirements and supply availability need to be adequately estimated, and workforce shortages or oversupply conditions need to be predicted. Forecasting requires that past and current trends in the demand for and supply of nursing workforce are carefully assessed. Predictors of levels and trends in demand and supply must be identified and models created that weigh these factors and use them to project future demand and supply.

The Bureau of Health Professions (BHPr), part of the Health Resources and Services Administration in the U.S. Department of Health and Human Services, created the Nursing Supply Model (NSM) ¹ and the Nursing Demand Model (NDM) ² to project the national supply and demand of registered nurses (RNs) in the United States. This report discusses these two models as a framework for analyses of data generated by the Hawai’i State Center for Nursing. Results will be used to adjust the models to project future estimates of RN supply and demand in Hawai’i. Data will be presented to forecast the growing shortage of RNs and policy recommendations made that may impact on the shortage over the next fifteen years.

Section I of the report begins by examining nursing supply data using the National Center for Health Workforce Analysis Nursing Supply Model (NSM). Nursing supply is modeled as a function of the changing population of licensed registered nurses, registered nurses participation in the labor market, and their decisions whether to work full or part time. A number of the underlying NSM data elements are adjusted to reflect Hawai’i’s environment.

Section II examines nursing demand data. Demand is modeled using the National Center for Health Workforce Analysis Nursing Demand Model (NDM). Demand is linked to Hawai’i’s population projections and the health care needs of individuals in various age groups. A number of the underlying NDM data elements are also adjusted to reflect Hawai’i’s environment.

Section III examines the nursing shortage forecasts using gap analysis derived from the NSM and NDM. Some of the major limitations of the models will be highlighted along with policy recommendations that may have an important impact the growing nursing shortage.

Section IV identifies some of the limitations associated with the NSM and NDM.

Section V identifies major drivers of the nursing shortage, and a number of policy recommendations are presented for consideration.