WEBVTT 00:00:07.500 --> 00:00:11.504 >> Hello, everyone. 00:00:11.504 --> 00:00:14.807 My name is Brendan Martin. I'm the director of research 00:00:14.807 --> 00:00:18.411 at NCSBN. I'm here today to discuss the results of one 00:00:18.411 --> 00:00:20.680 of our recently completed workforce studies examining 00:00:20.680 --> 00:00:23.649 the impact of the COVID-19 pandemic on the registered 00:00:23.649 --> 00:00:26.919 nurse workforce in the United States but before I dive 00:00:26.919 --> 00:00:30.857 into some of the details, it would be remiss if I did 00:00:30.857 --> 00:00:33.459 note, this is an example of cross department 00:00:33.459 --> 00:00:36.429 collaboration at NCSBN. Not only did the research team 00:00:36.429 --> 00:00:40.033 put in a considerable amount of time and effort on the 00:00:40.033 --> 00:00:43.302 study, but we are also indebted to Michelle Buck who 00:00:43.302 --> 00:00:46.572 serves as our APRN Sr. policy advisor for her support 00:00:46.572 --> 00:00:48.875 and insight throughout the project. Without further 00:00:48.875 --> 00:00:50.276 ado, let's get started. 00:00:50.276 --> 00:00:52.945 For today's presentation, I'm going to cover a few 00:00:52.945 --> 00:00:53.513 major points. 00:00:53.513 --> 00:00:57.183 To start, I will provide a bit of background on the 00:00:57.183 --> 00:00:59.819 national nursing workforce survey and APRN sub analysis 00:00:59.819 --> 00:01:03.489 to give you all the necessary context for why we wanted 00:01:03.489 --> 00:01:07.126 to pursue this study in the first place and what we 00:01:07.126 --> 00:01:08.127 hope to achieve. 00:01:08.127 --> 00:01:11.130 I will then share a brief overview of the study 00:01:11.130 --> 00:01:14.133 methodology so you are clear on how we identified our 00:01:14.133 --> 00:01:14.534 sample. 00:01:14.534 --> 00:01:18.471 Went about organizing the data and how we analyze the 00:01:18.471 --> 00:01:18.871 responses. 00:01:18.871 --> 00:01:21.841 Before getting into the meat of the presentation which 00:01:21.841 --> 00:01:25.111 I will cover the results in detail and identifies some 00:01:25.111 --> 00:01:28.081 key takeaways before opening things up to any questions 00:01:28.081 --> 00:01:29.716 or comments you might have. 00:01:29.716 --> 00:01:32.318 To provide context for discussing today, it is 00:01:32.318 --> 00:01:35.555 important to note that one of the principal and most 00:01:35.555 --> 00:01:38.491 critical studies be conducted in the past two years 00:01:38.491 --> 00:01:41.394 assessing the impact of the COVID-19 pandemic on the 00:01:41.394 --> 00:01:43.696 nursing profession with the 2022 national nursing 00:01:43.696 --> 00:01:46.599 workforce survey. For those of you who are less 00:01:46.599 --> 00:01:49.202 familiar with this project, let me provide some 00:01:49.202 --> 00:01:49.702 background. 00:01:49.702 --> 00:01:53.940 Since the 1970s, the health resources and services 00:01:53.940 --> 00:01:57.243 administration has administered a national sample 00:01:57.243 --> 00:01:59.445 survey of registered nurses. 00:01:59.445 --> 00:02:03.249 Every 4 years to evaluate and project the supply and 00:02:03.249 --> 00:02:06.419 demand for nursing services across the United States. 00:02:06.419 --> 00:02:10.556 This project ran without interruption through 2008. 00:02:10.556 --> 00:02:14.827 After which, HRSA temporarily discontinued the study. 00:02:14.827 --> 00:02:18.698 In 2012 when NCSBN and other collaborators became aware 00:02:18.698 --> 00:02:22.535 of this development, it was determined the need for 00:02:22.535 --> 00:02:26.406 this data to inform national and state level policy 00:02:26.406 --> 00:02:29.809 decisions was too great. NCSBN in partnership with -- 00:02:29.809 --> 00:02:34.113 stepped up in 2013 to fill the void by administering 00:02:34.113 --> 00:02:37.116 the first ever national nursing workforce survey. 00:02:37.784 --> 00:02:42.555 Similar to the NSS RN, the study done surveying a 00:02:42.555 --> 00:02:45.391 representative example of registered nurses including 00:02:45.391 --> 00:02:48.261 of course Advanced Practice registered nurses. 00:02:48.261 --> 00:02:52.532 Beginning in 2015, NCSBN and the National Farm decided 00:02:52.532 --> 00:02:55.868 to expand the national collection to comprehensively 00:02:55.868 --> 00:02:59.672 track the supply of vocational nurses as well. 00:02:59.672 --> 00:03:02.909 Since the initial survey administration in 2013, NCSBN 00:03:02.909 --> 00:03:06.979 and the national form around the survey every 2 years 00:03:06.979 --> 00:03:10.650 to ensure in-depth tracking on the supply of nurses 00:03:10.650 --> 00:03:12.685 across the entire United States. 00:03:12.685 --> 00:03:16.122 Regarding the methodology, the court of the survey 00:03:16.122 --> 00:03:19.992 instrument is comprised of a national forum of state 00:03:19.992 --> 00:03:23.029 nursing workforce centers, nurse apply minimum data 00:03:23.029 --> 00:03:27.400 center which was approved in 2009 and updated in 2016. 00:03:27.400 --> 00:03:29.936 However, the survey instrument includes several 00:03:29.936 --> 00:03:34.273 constant items for a total of 39 questions across 6 00:03:34.273 --> 00:03:34.774 domains. 00:03:34.774 --> 00:03:38.678 Custom items include but are not limited to pretext 00:03:38.678 --> 00:03:41.748 annual earnings, telehealth usage, the nurse licensure 00:03:41.748 --> 00:03:45.284 compact and in the most recent cycle, nurses 00:03:45.284 --> 00:03:48.788 experiences of emotional exhaustion in the role during 00:03:48.788 --> 00:03:49.689 the pandemic. 00:03:49.689 --> 00:03:54.027 The 2022 project took the form of a mixed mode survey 00:03:54.027 --> 00:03:57.563 study leveraging direct mail and email outreach as we 00:03:57.563 --> 00:04:00.700 have always done as well as data collected 00:04:00.700 --> 00:04:02.268 systematically through the system. 00:04:02.268 --> 00:04:06.039 Direct mail outreach was conducted in 43 jurisdictions 00:04:06.039 --> 00:04:10.276 with our vendors scan drunker than survey was initially 00:04:10.276 --> 00:04:12.645 fielded on April 11th 2022. 00:04:12.645 --> 00:04:15.214 The survey remained open for approximately six months 00:04:15.214 --> 00:04:18.551 with 2 scheduled mail reminders that week's 10 and 20. 00:04:18.551 --> 00:04:22.655 As you can see on the slide in front of you, all 00:04:22.655 --> 00:04:24.691 registered nurses and licensed practical vocational 00:04:24.691 --> 00:04:28.127 nurses with an active license in the U.S. and its 00:04:28.127 --> 00:04:30.496 territories are eligible to be survey participants. 00:04:30.496 --> 00:04:35.201 The bulk of the sample was drawn from nurses. 00:04:35.201 --> 00:04:37.236 NCSBN's licensure database. 00:04:37.236 --> 00:04:40.707 It contains basic demographic and licensure information 00:04:40.707 --> 00:04:43.142 for RN and LVN licensees. 00:04:43.142 --> 00:04:46.746 As nurses can hold multiple single state licenses, and 00:04:46.746 --> 00:04:50.316 initial review of all data was undertaken to duplicate 00:04:50.316 --> 00:04:53.086 license counts for individual practitioners by signing 00:04:53.086 --> 00:04:56.689 licensees a single home state based on primary address. 00:04:56.689 --> 00:05:01.060 Total figures for both the RN mail outs are provided 00:05:01.060 --> 00:05:03.830 on the slide in front of you. 00:05:03.830 --> 00:05:08.234 This approach was then mirrored with an exclusively 00:05:08.234 --> 00:05:12.071 email based strategy employed in 4 jurisdictions. 00:05:12.071 --> 00:05:15.041 For the 5 remaining jurisdictions, rigorous internal 00:05:15.041 --> 00:05:17.977 testing determined data collected through the nurses 00:05:17.977 --> 00:05:21.781 felt enrollment in a notify system was a sufficient 00:05:21.781 --> 00:05:23.149 volume and quality. 00:05:23.149 --> 00:05:24.484 Ultimately deemed unnecessary. 00:05:24.484 --> 00:05:28.755 For those not familiar, nurse a notify is a free online 00:05:28.755 --> 00:05:32.258 tool linked to the licensure database through which a 00:05:32.258 --> 00:05:35.361 nurse consultant role to receive reminders and updates 00:05:35.361 --> 00:05:38.064 to get their professional license or licenses 00:05:38.064 --> 00:05:38.464 up-to-date. 00:05:38.464 --> 00:05:42.335 As part of the registration process, a nurse must 00:05:42.335 --> 00:05:46.673 report and keep up to date information across all the 00:05:46.673 --> 00:05:47.106 fields. 00:05:47.106 --> 00:05:51.544 The 5 states by which we referenced a notify data where 00:05:51.544 --> 00:05:54.414 Missouri, Wyoming, New Mexico, North Carolina, and 00:05:54.414 --> 00:05:58.051 Washington. As a result of the sampling methodology, 00:05:58.051 --> 00:06:02.121 nurses from these 5 states did not contribute to any 00:06:02.121 --> 00:06:04.157 analyses of custom survey fields. 00:06:04.157 --> 00:06:07.827 For the final analysis, state-level weights were 00:06:07.827 --> 00:06:12.065 applied to all records following a rigorous nonresponse 00:06:12.065 --> 00:06:15.735 bias analysis to account for possible discrepancies. 00:06:15.735 --> 00:06:20.406 Leveraging this design, we were in turn able to use the 00:06:20.406 --> 00:06:23.776 trends observed in the respondent pool to extrapolate 00:06:23.776 --> 00:06:26.746 and generalize findings to the broader unmeasured 00:06:26.746 --> 00:06:27.146 population. 00:06:27.146 --> 00:06:31.351 In effect, this allows us to draw inferences about the 00:06:31.351 --> 00:06:34.687 entire nursing workforce across the U.S. by reporting 00:06:34.687 --> 00:06:36.356 population weighted national estimates. 00:06:36.356 --> 00:06:39.726 Full details on our methods and approach are provided 00:06:39.726 --> 00:06:43.429 in the publication of the main study findings which are 00:06:43.429 --> 00:06:46.799 readily available and free for download on the Journal 00:06:46.799 --> 00:06:50.169 for nursing regulation website. At the close of the 00:06:50.169 --> 00:06:52.405 survey, approximately 27,000 of the successfully 00:06:52.405 --> 00:06:55.008 delivered RN surveys were returned yielding response 00:06:55.008 --> 00:06:56.142 rate of 17.8%. 00:06:56.142 --> 00:07:01.614 In addition, 23,000 of this gospel LPN surveys were 00:07:01.614 --> 00:07:05.852 returned resulting in a 15.2% response rate. 00:07:05.852 --> 00:07:10.656 There was a drop-off associated with our email based 00:07:10.656 --> 00:07:11.190 jurisdictions. 00:07:11.190 --> 00:07:14.327 Approximately 27,000 RNs were selected in the email 00:07:14.327 --> 00:07:15.895 portion of the study. 00:07:15.895 --> 00:07:22.001 The overall response rate was 9.2% or about 2500 00:07:22.001 --> 00:07:22.702 nurses. 00:07:22.702 --> 00:07:26.305 Nearly 19,000 LPNs were also randomly selected for 00:07:26.305 --> 00:07:30.843 participation in the email portion of the study and the 00:07:30.843 --> 00:07:34.947 overall response rate was 11.6% or about 2200 nurses. 00:07:34.947 --> 00:07:40.553 Data for a total of nearly a quarter of a million RNs 00:07:40.553 --> 00:07:44.323 and 30,000 LPNs were connected in the study. 00:07:44.323 --> 00:07:47.193 For an accurate and comprehensive view of the 00:07:47.193 --> 00:07:50.430 statistics drawn from the sample, the number of actual 00:07:50.430 --> 00:07:53.666 valid answers to each question is reported for every 00:07:53.666 --> 00:07:55.468 table of the main report. 00:07:55.468 --> 00:07:59.439 Importantly, missing data were not imputed. 00:07:59.439 --> 00:08:02.208 All statistics represent the actual respondents from 00:08:02.208 --> 00:08:04.977 participants who responded to each respective survey 00:08:04.977 --> 00:08:05.478 item. 00:08:05.478 --> 00:08:08.681 If a participant did not respond to a certain item, 00:08:08.681 --> 00:08:11.317 they were simply not part of that analysis. 00:08:11.317 --> 00:08:17.757 As you can see on the slide in front of you, data or 00:08:17.757 --> 00:08:21.227 RNs were analyzed separately and sequentially and 00:08:21.227 --> 00:08:24.697 published in a comprehensive -- overall, the 2022 00:08:24.697 --> 00:08:28.167 report represents the largest most comprehensive and 00:08:28.167 --> 00:08:31.637 rigorous evaluation of the entire nursing workforce 00:08:31.637 --> 00:08:36.609 since the onset of the pandemic in the United States. 00:08:37.643 --> 00:08:41.814 I would highly encourage you to download the results 00:08:41.814 --> 00:08:43.683 for some light reading. 00:08:43.683 --> 00:08:46.919 Furthermore, for those not interested based on that 00:08:46.919 --> 00:08:50.123 background, the results of prior iterations of the 00:08:50.123 --> 00:08:51.357 survey are archived. 00:08:51.357 --> 00:08:55.128 Similarly remain free for download. 00:08:55.128 --> 00:08:58.564 With that background information now in place, we are 00:08:58.564 --> 00:09:02.335 here today to dive into the results of the 2022 00:09:02.335 --> 00:09:03.102 national survey. 00:09:03.102 --> 00:09:06.239 Given the events of the past two years, it will likely 00:09:06.239 --> 00:09:09.108 come as no surprise to you that the 2022 survey 00:09:09.108 --> 00:09:11.611 findings were of great interest to many stakeholders. 00:09:11.611 --> 00:09:14.881 And raised a new level of awareness of issues critical 00:09:14.881 --> 00:09:18.618 to the nursing workforce in the U.S. As a result for 00:09:18.618 --> 00:09:21.988 the first time ever, we decided to pursue and publish 00:09:21.988 --> 00:09:24.691 the results of several targeted sub-analyses in the 00:09:24.691 --> 00:09:26.726 Journal of nursing regulation this April. 00:09:26.726 --> 00:09:29.829 Please be on the lookout for those future results as 00:09:29.829 --> 00:09:30.329 well. 00:09:30.329 --> 00:09:35.468 Chief among these issues was an up-to-date and 00:09:35.468 --> 00:09:39.439 comprehensive descriptive summary of the advanced 00:09:39.439 --> 00:09:43.409 practice registered nurse or APRN workforce. 00:09:43.409 --> 00:09:47.046 One, to provide an up-to-date and comprehensive 00:09:47.046 --> 00:09:51.217 descriptive survey of the APRN workforce and in-depth 00:09:51.217 --> 00:09:55.388 examination of how the COVID-19 pandemic contributed to 00:09:55.388 --> 00:09:59.559 APRN's burnout and stress. Not understanding how these 00:09:59.559 --> 00:10:04.230 issues inform APRN's intent to leave in the public -- 00:10:04.230 --> 00:10:05.798 were critically important. 00:10:06.332 --> 00:10:10.570 As a subsample of the overall study findings, this 00:10:10.570 --> 00:10:13.406 cross-sectional study beverage the same stratified 00:10:13.406 --> 00:10:17.643 random sampling plan of all RNs practicing across the 00:10:17.643 --> 00:10:20.513 U.S. including representative proportions of APRNs. 00:10:20.513 --> 00:10:26.352 As a result, a little over hundred 20,000 APRNs or 00:10:26.352 --> 00:10:31.024 11.8% of the workforce are represented in this 00:10:31.024 --> 00:10:31.624 analysis. 00:10:31.624 --> 00:10:35.161 Including respondents across all 50 states, the 00:10:35.161 --> 00:10:38.698 District of Columbia and the northern islands. 00:10:38.698 --> 00:10:42.068 Respondents were asked to identify themselves as a APRN 00:10:42.068 --> 00:10:44.270 with 2 items on the survey. 00:10:44.270 --> 00:10:48.341 The first question 4 was a query about license type. 00:10:48.341 --> 00:10:51.110 This second pertain to their specific role. 00:10:51.110 --> 00:10:54.180 For example, as a certified nurse practitioner, 00:10:54.180 --> 00:10:58.117 combining information from these 2 fields, we were able 00:10:58.117 --> 00:11:02.088 to identify and isolate APRN respondents with a high 00:11:02.088 --> 00:11:03.489 degree of confidence. 00:11:03.489 --> 00:11:07.160 The general time frame for the study is displayed in 00:11:07.160 --> 00:11:08.261 front of you. 00:11:08.261 --> 00:11:11.531 Please note, this is pretty much the same procedure we 00:11:11.531 --> 00:11:12.832 employ every survey cycle. 00:11:12.832 --> 00:11:16.836 For the sake of transparency, we wanted to provide a 00:11:16.836 --> 00:11:19.605 bit more insight into the 2022 study. 00:11:19.605 --> 00:11:22.942 By January 2022, we have finalized our distribution 00:11:22.942 --> 00:11:25.445 plan and collated our mailing list. 00:11:25.445 --> 00:11:28.414 Data collection as I mention prior comments in April 00:11:28.414 --> 00:11:32.018 and carry through the end of September 2022 as you can 00:11:32.018 --> 00:11:34.654 see from the diagram in front of you. 00:11:34.654 --> 00:11:38.024 This earned as a major inflection point in the survey 00:11:38.024 --> 00:11:41.427 as we pivoted away from active data collection to the 00:11:41.427 --> 00:11:43.596 analysis of nurse's responses in October. 00:11:43.596 --> 00:11:47.967 On the end of December 2022, we had generated a full 00:11:47.967 --> 00:11:52.071 report which was then published as a supplement to the 00:11:52.071 --> 00:11:55.008 Journal of nursing regulations April 2023 addition. 00:11:55.008 --> 00:11:58.511 In parallel, we also published a standard length 00:11:58.511 --> 00:12:01.614 manuscripts specifically highlighting the impact of the 00:12:01.614 --> 00:12:04.283 COVID-19 pandemic on the nursing workforce. 00:12:04.283 --> 00:12:07.754 Again, the methods associated with the means of data 00:12:07.754 --> 00:12:10.456 collection, coding, and analysis largely mirrored the 00:12:10.456 --> 00:12:11.224 overall report. 00:12:11.224 --> 00:12:15.528 In addition to a detailed descriptive summary, this 00:12:15.528 --> 00:12:19.265 targeted sub-analysis did overlay statistics such as 00:12:19.265 --> 00:12:22.502 binary logistic regression in natural language 00:12:22.502 --> 00:12:26.239 processing to determine the significance of observed 00:12:26.239 --> 00:12:27.840 trends among APRNs. 00:12:27.840 --> 00:12:31.444 some data notes specific to this analysis. 00:12:31.444 --> 00:12:35.982 Five originated from the emotional exhaustion domain of 00:12:35.982 --> 00:12:41.120 the man's leg burnout human Tory human services survey. 00:12:41.120 --> 00:12:42.822 In this analysis. 00:12:42.822 --> 00:12:46.025 Respondents were asked to indicate how frequently they 00:12:46.025 --> 00:12:48.828 feel emotionally drained, used up, fatigued, burned 00:12:48.828 --> 00:12:53.666 out, or at the end of their rope using a 7-point scale 00:12:53.666 --> 00:12:57.370 where 1 means never and 7 means every day. 00:12:57.370 --> 00:13:00.640 Following a review of the distribution of real 00:13:00.640 --> 00:13:03.609 responses and to simplify interpretation and each 00:13:03.609 --> 00:13:06.979 dependent variable was banished to identify and isolate 00:13:06.979 --> 00:13:09.515 respondent characteristics that align with reported 00:13:09.515 --> 00:13:13.820 frequency of a few times a week or every day. 00:13:13.820 --> 00:13:18.491 Those are response options 6 and 7 respectively. 00:13:18.491 --> 00:13:21.661 My primary independent variable for this analysis was 00:13:21.661 --> 00:13:22.462 years experience. 00:13:22.462 --> 00:13:26.165 This variable was bent into courthouse to simplify the 00:13:26.165 --> 00:13:29.469 analysis and aid the reader's interpretation of the 00:13:29.469 --> 00:13:29.869 results. 00:13:29.869 --> 00:13:33.072 Therefore, for this analysis, cutoffs for what 00:13:33.072 --> 00:13:36.242 constitutes early and late career practice were 00:13:36.242 --> 00:13:39.445 determined by the distribution of respondents overall 00:13:39.445 --> 00:13:43.549 responses. Not a decision or an alignment with 00:13:43.549 --> 00:13:43.983 literature. 00:13:43.983 --> 00:13:47.920 Importantly, there are many ways in which such criteria 00:13:47.920 --> 00:13:49.655 could be formerly categorized. 00:13:49.655 --> 00:13:52.759 By allowing the nurse's responses to dictate their 00:13:52.759 --> 00:13:55.828 ranges chemically felt this minimize any potential for 00:13:55.828 --> 00:13:57.497 bias in our analysis. 00:13:57.497 --> 00:14:01.000 Furthermore, our goal was never to definitively define 00:14:01.000 --> 00:14:04.504 experience thresholds, but rather to generally speak to 00:14:04.504 --> 00:14:08.474 and highlight the experiences of nurses across a range 00:14:08.474 --> 00:14:10.209 of broader experience Strada. 00:14:10.209 --> 00:14:14.447 Like the overall report, this study stands as the most 00:14:14.447 --> 00:14:17.383 comprehensive and rigorous assessment of the APRN 00:14:17.383 --> 00:14:21.220 workforce in the United States since the onset of 00:14:21.220 --> 00:14:21.621 COVID-19. 00:14:21.621 --> 00:14:26.025 Not only do our results provide a critical update on 00:14:26.025 --> 00:14:30.430 the post-pandemic, but to our knowledge, it is the only 00:14:30.430 --> 00:14:33.966 study to leverage a nationally representative sample of 00:14:33.966 --> 00:14:35.702 all 4 APRN rose. 00:14:35.702 --> 00:14:38.237 Traditionally focused on certified nurse practitioners 00:14:38.237 --> 00:14:42.041 and the Bureau of Labor Statistics omits tracking on 00:14:42.041 --> 00:14:43.309 clinical nurse specialists. 00:14:43.309 --> 00:14:45.812 This report comprehensively tracks employment and 00:14:45.812 --> 00:14:49.148 educational trends as well as new developments and 00:14:49.148 --> 00:14:51.250 practice for all advanced providers. 00:14:51.250 --> 00:14:55.755 The results of this study will be available this month. 00:14:55.755 --> 00:14:58.858 Let's dive into the results. 00:14:58.858 --> 00:15:03.730 Overall, certified nurse practitioners at account for 00:15:03.730 --> 00:15:09.302 the bulk of the workforce. Certified registered nurse 00:15:09.302 --> 00:15:12.071 and certified nurse midwives. 00:15:12.071 --> 00:15:15.208 APRNs are an average 50 years old. 00:15:15.208 --> 00:15:18.244 Majority self identify as female, non-Hispanic, and 00:15:18.244 --> 00:15:18.745 white. 00:15:18.745 --> 00:15:23.483 Not presented in this table but of relevance, 1 and 2 00:15:23.483 --> 00:15:27.387 report a baccalaureate as their first nursing degree or 00:15:27.387 --> 00:15:30.490 credential followed by an associate or Masters. 00:15:30.490 --> 00:15:33.893 Three quarters report a Masters as their highest 00:15:33.893 --> 00:15:37.797 nursing degree or credential followed by a doctor of 00:15:37.797 --> 00:15:40.400 nursing practice at just under 10%. 00:15:40.400 --> 00:15:43.036 Most APRNs indicate they are actively employed in 00:15:43.036 --> 00:15:45.672 nursing and worked in direct patient care settings. 00:15:45.672 --> 00:15:50.243 Furthermore, on average, APRNs report being license for 00:15:50.243 --> 00:15:56.516 nearly 24 years and working an average of 40 hours a 00:15:56.516 --> 00:15:57.083 week. 00:15:57.083 --> 00:16:00.920 Primary practice settings vary considerably by role 00:16:00.920 --> 00:16:05.291 with nearly half of CMP during this reporting 00:16:05.291 --> 00:16:09.662 ambulatory or other outpatient clinic compared to 77% 00:16:09.662 --> 00:16:13.499 of cRNA thoroughness and 44% reporting hospital. 00:16:13.499 --> 00:16:19.872 The median reported salary is highest for CRNAs 00:16:19.872 --> 00:16:23.876 compared to $109,000 for CMPs. 00:16:23.876 --> 00:16:26.646 $104,000 for CNNs. 00:16:26.646 --> 00:16:28.748 And CNSs. 00:16:28.748 --> 00:16:36.522 Two-thirds of APRNs practice telehealth as part of the 00:16:36.522 --> 00:16:37.357 road. 00:16:37.357 --> 00:16:38.624 Approximately 2-3. 00:16:38.624 --> 00:16:42.495 Most employed video calls, notable proportions also 00:16:42.495 --> 00:16:45.932 used electronic messaging, email, or telephone. 00:16:45.932 --> 00:16:51.404 In addition, APRNs estimate that 22% support remote 00:16:51.404 --> 00:16:56.876 patient care within a single jurisdiction and 10% 00:16:56.876 --> 00:16:58.244 cross-border care. 00:16:58.244 --> 00:17:04.017 More than half of the sample, about 55% reported an 00:17:04.017 --> 00:17:08.054 increase in their workload during the COVID-19 00:17:08.054 --> 00:17:08.621 pandemic. 00:17:08.621 --> 00:17:11.024 Similarly, high proportions reported feeling 00:17:11.024 --> 00:17:14.394 emotionally drained, used up, fatigued, burned-out, or 00:17:14.394 --> 00:17:20.633 at the end of their rope a few times a week or every 00:17:20.633 --> 00:17:21.100 day. 00:17:21.100 --> 00:17:26.439 APRNs with the least experience defined as 12 or fewer 00:17:26.439 --> 00:17:29.075 years consistently reported heightened emotional 00:17:29.075 --> 00:17:32.278 distress compared to their more experienced 00:17:32.278 --> 00:17:32.812 counterparts. 00:17:32.812 --> 00:17:36.249 Similarly, APRNs who reported an increased workload 00:17:36.249 --> 00:17:38.217 displayed a similar pattern. 00:17:38.217 --> 00:17:41.421 Trends related to years experience at increased 00:17:41.421 --> 00:17:44.624 workload held on multivariable analysis after further 00:17:44.624 --> 00:17:46.893 adjustments for respondent self-reported ethnicity, 00:17:46.893 --> 00:17:50.997 race, salary, and role as well as indicators for 00:17:50.997 --> 00:17:54.200 full-time nursing employment and direct patient care. 00:17:54.200 --> 00:17:59.872 Consistent with the variable results, APRNs with the 00:17:59.872 --> 00:18:04.110 least experience reported heightened emotional distress 00:18:04.110 --> 00:18:08.381 compared to their more experienced counterparts. 00:18:08.381 --> 00:18:11.384 Importantly, the adjusted odds ratio you see before you 00:18:11.384 --> 00:18:13.753 on the slide correspond specifically to direct 00:18:13.753 --> 00:18:16.089 comparisons between the least and most experienced 00:18:16.089 --> 00:18:16.589 APRNs. 00:18:16.589 --> 00:18:20.660 So that would be those with 12 or fewer years of 00:18:20.660 --> 00:18:24.097 experience compared to those with 36 or more years 00:18:24.097 --> 00:18:25.631 experience in this analysis. 00:18:25.631 --> 00:18:29.335 Trends associated with APRNs reported increased 00:18:29.335 --> 00:18:31.804 workloads were similarly durable. 00:18:31.804 --> 00:18:34.674 Again, these models control for respondent 00:18:34.674 --> 00:18:38.544 self-reported ethnicity, race, salary, and role as well 00:18:38.544 --> 00:18:41.948 as indicators for full-time nursing employment and 00:18:41.948 --> 00:18:43.383 direct patient care. 00:18:43.383 --> 00:18:46.085 This likely goes without saying, the adjusted odds 00:18:46.085 --> 00:18:49.489 ratios here use those who reported no increase in their 00:18:49.489 --> 00:18:52.191 workloads during the pandemic as the comparison group. 00:18:52.191 --> 00:18:56.562 What are the key takeaways? Acute experiences of stress 00:18:56.562 --> 00:19:00.433 and burnout during the COVID-19 pandemic oven felt 00:19:00.433 --> 00:19:03.369 disproportionately by younger and comparatively less 00:19:03.369 --> 00:19:04.337 experienced APRNs. 00:19:04.337 --> 00:19:08.541 Similarly, outside the scope of our research, there are 00:19:08.541 --> 00:19:11.811 emerging signs that disruptions to graduate nursing 00:19:11.811 --> 00:19:15.548 education could impact the pipeline of new career 00:19:15.548 --> 00:19:16.015 entrance. 00:19:16.015 --> 00:19:19.052 However, this report also illustrates a parallel 00:19:19.052 --> 00:19:19.552 concern. 00:19:19.552 --> 00:19:22.822 That is the potential loss of the diverse educational 00:19:22.822 --> 00:19:26.125 training and skill sets of a generation of more 00:19:26.125 --> 00:19:30.196 experienced APRNs. As I hope you will be able to review 00:19:30.196 --> 00:19:33.533 them our full report documents that past and projected 00:19:33.533 --> 00:19:36.469 attrition among the most experienced cohort of APRNs 00:19:36.469 --> 00:19:39.806 will be most pronounced among CNSs into her lesser 00:19:39.806 --> 00:19:40.907 degree CNN thoroughness. 00:19:40.907 --> 00:19:45.211 At a time where in more nurses than ever are needed 00:19:45.211 --> 00:19:48.348 to -- related to COVID-19 and an aging patient 00:19:48.348 --> 00:19:51.451 population. How nurses are trained in the skills 00:19:51.451 --> 00:19:55.388 perhaps at risk of being lost may in fact hinder 00:19:55.388 --> 00:19:58.524 patient access and provider choice in the future. 00:19:58.524 --> 00:20:03.129 Finally and on a related note, as though APRN Consensus 00:20:03.129 --> 00:20:06.799 Model confirms, there is value in unique contributions 00:20:06.799 --> 00:20:09.102 from all 4 APRN roles. 00:20:09.102 --> 00:20:13.139 To ensure current models of care remain fit for the 00:20:13.139 --> 00:20:16.776 future and flexible to meet the diverse needs of 00:20:16.776 --> 00:20:18.778 tomorrow's patients, policymakers, nursing leaders, 00:20:18.778 --> 00:20:22.015 employers and educators must be intentional and how 00:20:22.015 --> 00:20:25.618 they recruit, train, and support the current and future 00:20:25.618 --> 00:20:26.519 APRN workforce. 00:20:26.519 --> 00:20:29.288 Continued investments to diversify the workforce not 00:20:29.288 --> 00:20:32.425 only related to their demographic profile but also 00:20:32.425 --> 00:20:35.595 their professional training is essential to foster a 00:20:35.595 --> 00:20:38.731 more sustainable and safer U.S. nursing workforce is 00:20:38.731 --> 00:20:41.901 adequately prepared to address a range of patient 00:20:41.901 --> 00:20:42.402 needs. 00:20:42.402 --> 00:20:57.383 With that, I would like to thank you for your time and 00:20:57.383 --> 00:21:11.197 I will open the floor to any questions you might have. 00:21:11.197 --> 00:21:14.701 >> Thank you so much. 00:21:14.701 --> 00:21:16.002 Terrific presentation. 00:21:16.002 --> 00:21:16.502 Thank you. 00:21:16.502 --> 00:21:22.075 Let's just jump right into the questions, if you don't 00:21:22.075 --> 00:21:22.642 mind. 00:21:22.642 --> 00:21:27.080 321 in the research team has done extensive work around 00:21:27.080 --> 00:21:28.848 the workforce, nursing workforce. 00:21:28.848 --> 00:21:36.589 Out of the APRN results compared to the RN LPN 00:21:36.589 --> 00:21:37.357 findings? 00:21:37.357 --> 00:21:38.257 >> Thank you, Michelle. 00:21:38.257 --> 00:21:42.228 I would like to say thank you once again for inviting 00:21:42.228 --> 00:21:43.663 me to this event. 00:21:43.663 --> 00:21:45.565 I love the NCSBN roundtable. 00:21:45.565 --> 00:21:48.067 I hope that participants have found this as interesting 00:21:48.067 --> 00:21:49.469 in education as I had. 00:21:49.469 --> 00:21:52.505 Kudos to you for putting on an absolutely fantastic 00:21:52.505 --> 00:21:55.708 event here. I think your question is really important. 00:21:55.708 --> 00:21:57.877 I don't need to necessarily explain this to your 00:21:57.877 --> 00:21:58.378 audience. 00:21:58.378 --> 00:22:01.447 That is one of the things I love about this event. 00:22:01.447 --> 00:22:05.018 There are no shortage of health care workforce studies 00:22:05.018 --> 00:22:05.918 out there. 00:22:05.918 --> 00:22:08.921 When you dive into the weeds out the disparate results 00:22:08.921 --> 00:22:12.225 and findings, and I think it's easy to get confused as 00:22:12.225 --> 00:22:15.795 to what is the license type and level of nursing we are 00:22:15.795 --> 00:22:16.095 discussing. 00:22:16.095 --> 00:22:18.664 When is the basis for your sample. 00:22:18.664 --> 00:22:22.902 Are you looking at the current state of the nursing 00:22:22.902 --> 00:22:24.170 workforce, et cetera? 00:22:24.170 --> 00:22:27.907 I appreciate the opportunity to set a little bit more 00:22:27.907 --> 00:22:31.277 in addition to my presentation, the context for our 00:22:31.277 --> 00:22:31.644 findings. 00:22:31.644 --> 00:22:36.115 As you mentioned, as I mentioned in my remarks, we 00:22:36.115 --> 00:22:39.218 conduct arguably the most comprehensive and largest 00:22:39.218 --> 00:22:43.289 nursing workforce survey in the country every 2 years. 00:22:43.289 --> 00:22:47.293 We looked at registered nurses and LPNs and LVNs 00:22:47.293 --> 00:22:50.463 including in our sample as a representative 00:22:50.463 --> 00:22:54.067 proportional representation of APRNs. As it relates to 00:22:54.067 --> 00:22:58.604 the findings at the other license types, I would say 00:22:58.604 --> 00:23:02.208 really go back to that key takeaways slide. 00:23:02.208 --> 00:23:05.712 For thou APRN analysis, projected attrition was likely 00:23:05.712 --> 00:23:09.682 not near as pronounced and in fact observed attrition 00:23:09.682 --> 00:23:14.954 over the past 2 years was not near as announced as it 00:23:14.954 --> 00:23:19.359 was among the general RN workforce centered in acute or 00:23:19.359 --> 00:23:22.061 kind of led bedside care setting. 00:23:22.061 --> 00:23:25.531 Similar and stands for LPN toes, what we saw that when 00:23:25.531 --> 00:23:27.734 there was attrition, it was felt unequally. 00:23:27.734 --> 00:23:31.637 Both in terms of looking back and in terms of 00:23:31.637 --> 00:23:34.741 projecting forward. That really gets at the wrong 00:23:34.741 --> 00:23:38.244 designation. In particular, one of the things that 00:23:38.244 --> 00:23:41.748 emerge from our analysis -- which I think is confirmed 00:23:41.748 --> 00:23:45.251 in the literature and other research groups that have 00:23:45.251 --> 00:23:49.155 delved into this topic, the attrition and kind of the 00:23:49.155 --> 00:23:51.858 attrition among the CNS workforce and particular. 00:23:52.058 --> 00:23:55.528 That was one of the major conclusions that emerge from 00:23:55.528 --> 00:23:56.195 our analysis. 00:23:56.195 --> 00:23:59.399 One of the things that I might do with the stage here 00:23:59.399 --> 00:24:00.199 so to speak. 00:24:00.199 --> 00:24:03.536 Bear with me here hopefully is to kind of broad an 00:24:03.536 --> 00:24:05.071 outlay gaze a little bit. 00:24:05.071 --> 00:24:09.175 One of the things I wanted to draw a distinction in my 00:24:09.175 --> 00:24:12.278 discussion today is when people are looking at our 00:24:12.278 --> 00:24:15.381 workforce results, and they are trying to compare to 00:24:15.381 --> 00:24:17.784 other workforce results, what are the particular 00:24:17.784 --> 00:24:20.887 distinctions for our work in particular as it relates 00:24:20.887 --> 00:24:21.888 to other entities? 00:24:21.888 --> 00:24:25.792 I think in that endeavor when you're thinking about it 00:24:25.792 --> 00:24:28.895 through the lens of comparisons in particular, any 00:24:28.895 --> 00:24:31.631 discussion of the underlying contrast our similarities 00:24:31.631 --> 00:24:32.799 with other studies. 00:24:32.799 --> 00:24:35.968 It's important to be transparent with your reference 00:24:35.968 --> 00:24:40.373 points. Maybe for a minute, note that when you think 00:24:40.373 --> 00:24:43.576 about the national sample of survey of registered 00:24:43.576 --> 00:24:47.980 nurses -- which we very much of you as a sister or 00:24:47.980 --> 00:24:51.184 companion study to her own national nursing workforce 00:24:51.184 --> 00:24:51.584 survey. 00:24:51.984 --> 00:24:55.021 That has a distinction when it relates to the APRN 00:24:55.021 --> 00:24:55.521 workforce. 00:24:55.521 --> 00:24:58.691 We have long felt as though it is absolutely critical 00:24:58.691 --> 00:25:02.028 that we are is comprehensive as we can be as 00:25:02.028 --> 00:25:04.697 intentional and are sampling frame for the APRN 00:25:04.697 --> 00:25:05.198 workforce. 00:25:05.198 --> 00:25:10.670 We track us thoroughly and accurately as possible 00:25:10.670 --> 00:25:14.173 including clinical and nurse specialists. 00:25:14.173 --> 00:25:17.410 HRSA tracks certified nurse practitioners and certified 00:25:17.410 --> 00:25:20.213 nurse midwives and registered nurse anesthetist. 00:25:20.213 --> 00:25:22.648 But does not include CNSs historically for the same can 00:25:22.648 --> 00:25:24.617 be said for the Bureau of Labor Statistics. 00:25:24.617 --> 00:25:28.321 When you get into other research groups and often times 00:25:28.321 --> 00:25:31.657 make a living and doing health care in particular 00:25:31.657 --> 00:25:33.893 nursing workforce study analyses, it's really 00:25:33.893 --> 00:25:37.230 imperative that you like and who constitutes the sample 00:25:37.230 --> 00:25:39.799 and what are you trying to achieve. 00:25:39.799 --> 00:25:44.237 With this final comment, I will take an opportunity to 00:25:44.237 --> 00:25:47.774 know, when you think about workforce projections, often 00:25:47.774 --> 00:25:51.310 times, you're trying to participate in the broader 00:25:51.310 --> 00:25:53.079 discussion of workforce shortages. 00:25:53.079 --> 00:25:56.482 That absolutely by necessity requires that you have 00:25:56.482 --> 00:26:00.787 both an understanding of the nerve supply as well as 00:26:00.787 --> 00:26:02.055 the nurse demand. 00:26:02.055 --> 00:26:04.824 For our particular survey, we track comprehensively 00:26:04.824 --> 00:26:07.960 nerve supply and looking particularly at the current 00:26:07.960 --> 00:26:11.497 issue facing the workforce and how that can inform 00:26:11.497 --> 00:26:14.634 retention issues and policies around the retention of 00:26:14.634 --> 00:26:15.802 the current workforce. 00:26:15.802 --> 00:26:19.172 When you get into things such as their projections, 00:26:19.172 --> 00:26:22.508 often times, that is on model-based design where you're 00:26:22.508 --> 00:26:25.878 making certain key assumptions which must hold over a 00:26:25.878 --> 00:26:29.582 prescribed period of time, often times 10 years or more 00:26:29.582 --> 00:26:33.319 per those might be that the number of nurse graduates 00:26:33.319 --> 00:26:34.053 remain static. 00:26:34.053 --> 00:26:37.123 There is migration following a prelicensure program 00:26:37.123 --> 00:26:38.024 remains stable. 00:26:38.024 --> 00:26:42.028 Meaning that new nurse graduates tend to relocate to 00:26:42.028 --> 00:26:42.495 work. 00:26:42.495 --> 00:26:45.798 Remained fairly steady over that given period of time. 00:26:45.798 --> 00:26:50.169 It is really critical as you try to evaluate all of the 00:26:50.169 --> 00:26:52.805 disparate sources associated with health care workforce 00:26:52.805 --> 00:26:55.942 studies that you always start with the methods. 00:26:55.942 --> 00:26:58.911 I have been drinking from the Kool-Aid a long time as a 00:26:58.911 --> 00:26:59.178 researcher. 00:26:59.178 --> 00:27:01.681 I think it is imperative that when you want to 00:27:01.681 --> 00:27:03.716 understand, what are the impacts where the findings, 00:27:03.716 --> 00:27:05.985 what sorts of policies should they be informing that 00:27:05.985 --> 00:27:09.288 you really go back to the root of what are the methods. 00:27:09.288 --> 00:27:12.225 What is the sampling frame? 00:27:12.225 --> 00:27:16.662 To round out your question a little bit. I think it is 00:27:16.662 --> 00:27:19.999 a critically important question when you think about it 00:27:19.999 --> 00:27:23.670 not only in relation to our other studies for the 00:27:23.670 --> 00:27:27.373 general RN workforce but also has a relates to other 00:27:27.373 --> 00:27:28.141 research groups. 00:27:28.141 --> 00:27:29.842 >> Thank you. 00:27:29.842 --> 00:27:34.380 So the research team -- what are the plans for their 00:27:34.380 --> 00:27:38.918 current workforce study that is in the field now or 00:27:38.918 --> 00:27:43.456 will be in the field to further dive into information 00:27:43.456 --> 00:27:44.457 about APRNs? 00:27:44.457 --> 00:27:47.994 Is that an area that you are going to continue to focus 00:27:47.994 --> 00:27:49.462 on as you move forward? 00:27:49.462 --> 00:27:51.764 >> That is an excellent question. 00:27:51.764 --> 00:27:53.966 I appreciate the plug. 00:27:53.966 --> 00:27:57.637 The timing of this presentation is perfect. 00:27:57.637 --> 00:28:01.407 We actually went into the field with our 2024 national 00:28:01.407 --> 00:28:04.444 nursing workforce survey just about 1.5 weeks ago. 00:28:04.444 --> 00:28:07.313 If you're one of the jurisdictions that will be 00:28:07.313 --> 00:28:10.216 receiving direct mail, I highly encourage you if you 00:28:10.216 --> 00:28:13.453 receive that to please fill it out and send your 00:28:13.453 --> 00:28:16.656 important responses back to Wells. As it relates to our 00:28:16.656 --> 00:28:20.193 plans for the future, one of the things that makes our 00:28:20.193 --> 00:28:23.096 study so important in addition to being the most 00:28:23.096 --> 00:28:25.031 comprehensive is how timely it is. 00:28:25.031 --> 00:28:27.800 It comes out every 4 years. 00:28:27.800 --> 00:28:31.137 Researchers who make use of secondary nonnursing data 00:28:31.137 --> 00:28:34.874 sets such as the American community survey are beholden 00:28:34.874 --> 00:28:38.644 to their timelines with the census I think presenting 00:28:38.644 --> 00:28:41.647 the most obvious obstacles to timely reporting. 00:28:41.647 --> 00:28:44.450 We conduct a national nursing workforce survey every 2 00:28:44.450 --> 00:28:44.784 years. 00:28:44.784 --> 00:28:48.287 What that means is that the project becomes a labor of 00:28:48.287 --> 00:28:48.621 love. 00:28:48.621 --> 00:28:51.657 We believe in the project and the importance of the 00:28:51.657 --> 00:28:52.158 project. 00:28:52.158 --> 00:28:55.495 We think it is absolutely imperative that nurses make 00:28:55.495 --> 00:28:59.065 their voices heard and inform state and federal policy. 00:28:59.065 --> 00:29:03.770 To do that and make sure that we are at the forefront 00:29:03.770 --> 00:29:07.707 of the discussion, we administer this every 2 years. As 00:29:07.707 --> 00:29:12.045 I provided and filled in a few more details, the 2024 00:29:12.045 --> 00:29:16.382 survey is live. Moving forward, it is our plan that we 00:29:16.382 --> 00:29:19.552 will provide separate and targeted breakouts for the 00:29:19.552 --> 00:29:23.489 APRN workforce so that we can track many of these 00:29:23.489 --> 00:29:25.858 important family issues associated with practice 00:29:25.858 --> 00:29:28.594 characteristics and demographic profiles and shifts in 00:29:28.594 --> 00:29:30.163 practice settings, et cetera. 00:29:30.163 --> 00:29:33.966 Policy makers at the state and federal level can be 00:29:33.966 --> 00:29:36.235 kept abreast of these important issues. 00:29:36.235 --> 00:29:39.839 >> Terrific, thank you. 00:29:39.839 --> 00:29:43.643 You mentioned that the Psalm analysis for about APRNs 00:29:43.643 --> 00:29:48.281 that you have reported on today will be coming out in 00:29:48.281 --> 00:29:50.416 the Journal of nursing regulation. 00:29:50.416 --> 00:29:51.617 >> Yes, correct. 00:29:51.617 --> 00:29:55.221 It will be a little bit longer than the standard length 00:29:55.221 --> 00:29:56.656 as you might guess. 00:29:56.656 --> 00:30:00.593 This is our first foray into the APRN workforce in 00:30:00.593 --> 00:30:03.396 terms of a specific highlight or spotlight. 00:30:03.396 --> 00:30:05.598 It's a little bit longer than the standard issue. 00:30:05.598 --> 00:30:10.169 It is not necessarily the same level of scope as the 00:30:10.169 --> 00:30:10.670 supplement. 00:30:10.670 --> 00:30:13.639 The rationale behind that was because APRNs to a 00:30:13.639 --> 00:30:16.376 limited extent have historically been included in that 00:30:16.376 --> 00:30:20.079 supplement. We tried not to kind of cover of the same 00:30:20.079 --> 00:30:21.447 ground so to speak. 00:30:21.447 --> 00:30:25.018 That particular sub analysis as well as targeting 00:30:25.018 --> 00:30:28.121 analyses from our 2022 national nursing workforce 00:30:28.121 --> 00:30:33.026 surveys are due out and probably than next week or so. 00:30:33.026 --> 00:30:37.030 I highly encourage you to monitor the Journal of 00:30:37.030 --> 00:30:41.467 nursing regulation work site and to reach out to me 00:30:41.467 --> 00:30:45.038 should you have any further questions and want 00:30:45.038 --> 00:30:49.475 clarification or maybe want to get some early access to 00:30:49.475 --> 00:30:51.711 some of those detailed findings. 00:30:51.711 --> 00:30:56.082 >> Thank you so much for your presentation and for your 00:30:56.082 --> 00:31:00.053 terrific work of you and your team on the tremendous 00:31:00.053 --> 00:31:04.424 research to that that you do for NCSBN and for the 00:31:04.424 --> 00:31:05.591 entire nursing community. 00:31:05.591 --> 00:31:10.163 Thank you very much.