Follow-Up to Regents Task Force on Nursing

This report was presented at the March 2002 meeting of the New York State Board of Regents.

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TO: SUBJECT:

The Honorable the Members of the Board of Regents Follow-Up Activities on Recommendations of the Regents Blue Ribbon Task Force on the Future of Nursing

Summary

In December 2001, Regent Diane O'Neill McGivern presented a report to the Board of Regents on the following six recommendations of the Regents Blue Ribbon Task Force on the Future of Nursing to address the nursing shortage in New York State:

• Retention: Support initiatives to retain current nursing workforce, including pursuit of best practice principles such as the magnet hospital model.
  
  
• Recruitment: Expand the nursing workforce by recruiting additional numbers of men, minorities, non-practicing nurses, and recent high school graduates.
  
  
• Education: Provide additional academic and financial support systems to increase the pool of nursing school graduates and create career ladders.
  
  
• Technology: Increase the application of labor-saving technology to eliminate unnecessary, duplicative paper work and improve access to and communication of patient information, thereby improving workplace conditions.
  
  
• Data Collection: Develop a reliable central source of data on the future need for nurses in the workforce upon which employers, policymakers, futurists, researchers and legislators may base public policy and resource allocations.
  
  
• Clarification of Existing Laws and Regulations regarding:
  
  
  1. Scope of practice: Issue practice guidelines to clarify the legal scope of practice of nursing, including those tasks that do not require licensure. These guidelines will reaffirm the individual practitioner's responsibility for patient care, even within demanding workplace settings.
     
     
  2. Definition of patient abandonment: Familiarize field with existing Regents regulations which describe patient abandonment, clarifying that refusal to work a double shift or other mandatory overtime in ordinary circumstances does not necessarily constitute professional misconduct.

At the conclusion of the presentation to the Board of Regents on these recommendations, Chancellor Carl T. Hayden requested that a timeline be developed to project and monitor progress by the Task Force, the State Board for Nursing and the Department, in meeting these recommendations. This report provides that timeline and an update on ongoing and projected activities to carry out the recommendations of the Task Force.

Improve Available Data

The Department has begun a two-phased approach to collect data in response to the Task Force's recommendation to develop a reliable, central source of data on the need for nurses. The data will be used to guide public policy decisions and resource allocations.

Phase I: Identify and coordinate repositories of existing data

Existing data on the nursing workforce in New York State are plentiful. Researchers, employers, and organizations regularly collect independent data on a wide variety of factors influencing the nursing profession. Some studies sample large numbers of nurses across the State to determine wide-ranging trends while others attempt to uncover specific tendencies of sub-populations of nurses in a single county or region. To facilitate usefulness of existing data and to identify gaps in data on which to build Phase II, the Department is collecting data and reports related to the nursing profession and organizing them based on source, purpose and outcome. Resulting conclusions could prove valuable to employers, policymakers, educators, legislators or others depending on their specific requirements.

Since the Board of Regents licenses nurses and regulates the practice of the nursing profession in New York State, the Department is also a significant source of existing data on the nursing workforce. In Phase I, Department staff have already begun to identify longitudinal trends in the number of new licensees and annual re-registration counts. For example, over a recent ten-year period, the number of new licenses issued for licensed practical nurses (LPN) has decreased 58 percent, from 7,139 licenses in 1991 to 3,009 in 2000. Likewise, the number of newly licensed registered professional nurses (RN) has decreased 22 percent, from 10,365 licenses issued in 1991 to only 8,057 issued in 2000.

Number of Nursing Licenses Issued Each Year in New York

In addition, while the total number of licensed and registered RNs increased almost 25 percent from 1980 to 1990, that number is approaching stagnation. Since 1990, there has been a mere 4.3 percent increase in licensed and registered RNs in New York State, as the following chart shows.

Number of RNs Licensed and Registered in New York State

Staff are also analyzing Department data on the geographic distribution of all licensed RNs in relation to select United States Census data. A partnership with the State Library is being explored to use a Geographic Information System (GIS) to examine and display data. GIS will enable the identification of estimates such as the number of RNs per county in New York State and the ratio of RNs to New Yorkers by geographic region. This information could guide decision-making and resource allocations for key areas significantly impacted by the nursing shortage.

Phase II: Collect new data based upon the gaps identified in existing data

To supplement existing data, the Department will conduct a survey of RNs, which will precisely define the current nursing workforce and track key indicators of the nursing shortage. The Office of the Professions has partnered with the Department's Fiscal Analysis and Research Unit within the Office of Management Services to design and distribute a comprehensive survey to identify specific characteristics, attributes and expectations of New York's nurses. Workforce surveys administered by the Department in the past are being used as design models. Members of the Blue Ribbon Task Force, the State Board for Nursing, as well as representatives from other professions will be engaged in contributing to the development of the survey tool. The survey tool will be mailed to nurses by September 2002 and the collection and analysis of results will be completed by June 2003.

Clarify Existing Laws and Regulations

Patient Abandonment:

The Nurse Practice Committee of the State Board for Nursing has begun development of guidelines to clarify that refusal to work a double shift or other mandatory overtime in ordinary circumstances does not necessarily constitute professional misconduct. Nurses need to know that threats of charges of professional misconduct for such instances are not warranted. Position statements on this issue have been gathered from throughout the country to inform the work of the Nurse Practice Committee. The Committee's recommendations will be reviewed by the full Board for Nursing and the Deputy Commissioner for the Professions. It is projected that the work of the Committee will conclude by August 2002. Regulatory action, if required, could be considered and implemented by the Regents by February 2003.

Scope of Practice for Nurses:

Practice guidelines are being developed to clarify the legal scope of the practice of nursing, including those tasks that do not require licensure, the use of unlicensed assistive personnel, and the role of the Licensed Practical Nurse performing certain tasks in certain settings. It is projected that practice guidelines on these topics will be available for consideration and approval by the Regents by September 2002. However, providing guidance on practice issues is an activity that has no end since nursing, as all other professions, exists in a dynamically changing environment that challenges licensees to continually consider and update "best practices."

Address Recruitment and Retention Needs

Through the Regents leadership, many of the resources of The University of the State of New York will be tapped to inform students about the nursing profession and encourage nurses to stay in practice.

• The State Board for Nursing has pursued a collaborative relationship with the Office of Elementary, Middle, Secondary, and Continuing Education (EMSC) to work together with school counselors to promote nursing as a viable and desirable career choice. A pilot project is slated to begin in September 2002. Extensive outreach to guidance counselors is projected to occur throughout the 2002-3 school year to be followed by ongoing field outreach.
  
  
• The Office of the Professions is supporting outreach through various speaking engagements. Deputy Commissioner Johanna Duncan-Poitier will discuss the nursing shortage as keynote speaker for the annual March of Dimes convention while the Executive Secretary for Nursing will speak to recruiters for nursing students and new nursing graduates in the greater New York City region.
  
  
• The State Board for Nursing established a speaker's bureau where Board members speak to student groups about careers in nursing. Board members have presented information to hundreds of students in elementary and junior high schools as well as to parents and other relatives. This activity is ongoing.
  
  
• In January, the Department announced the availability of Regents Professional Opportunity Scholarships for New York State residents who are economically disadvantaged and/or a member of an underrepresented minority group and who are beginning or enrolled in an approved nursing program. Deadline for receipt of applications is May 1, 2002. The scholarships directly support the Task Force's recommendation to encourage minorities and men to consider the nursing profession.
  
  
• The Department has developed supportive position statements on several legislative proposals that would provide financial benefits to students of nursing science, nurses who choose to stay in the field, and nurses who teach at the post-secondary level. Support would come in the form of scholarship funding, loan forgiveness plans, as well as tax relief prorated on time spent in actual nursing practice. The Department will develop a position on related proposed legislation based on a careful analysis of the cost/benefits of such proposals. This activity is tied to the legislative session calendar.

Develop a Nursing Shortage Clearinghouse

The leadership role of the Regents, through the formation of the Blue Ribbon Task Force on the Future of Nursing, has focused the attention of many health care providers, educators and legislators on addressing the nursing shortage. Copies of the Task Force report were distributed to all Forum invitees, members of the New York State Congressional delegation, members of the New York State Senate and Assembly, and key members of the Governor's staff. It has also been distributed widely to thousands of individuals in the healthcare and nursing community.

• The report is being read and cited as a reference in articles in the press and by other agencies and organizations reporting on their initiatives to address the nursing shortage. For example, the Spring 2002 issue of The Independent Sector, a publication highlighting New York's 100+ private colleges and universities, featured an article titled "Changing the Future of Nursing" which cited the Regents Blue Ribbon Task Force on the Future of Nursing. The article describes initiatives consistent with the recommendations of the Task Force in nine private colleges and universities with nursing programs.
  
  
• A number of Task Force members are addressing the nursing shortage and implementing recommendations through their respective organizations.
  
  
• Other states, other organizations, many private individuals, and the federal government are working hard to solve this impending crisis. Their work is being monitored regularly by State Board for Nursing staff.

Recognizing opportunities for benchmarking and collaboration, the State Education Department will serve as a clearinghouse for sharing information on these efforts. The Office of the Professions will collect periodic reports from Task Force members and from the literature, tracking:

• recent activities or strategies to address the nursing shortage,
• subsequent impacts, and
• contacts for additional information and/or opportunities for alliance.

Information will then be distributed to Task Force members and other designated partners, encouraging further activity and collaboration. Information gathering has already begun. Distribution of information is slated to begin in June 2002.

Conclusion

A major strength of the Regents important role in addressing work force shortages is the ability to initiate dialogue with leaders, provide strong general guidance and direction and clearly articulate the public protection responsibility of all involved. The recommendations of the Task Force have sparked others to initiate activities to address the shortage through local partnerships and activities. The State Board for Nursing will carry out the Regents recommendations and continue to spearhead a variety of efforts to address the nursing shortage from every possible angle and in partnership with all stakeholders. We will continue to gather data, provide information, support professionals, and to contribute to a variety of efforts aimed at solving the shortage.

The Task Force addressed an immediate need in the largest of New York's licensed professions. Signaled by demographic shifts brought about by the aging of the "Baby Boom" generation, however, nearly all professions will face similar workforce issues. Continuous, broad-based, and collaborative action will be needed to address workforce demands in all professions.

As a citizen board with oversight of more than 650,000 licensees in 39 professions and over 200,000 practicing certified teachers, the Regents are well positioned to lead by engaging partners and marshaling resources necessary to address this impending crisis. From the Regents vantage point, appropriate strategies and lessons learned in addressing the nursing shortage workforce can be applied across the spectrum of all the licensed and certified professions they regulate.

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Timeline: Addressing the Nursing Shortage

Data Collection

• Assemble and make Current Data Available: March - August 2002
• Construct and Distribute Survey: May - September 2002
• Collect and Analyze Survey Results: January - September 2003
• Complete and Release Results: September 2003

Clarify Existing Laws and Regulations

Patient Abandonment

• Research and Gather Input: March - June 2002
• Distribute: July - August 2002
• Regulatory Changes Adopted: September 2002 - February 2003

Scope of Practice for Nurses

• Gather Input: March - August 2002; ongoing
• Distribute: September - October 2002; ongoing

Share Clearinghouse Information

• Research and Gather Input: March - July 2002
• Assemble and Distribute: July - August 2002; ongoing

Recruitment and Retention

Field and Guidance Counselor Outreach

• Planning Stage: April - June 2002
• Outreach: September 2002 - July 2003; ongoing

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