In Florida, a Detailed Picture of the Nursing Shortage Leads to Smarter Solutions

Ever since the philosophical debate over how many teeth were in a horse’s mouth was settled by actually counting them, evidence-based research has been the cornerstone of good science and sound policy. This is exactly what’s happening at the Florida Center for Nursing in Orlando, where a veteran nurse administrator and a sociologist are setting the standard for how to measure a state’s nursing shortage with a precision that results in targeted solutions.

When the Florida Center for Nursing was established in 2001, the state ranked 31st in its ratio of working nurses to the patient population, and was predicting a shortage of about 8,060 nurses by 2011. While the projected health care needs of an aging baby boom are responsible for these kinds of trends in all 50 states, the Sunshine State’s challenge is even greater: as a popular retirement destination, it has the highest percentage of citizens aged 65 and older, and its hospitals are seeing their admission rates outpace the rest of the country every year. The current nursing workforce in Florida, as elsewhere, is not big enough and does not have the necessary skills to meet the needs of this aging population. Older Americans have evolving and often complex health care needs, and will also be receiving more of their care in non-hospital settings. Legions of new, well-educated nurses will be needed to provide the primary and preventive care, chronic care management and care coordination necessary to increase older Americans’ access to quality health care while still reducing waste and bringing down costs.

“For the 36 years I have practiced nursing I have always had a commitment to do advocacy for nurses and for patients,” says Mary Lou Brunell, MSN, RN, Executive Director of the Florida Center for Nursing. This approach also informs Brunell’s work as co-leader of the Florida state team, one of 30 state teams working with the Center to Champion Nursing in America (CCNA), an initiative of AARP, the AARP Foundation and the Robert Wood Johnson Foundation. CCNA works to ensure that all Americans have access to a highly-skilled nurse, when and where they need one.

At the Florida Center for Nursing, Brunell and Associate Research Director, Jennifer Nooney, PhD, know that getting where you want to go starts with knowing where you are, and that begins with a rigorous analysis of their state and its current nursing workforce.

Florida is a large and complex state, the 4th most populous in the country, from its densely populated Southern tip to its sparsely populated panhandle. Brunell says that because “Florida is so big and diverse, we decided the approach of regional teams was the best way to go.” The Florida Center’s analysis of the state’s residents and nursing workforce by region gives six designated regional teams the information they need to implement solutions that make sense locally while also generating a clearer statewide picture of where Floridians need more nurses to meet their health care needs.

For example, Florida’s Northeastern region, which includes the cities of Jacksonville and Gainesville, has about 931 registered nurses per 100,000 residents, which is more nursing labor per population than any other area in the state. In the heavily populated South, (mainly Miami-Dade county) however, there are only about 650 nurses per 100,000 residents. South Florida and the Northwest panhandle (which is bordered along the south by the Gulf of Mexico and includes Tallahassee and Pensacola) are also behind the statewide average on the measure of nurses per hospital bed, which is a key indicator of quality of care for patients and quantity of workload for nurses.

One vital source of information used in Brunell and her colleagues’ research is licensing data from the Florida Board of Nursing. At the Florida Center for Nursing’s request, the Board has added nine additional questions to the renewal application that allows for a detailed portrait of Florida’s nurse workforce, including: level of education, years of experience, hours worked and in what settings, and demographics such as age, gender and ethnicity. This data is collected every two years to coincide with the license renewal calendar and ensure its real time accuracy.

Perhaps most relevant to addressing the nursing shortage are discoveries gleaned from this data about the age and experience of the potential nurse workforce in Florida. Although the number of newly graduating nurses has spiked recently, the overall number of available nurses is growing too slowly to keep up with projected demand because so many are leaving the profession. Roughly 40% of Florida’s nurses are over age 51 and will be retiring in the next ten years; this is loss that directly impacts the state’s health care consumers, and points to an urgent need for retention programs to keep experienced nurses at patients’ bedsides and mentoring younger colleagues.

Using their success with data gathering and analysis, Brunell and Nooney are leading the National Forum of State Nursing Workforce Centers’ effort to create a model that will help other states build their own data sets and adhere to consistent terminology to generate accurate descriptions of the supply of, demand for and educational levels of the nurse workforce in any given state. This portion of their work is supported by the Center to Champion Nursing in America.
As one of 30 state teams, Florida illustrates the value of reliable research – and generous outreach. All the state teams are committed to increasing nursing education capacity to address the looming nursing shortage and educate, build and deploy the nursing workforce of the future. Teams are comprised of representatives from nursing education, state workforce offices, state departments of labor, consumers (often AARP state offices), local business, philanthropies, and others. Through strategic partnerships, they implement changes to nursing education, advocate for policy changes, and address faculty shortages all to increase nursing school enrollment and bring more nurses into the workforce. The Center to Champion Nursing in America provides ongoing technical assistance to help teams accomplish these critical tasks and fosters collaborative learning experiences that link the teams and allow them to share best practices and lessons learned with their peers in the other states.
Says Brunell, “nurse advocacy and consumer advocacy are critical partners in resolving this public health issue. AARP represents consumers and its outreach to nurses through this program is a great model. It’s these broader relationships that are going to make the difference.”