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Retention of Nurses in Wyoming

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Retention of Nurses in Wyoming REETENTIONTENTION OOFF NUURSESRSES IINN WYYOMINGOMING Wyoming Department of Employment R&P Part II in a Series of Publications Related to the Nursing Situation in Wyoming Research & Planning Wyoming DOE August 2008 Contents Page ii A summary of this report is available at Research & Planning’s Nursing Studies website: http://doe.state.wy.us/LMI/nursing.htm Nurse Advisory Committee Cheryl Koski, MN, RN WYOMING BOARD OF NURSING (RETIRED) Mary Beth Stepans, PhD, RN WYOMING BOARD OF NURSING (ASSISTANT EXECUTIVE DIRECTOR) Faith Jones, MSN, RN WYOMING ORGANIZATION OF NURSE EXECUTIVES, POWELL VALLEY HEALTHCARE Toni Decklever, MA, RN WYOMING COMMISSION FOR NURSING AND NURSING EDUCATION Karen Outz, PhD, RN WYOMING DEPT OF HEALTH, PUBLIC HEALTH COMMUNITY AND RURAL HEALTH DIVISION Judy McDowell, MS, RN, CNE NURSE EDUCATORS OF WYOMING Veronica Taylor, RN, MS WYOMING NURSES ASSOCIATION, PRESIDENT Tracy Farris, MS, FNP-C WYOMING ADVANCED PRACTICE, NURSES ASSOCIATION Cindy Rankin, RN, CRRN WYOMING LONG TERM CARE ASSOCIATION Wyoming Department of Employment Research & Planning RETENTION OF NURSES IN WYOMING Wyoming Department of Employment Gary W. Child, Director Research & Planning Tom Gallagher, Manager Prepared by: Edited by: Dr. Mark A. Harris Phil Ellsworth Sylvia D. Jones April Szuch Lisa Knapp Douglas W. Leonard Reviewed by: David Bullard Valerie A. Davis Carol Toups Sara Saulcy Submitted for Publication August 2008 ©2008 by the Wyoming Department of Employment, Research & Planning Research & Planning Wyoming DOE Department of Employment Nondiscrimination Statement The Department of Employment does not discriminate on the basis of race, color, religion, national origin, sex, age, or disability. It is our intention that all individuals seeking services from our agency be given equal opportunity and that eligibility decisions be based upon applicable statutes, rules, and regulations. Research & Planning P.O. Box 2760 Casper, WY 82602-2760 Phone: (307) 473-3807 Fax: (307) 473-3834 Website: http://doe.state.wy.us/LMI/ “Your Source for Wyoming Labor Market Information” Contents Page iv Retention of Nurses in Wyoming Contents Chapter 1: The System as a Whole 1 Introduction 2 Glossary 2 Review of Literature Related to Nursing Retention 7 Retention Issues 8 Rural Nursing and Migration 10 Solutions 12 References 14 Synopsis of Methodology 20 Table 1: Timeline for Wage Record Follow-Up on Nurse Intention to Leave Primary Employer Within One Year 20 Table 2: Ambulatory Health Care Services Nurses Who Indicated an Intent to Leave Their Primary Employer Within One Year 21 Table 3: Hospital and Nursing & Residential Care Facilities Nurses Who Indicated an Intent to Leave Their Primary Employer Within One Year 21 Factor Analysis 22 Table 4: Factor Analysis Question Groupings 22 Logistic Regression Model Development 23 Logistic Regression Results 24 Table 5: SAS Logistic Regression Model Variables and Descriptions 24 Table 6: Analysis of Maximum Likelihood Estimates 24 Table 7: Odds Ratio Estimates 25 Table 8: Association of Predicted Probabilities and Observed Responses 25 Discussion 26 Summary 26 Figure 1: Probability of Respondents’ Stated Intent to Leave Primary Employer Within One Year and Correlated Factors 26 References 30 From Modeling to Prediction 27 Methodology 27 Results 27 Figure 2: Wyoming Firm-Level Registered Nurse Exit Rates and Salary Satisfaction Scores, Third Quarter 2007 28 Summary 28 Figure 3: Wyoming Firm-Level Registered Nurse Exit Rates from Hospitals vs. Feelings of Being Tied to the Community, Third Quarter 2007 29 Figure 4: Wyoming Firm-Level Registered Nurse Exit Rates from Hospitals and Professional Development Satisfaction Scores, Third Quarter 2007 29 Comment Analysis 30 Comments on Modeled Concepts 31 Table 9: Comments by Factor Analysis Question Grouping 32 Themes in the Comments Not Found in the Model 35 Why Age Is important 37 Age by Intent to Leave Primary Employer Within One Year 37 Age by Primary Reason for Leaving Primary Employer Within One Year 38 Table 10: Wyoming Registered Nurses’ Intent to Leave Primary Facility Within One Year by Age Group 38 Table 11: Wyoming Registered Nurses by Age Group and Stated Reason for Intent to Leave Primary Facility 39 Wyoming Department of Employment Research & Planning Contents Retention of Nurses in Wyoming Page v Age and Nativity 40 Meeting with Nurse Advisory Committee, May 19, 2008, Casper, WY 42 Table 12: Table 12: Age Distribution of Registered Nurses by Age Group and High School Location 42 Table 13: Statistical Tests of Frequency Distribution 43 Summary 44 References 44 Analysis of Comments by Age 45 Table 14: Age Distribution of Total Responding Nurses and Those Who Wrote Comments 45 Table 15: Theme of Comment by Age of Respondent 46 Labor Flow Components 49 Introduction 49 Market-Level Exits 49 Labor Market Permanent Exits 49 New and Re-Entrant RNs 49 Table 16: Market-Level Exits from Health Care for Registered Nurses by Age Group, First Quarter 2000 to Fourth Quarter 2005 50 Table 17: Market-Level Turnover Exits from All Other Industries for Registered Nurses by Age Group, First Quarter 2000 to Fourth Quarter 2005 50 Combining the Elements 51 Table 18: Labor Market Level Permanent Exits for Registered Nurses 51 Table 19: New Entrant Registered Nurses in Health Care by Age Group, First Quarter 1999 to Third Quarter 2006 52 Table 20: New Entrant Registered Nurses in All Other Industries (Not Health Care) by Age Group, First Quarter 1999 to Third Quarter 2006 52 Description of Net Mortality 53 Table 21: Re-Entrant Registered Nurses in Health Care by Age Group, First Quarter 1999 to Third Quarter 2006 53 Table 22: Re-Entrant Registered Nurses in All Other Industries (Not Health Care) by Age Group, First Quarter 1999 to Third Quarter 2006 53 Figure 5: Stock and Flow of Wyoming Registered Nurses (Four-Quarter Moving Average) Fourth Quarter 1999 to Fourth Quarter 2005 54 Summary 54 Figure 6: Subsequent Wyoming Work Status of the Cohort of Nurses Who Graduated From a Nursing Program and Became Registered in Wyoming During Calendar Year 2001 55 Differences Between Net Mortality and Permanent Exit 55 Figure 7: Subsequent Wyoming Work Status of the Cohort of Nurses Who Graduated From a Nursing Program and Became Registered in Wyoming During Calendar Year 2002 56 Figure 8: Subsequent Wyoming Work Status of the Cohort of Nurses Who Graduated From a Nursing Program and Became Registered in Wyoming During Calendar Year 2003 56 Employer-Level Turnover Rates by Industry and Experience 57 Ambulatory Health Care Services 57 Hospitals 57 Nursing Homes and Residential Care Facilities 57 Table 23: Employer-Level Turnover Rates for Registered Nurses in Ambulatory Health Care Services by Health Care Experience, First Quarter 2000 to Fourth Quarter 2006 58 Table 24: Employer-Level Turnover Rates for Registered Nurses in Hospitals by Health Care Experience, First Quarter 2000 to Fourth Quarter 2006 58 Summary 59 Table 25: Employer-Level Turnover Rates for Registered Nurses in Nursing & Residential Care Facilities by Health Care Experience, First Quarter 2000 to Fourth Quarter 2006 59 Comparing Labor Market Outcomes for Nurses, Teachers, State Employees, and a Control Group 60 Data and Methodology 60 Exit Rate Comparisons 61 Average Age Comparisons 61 Figure 9: Exit Rates for Nurses, State Employees, and Teachers in Wyoming, First Quarter 2003 to Fourth Quarter 2005 62 Table 26: Registered Nurses with Active Licenses by Place of Work, Third Quarter 2006 62 Summary 62 Table 27: Gender Distribution for Nurses, Teachers, and Highly Educated State Employees, Second Quarter 2003 63 References 63 Figure 10: Exit Rates for Female Nurses, State Employees, and Teachers in Wyoming, First Quarter 2003 to Fourth Quarter 2005 63 Wyoming Department of Employment Research & Planning Contents Page vi Retention of Nurses in Wyoming Figure 11: Exit Rates for Male Nurses, State Employees, and Teachers in Wyoming, First Quarter 2003 to Fourth Quarter 2005 64 Figure 12: Exit Rates for Nurse and Control Groups in Wyoming, First Quarter 2003 to Fourth Quarter 2005 64 Figure 13: Average Age for Exiting Nurses, State Employees, and Teachers in Wyoming, First Quarter 2003 to Fourth Quarter 2005 65 Figure 14: Average Age for Exiting Female Nurses, State Employees, and Teachers in Wyoming, First Quarter 2003 to Fourth Quarter 2005 65 Figure 7: Average Age for Exiting Male Nurses, State Employees, and Teachers in Wyoming, First Quarter 2003 to Fourth Quarter 2005 66 2. Description of the System 67 Nurse Commuting Patterns: Where Nurses Live and Work 68 Table 1: Registered Nurses Residing and Working in Wyoming Counties, Fourth Quarter 2004 to First Quarter 2007 68 References 70 Map 1: Intercounty Commuting Infl ow of Nurses to Sweetwater County, Fourth Quarter 2005 71 Map 2: Intercounty Commuting Outfl ow of Nurses from Sweetwater County, Fourth Quarter 2005 71 Nurses Leaving the Labor Market 72 Table 2: Market-Level Exits for Wyoming Registered Nurses in Health Care Industries by Age Group, First Quarter 1999 to Third Quarter 2006 72 Table 3: Market-Level Exits for Wyoming Registered Nurses in All Other Industries (Not Health Care) by Age Group, First Quarter 1999 to Third Quarter 2006 73 Figure 1: Market-Level Exits for Registered Nurses in Health Care Industry by Age Group, First Quarter 1999 to Third Quarter 2006 74 Figure 2: Market-Level Exits for Registered Nurses in Other Industries (Non-Health Care) by Age Group, First Quarter 1999 to Third Quarter 2006 74 Staffi ng Levels, Employment, and Employer-Level
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