The Hunt for Good Nursing Workforce Data: Lessons Learned
Eichelberger, Lisa Wright
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Session presented on Saturday, July 23, 2016 and Sunday, July 24, 2016: Purpose: The purpose of presentation is to share Georgia's nursing workforce survey results, identify strategies used to significantly increase response rates, describe lessons learned from the collaboration processes critical to the success in obtaining the statewide workforce data and identify all state, national, legislative, and political agents needed to accomplish the task. Background and Significance: Nursing workforce supply data are key for any kind of state workforce planning. Georgia, like so many other states, have been challenged to meet the growing health care needs of its citizens and without valid and reliable workforce information, it is impossible to plan for changing needs. Georgia had no system in place to collect nursing data that yielded meaningful results. Georgia's re-licensure survey did collect some general demographic information but the questions were not based on the National Nurse Minimum Dataset (NDS) which was developed by the National Forum of State Nursing Workforce Centers and the highest response rate was only 14% or so. Georgia's leaders understood that incorporating the NDS into Georgia's nursing workforce data was critical to nursing if we were to be able to facilitate cross-state comparisons and build a national repository of data. Georgia's attorney general had ruled that making the collection of any sort of survey data a part of the required nurse licensure renewal process was an invasion of privacy and therefore could not be mandated so requiring nurses to complete any type of survey questionnaire was out of the question. Methods: With the release of the Institute of Medicine Future of Nursing Report, Georgia nurse leaders began to address workforce data by advocating for changes to the re-licensure survey in 2011. Twenty seven thousand dollars was obtained from the Secretary of State's office to redesign the existing nursing relicensure survey using the NDS. The new survey (still voluntary) included questions from the NDS and very importantly, the placement of the survey was changed placing it before the payment section of the renewal process. Though the questionnaire was slightly longer that before, there was a huge growth in the response rate, going from 14% to 85%. Georgia license half its nursing workforce one year and half the next. So it took the GNLC two years to get a complete data set that included over 120,000 individual nurses' datasets. The methods used was to notify via email that all current Georgia RN license holders whose license was expiring to go to the Georgia Board of Nursing website to renew online. Any new license could also obtain a new license through the website as well. Data was collected at the end of the renewal period at stored on servers at the Secretary of State's office for analysis. However, there were numerous unanticipated problems delayed the release of correct data three years, until fall of 2015. These problems included issues with the technology processing the data, the governmental office overseeing the nursing licensure process, and the communication among the various stakeholders involved at the state and national levels. The Georgia Nursing Leadership Coalition (GNLC) worked for over four years to obtain good state nursing workforce data using four strategies: patience, partnerships, pressure and perseverance. The first strategy was patience. Patience was used initially and through the process. While not successful initially and valuable time was lost being too patient, patience was extremely important later in the process when relationships were strained and situations tense. Pushing and making demands of the multiple partners could have caused the collaboration to split apart so I believe that patience truly was and is a virtue in dealing with multi state agencies and political entities. The person involved in the process truly must be able to finesse the situation and read the players carefully. Patience was the strategy we used first but if I had to identify one strategy as the most important or list them in order of priority, I would have to list the quality of your partnerships as the most important in getting your workforce research accomplished. Georgia would not have its nursing workforce data without the support of our external partners and behind the scene assistance. It was absolutely critical. So if there is one lesson learned, it was to know that you can't do it alone, you need good partnership and when to ask for help. The GNLC partnered with the Georgia Nurses' Association, the Georgia Board of Nursing, the National Council of State Boards of Nursing, the Georgia Board of Regents, the Governor's Office, Clayton State University's lobbyist, the Center to Champion Nursing in America and used the weight of Robert Wood Johnson Foundation because the third strategy was to know when and how to use pressure if you have to to get the job done. The GNLC co-lead pressured the Secretary of State and his staff and the paid consultant to address internal problems, the resource problems and non-performance issues when they existed. The last strategy I will speak about GNLC leadership did not give up. They were committed to the task and that is the fourth strategy perseverance. They worked together to develop a plan on how they were going to stick with it and allowed one person to be the point person to facilitate communication among all the stakeholders to ultimately find a solution to obtain good data. Others agreed to trust the point person and back off. Results: A final set of correct data for one complete nursing re-licensure cycle was received in September, 2015 due to the strategies followed by the GNLC. For the first time in Georgia's history, we have meaningful, ongoing nursing supply data. With a response rate of approximately 85%, we are able to generalize and extrapolate to make meaningful conclusions about the workforce in Georgia. The benefits are many. Our nursing data are being reported to National Council of State Boards of Nursing's NurSYS program to help protect the public from nurses who lose their licenses. We are now able to share our data with the National Forum of State Nursing Workforce Centers and add to the national dataset, this legislative session as an example, we will be able to use our data about where Advance Practice Nurses are working etc. to support legislation as we open Nurse Practice Act in 2016. Conclusions: Obtaining good state data can be a complicated process that at times may seem impossible. However, if meaningful planning is to occur, there is no other way for this to happen particularly in small states where using national data for small states proves unreliable (Hassmiller, 2015). Obtaining reliable and valid statewide workforce data involves many partners and strategies to manage both the evolution and the relationships. This presentation has described one state's process to success and lessons learned.