A Few (More) Good Nurses

Over the last several weeks I’ve been doing what many of us do to support the next generation: keeping my fingers crossed. My nephew, who is in college and works part-time as a certified nursing assistant (CNA), has applied to nursing school in the hopes of getting one of the few slots available.

He does well academically and has wanted to become a nurse since he began volunteering at a local agency that serves the homeless and people with substance abuse problems. In a few days he’ll know whether his dream will come true.

In 2008, the Institute of Medicine published The Future of Nursing: Leading Change, Advancing Health. One recommendation of the report was to increase the number of registered nurses (RNs) with a bachelor’s degree to 80% by 2020. The report noted that 75,000 qualified applicants are turned away every year.

This week the California Health Care Foundation released a package of workforce-related publications as part of our long-running California Health Care Almanac. It includes a number of interesting findings.

For example, California Nurses: Taking the Pulse finds that new student enrollment in California’s prelicensure nursing programs nearly doubled between 2002 and 2011. Yet the state still significantly trails the national average in RNs per capita. And while the nursing workforce has grown more diverse — nonwhite RNs accounted for almost half (47%) of employed nurses in 2012 — Latinos remain significantly underrepresented at 7%.

As the health care delivery system prepares for increasing demand — the result of newly insured patients under the Affordable Care Act and an aging population — we need to figure out ways to expand the number of nurses, who are a vital sector of our medical workforce.

When it comes to the number of physicians in California, we need to answer another question: Are there too few or too many? Our new report, California Physicians: Surplus or Scarcity?, reveals that the number of physicians in the state increased by nearly 40% from 1993 to 2011, outpacing growth in the general population. Yet close to one-third of California’s physicians are nearing retirement age. How many will stick around to care for the expanding population of insured Californians?

These publications raise important questions about what the correct ratio of health professionals to population ought to be. For example, as highlighted by the infographic below (click to see full view), there are enormous differences in the number of primary care doctors and specialists in the San Joaquin Valley compared to the San Francisco Bay Area. Is the valley’s generally poorer health due to a lack of specialists? Or are poverty and other social problems the real drivers?

To bring context to such regional gaps in supply and what they might mean for California, we interviewed Ed O’Neil, former director of the Center for Health Professions at UCSF, as part of a new CHCF video series called “On Deck.”

The larger message here is that we shouldn’t have to keep our fingers crossed about whether there will a sufficient number of nurses, physicians, and other health professionals to take care of us. We need a better working theory about the right number, and then we need to work together to plan accordingly.

And in a plug for my nephew, the nursing field could still use more good nurses.

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