The need to know.

Rarely does a need resonate so clearly as does Georgia's current critical need for a nursing workforce planning center. What we already know is that despite the fact that Georgia is the ninth largest state, it ranks 19th in the production of nurses. Currently the nursing vacancy rate in Georgia hospitals and nursing homes is 15-18% with a 20% vacancy rate for public health nurses. There is also a 10% nurse faculty vacancy rate with 41% of nursing professors in our state age 55 or older and a reported 63 retirements planned in the next five years. The lack of adequate compensation for nursing faculty has been a deterrent for recruitment and retention of Georgia's nursing faculty. A high vacancy rate in faculty currently prevents Georgia's nursing schools from admitting 4000 qualified applicants each year and exacerbates the workforce shortage. In fact, in 2006 Georgia graduated 600 less RNs than in 1996 and has only produced 15 nurses with doctoral degrees since 2000. Georgia's population is expected to grow 20% over the next decade. Our state's growing and aging population is creating a continuous increase in the demand for healthcare services that exceeds the current workforce capacity. Nurses know this because they live it everyday. Georgia ranks 42nd in its per capita supply of registered nurses and 48th in advanced practice nursing care.

The current nursing shortage is not news to anyone and it is not the first shortage Georgia has experienced. If there is any hope of a well thought out process to address this one and others in the future then there is an undeniable need to have a centralized process for collecting and analyzing statewide nursing workforce data related to all work settings so it can be fully understood. The collaborative work of the Georgia Nurses Foundation lead by Tim Porter O'Grady during its Leadership Initiative Project several years ago gathered community stakeholders together to do an environmental scan and raise awareness about the need to address these issues. This work included the participation of nurse leaders from all over the state along side community leaders and workforce stakeholders. It was clear then, as it is now, that GNA & GNF have the capacity to bring the community together around this issue.

The Georgia Nurses Association also actively engaged in the earlier work of the Georgia Health Care Workforce Advisory Committee (HCWPAC) created by the Georgia General Assembly in 2001. In 2004 this committee was allocated $343,000 from the state budget which ultimately helped generate an additional $13 million from private sector and government partners. The critical success and the momentum of this work were evident but the Committee's funding fell victim to state budget cuts in 2005. One of the HCWPAC successful initiatives that the Georgia Nurses Association helped initiate was Data/ Forecasting which provided an infrastructure to monitor the workforce, forecast pending supply and demand, and prevent future shortages. This framework for the management and utilization of data established a data consortium between relevant state agencies and created a mechanism for centralized data storage and effective use. RN license renewal surveys and statewide sample surveys were developed and critical research efforts were initiated. Three annual reports on Georgia's health care workforce were developed. Ongoing research relationships with state universities were established. In just two years enrollment in Georgia university system's nursing programs went up 50% and vacancy rates for RNs in nursing homes and hospitals dropped by 1.4% and 2.4% respectively.

These license renewal questionnaires and sample surveys helped policymakers and professionals get a better understanding of the distribution and demographics of the current workforce. These tools also helped professionals learn about perceptions and practice patterns that would promote better planning for future workforce needs. Data combined with strong analysis and forecasting capabilities are the keys to understanding and addressing workforce shortages over the long term. Other states and national entities recognized Georgia as a leader in developing this essential kind of integrated data and evaluation system.

It is unfortunate that this good work could not have continued.

Georgia is not alone in these alarming statistics but missing is the advantage 34 other states in our nation have--a nursing workforce center with an ongoing system for collecting, analyzing and researching accurate workforce data to predict the current and future demands for nurses in our state. By 2020 Georgia's estimated shortfall of registered nurses will be 37,000. At issue is the lack of a reliable and focused effort to centralize the collection and prediction factors that are necessary to ensure the citizens of this state a healthcare delivery system that is sustainable.

That is why the Georgia Nurses Association was pleased to participate this summer in the Georgia Senate Study Committee on the Shortage of Doctor's and Nurses in Georgia Chaired by Senator Cecil Stanton (District 18). This study committee was a result of Senate Resolution 66 to examine ways the legislature can promote the increase of Georgia's physician and nurse supply. Several GNA members gave testimony during the hearings including GNA Legislative Public Policy Director Michael McCann; GNA member Dr. Jean Bartels (Dean--Georgia Southern University SON); GNA member Dr. Donna Hodnicki (Professor--Georgia Southern University SON); GNA member Carole Jakeway (Chief Nurse, Georgia Department of Human Resources/Division of Public Health); GNA member Mary Anderson (CNO East Georgia Regional Medical Center); GNA member Dr. Lucy Marion (Dean, Medical College of Georgia-SON); GNA member Dr. Lisa Eichelberger (Dean, Clayton State University SON) and GNA member Maria Kulma (VP of Patient Services and CNO, Southern Regional Health System).

As it relates to the nursing shortage, the Senate Committee's final report found that: "Georgia is in need of a system to collect, analyze and research accurate nursing workforce data and needs a statewide Nursing Data Center to accurately predict the current and future demand for nurses in our state." The report also recommends that the Board of Regents consider the expansion of doctoral programs and the increase of nursing faculty salaries so that they are competitive with the salaries of clinical nurses.

Senator Renee Unterman (District 45) participated on the State Senate Committee about the Shortage of Doctor's and Nurses in Georgia and she has shown great leadership in communicating with the Georgia Nurses Association elected leadership and GNA lobbyists to determine how the Committee's recommendations could be implemented to create a Georgia Center for Nursing Workforce (GCNW). To assist in this process the GNA/GNF staff have examined several models in other states and found the successful models based in Florida and North Carolina to be of particular relevance. GNA leadership has proposed that the GCNW be governed by a collaborative policy-setting board of directors from key nursing workforce stakeholders within the state with at least a simple majority of the Board being nurses representative of various practice areas to oversee all aspects of the nursing workforce center. We continue to work with Senator Unterman and other members of the General Assembly and policy makers in support of these efforts to identify the funding necessary for the development of a Georgia Center for Nursing Workforce as soon as possible.

National research shows that with every additional patient added to a nurse's workload, patient mortality increases by 7%. Research also shows that 93% of nurses report problems with maintaining patient safety because of increased workloads and mandatory overtime shifts. Our citizens in the great state of Georgia deserve more. Solutions to provide an adequate nursing workforce will require accurate data.

In the meantime, GNA and GNF will continue to bring focus, knowledge and leadership to this and other issues within the nursing profession. For this project in particular, we thank the GNA members who have contributed in positive and productive ways. Hopefully through this effort, one day soon there will be consistent methods and centralized data that will drive knowledge based decisions to address the nursing workforce shortages in Georgia.

Debbie Hackman, CAE 

Hackman is GNA/GNF Chief Executive Officer.