House Joint Resolution (HJR) 682 of the 1999 Session of the General Assembly directed the Joint Commission on Health Care to study the need to collect workforce data on nurse practitioners, clinical nurse specialists, registered nurses, licensed practical nurses and certified nurse aides.

Specifically, HJR 682 required that the Joint Commission's study include, but not be limited to, an examination of:

(i) what data are currently available on regulated nurses and other nursing-field professionals;

(ii) where gaps exist in current data collection efforts;

(iii) what other states are doing in the area of data collection on nurses and other nursing-field professionals;

(iv) what additional specific geographic, demographic or other information on nurses and other nursing-field professionals would enable the public and private sectors to make more informed health care policy and business decisions;

(v) what additional kinds of data on nurses and other nursing-field professionals would be the most useful;

(vi) the various mechanisms that could be utilized to collect these data; and

(vii) the cost of collecting any data deemed useful.

HJR 682 also directs the Joint Commission to recommend what data, if any, should be collected; the most efficient method to collect, compile, and analyze such data; and, based on an analysis of the costs and benefits of such information, whether the Commonwealth should participate in this data collection.

Based on our research and analysis during this review, we concluded the following:

• There are five categories of nurses in Virginia: Registered Nurses (RNs), Clinical Nurse Specialists (CNSs), Nurse Practitioners (NPs), Licensed Practical Nurses (LPNs), and Certified Nurse Aides (CNAs).

• The Board of Nursing collects only minimal data on nurses and indicates it does not need additional information. Other state agencies collect limited data. The Board of Nursing recently approved proposed fee increases for all nurses except NPs. The increases ranged from $15.00 to $80.00. Fees are collected biennially.

• Current data collected by the Board of Nursing do not support comprehensive workforce planning, and cannot answer questions such as: How many licensed nurses are employed? Where do nurses work? In what employment setting do nurses work? What areas of specialty have the greatest and least number of nurses? What types of nurses should educational programs be graduating? What demographic trends are occurring?

• Nursing representatives believe strongly that additional data are needed. Health care and long-term care provider groups expressed varying degrees of support for collecting additional nurse data. A 1988 Joint Subcommittee concluded additional nurse data are needed for workforce planning. About 20 other states collect additional workforce data; all of which collect the information as part of their license renewal process.

• If additional data were to be collected, the Department of Health Professions would be the appropriate agency. The cost of collecting the information could be funded through state general funds, nurse fees, or a combination of both. The total cost of collecting additional nurse workforce data ranges from $119,500 to $510,000 depending on how the data are collected.

A number of policy options were offered for consideration by the Joint Commission on Health Care regarding the issues discussed in this report. These policy options are listed on pages 33-34.

Our review process on this topic included an initial staff briefing, which comprises the body of this report. This was followed by a public comment period during which time interested parties forwarded written comments to us regarding the report. The public comments provide additional insight into the various issues covered in this report.