House Joint Resolution (HJR) 288 and Senate Joint Resolution (SJR) 228 of the 2000 Session of the General Assembly directed the Joint Commission on Health Care to conduct a study to identify specific and effective short- and long-term strategies to educate, train, recruit and retain qualified nurses in Virginia. A copy of HJR 288 and SJR 228 is attached at Appendix A.

Neither HJR 288 nor SJR 228 were adopted by the General Assembly. However, both resolutions were communicated to the Joint Commission via letter from the Speaker of the House of Delegates. The Speaker's letter states that:

"The House Rules Committee believes that the issues addressed by the resolutions merit review. Therefore, the Commission is directed to undertake the study and to submit a written report of its findings and any recommendations to the Governor and the 2001 Session of the General Assembly."

A copy of the Speaker's letter is attached at Appendix B.

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

• Overall, the number of nurses, both nationally and in Virginia, have increased in recent years. However, several researchers have projected a serious nursing shortage in the next 8-12 years. Several factors are believed to be driving the projected shortage: (0 expanded employment opportunities for women; (ii) increasing work pressures; (iii) decreasing nursing school enrollments and graduations; and (iv) an insufficient number of younger nurses entering the profession to replace those who will be retiring beginning in 2008.

• In Virginia, the number of licensees in all categories of nurses, except certified nurse aides (CNAs), has increased in recent years. The number of CNAs decreased by more than 3,000 between 1999 and 2000. The primary reasons for the decrease in the number of CNAs are believed to be the recent increase in the certification renewal fee from $30 to $45, and the recent decline in the passing rate of nurse aides taking the certification exam.

• The number of enrollments and graduations in Virginia's educational programs for RNs, LPNs and CNAs has declined in recent years. These declines are occurring at the same time Virginia Employment Commission data project significant employment growth for nurses.

• Many health care employers in Virginia, including the Virginia Hospital & Healthcare Association, the Virginia Health Care Association, the Virginia Association of Non-Profit Homes for the Aging, the Virginia Association for Home Care and others have indicated that their member organizations are experiencing difficulty in hiring all categories of nurses. The most pressing need appears to be in hiring and retaining CNAs.

• The hiring difficulties experienced by health care employers in Virginia will get worse if the number of available nurses declines as projected by health workforce researchers.

• Very limited information currently is available on nurses in Virginia. While there are data on the number of licensees, there is no statewide information on: (i) the number of licensed nurses who actually are working as nurses, (ii) where nurses are working (geographic location); or (iii) employment settings (e.g., hospital, nursing home, physician's office, etc.). Legislation was passed last year to collect additional information; however, the level of funding that was approved has limited the data collection to a rather small sample of nurses. Additional funding would enable more complete data to be completed for nurse workforce planning.

• The Commonwealth cannot resolve all nursing issues. A number of the issues that must be addressed are beyond the scope of state actions such as: certain marketplace trends, employer practices, work hours, salaries, benefits, etc. The state's greatest potential impact is on "supply side" issues such as recruitment, education/training, licensure and regulation, and workforce planning.

• The General Assembly may wish to take certain actions to ensure nursing issues continue to be addressed in the future. One such action could include placing a representative of the health care industry on the Virginia Workforce Council. Another possible action-would be to establish an advisory council on the future of nursing to provide ongoing attention to nurse workforce issues.

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 43-45. Public comments were requested on a draft of this report. A summary of the public comments is attached at Appendix C.