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Washington State Health Workforce Sentinel Network

Highlights of Findings to Date

The Sentinel Network supports efficient and effective health workforce preparation and deployment by identifying emerging health workforce demand signals and trends and rapidly disseminating information to education, training and policy partner who can take action based on findings.

A summary of findings to date was included in Washington’s Health Workforce Council 2017 annual report. Click here to see the report.

Examples of some of the findings to-date are displayed below. Please also explore the information submitted by Sentinel employers on the “Findings to Date” pages to see what workforce demand signals you find for healthcare occupations, facilities and geographic regions of Washington.

Select Findings: By Occupation

Select an occupation:
Medical Assistants | Registered Nurses | Licensed Practical Nurses | Selected Behavioral Health Occupations

Medical Assistants (MAs)

By facility type: 
MAs were among the top occupations with exceptionally long vacancies recently reported by

  1. FQHCs/community clinics
  2. Other primary care clinics
  3. Specialty medical clinics
  4. Acute care hospitals
  5. Psychiatric/substance abuse hospitals

By geography: 
MAs were among occupations with exceptionally long vacancies

  1. July 2016: in 8 of 9 Accountable Communities of Health (ACHs)
  2. Nov. 2016: in 9 of 9 ACHs
  3. April 2017: in 9 of 9 ACHs
  4. Oct. 2017: in 8 of 9 ACHs

Examples of reasons for MAs’ exceptionally long vacancies:

  1. Difficulty finding MAs with needed skills.
  2. Very limited workforce and all organizations need them. Some organizations are thinking of developing their own MA programs.
  3. Competition with other facilities that are able to pay more.
  4. Difficulty attracting candidates to rural areas.
  5. Not enough MAs in region, extremely tight & expensive housing market in our local area.
  6. Not a lot of medical assistants in the area. Nearest school is 75 miles away.
  7. High cost of living in some counties (King) makes recruitment and retention of MAs more difficult.

Changes in MAs’ onboarding and training priorities – examples of comments:
EHR/HIT

  1. EHR training/more EHR skills.
  2. Knowledge of quality data tracking.
  3. Onboarding curriculum tailored to focus on EHR competency and documentation of clinical measures.

Other Skills

  1. Gathering SO/GI [sexual orientation/gender identity] demographics.
  2. Enhanced training to work to full scope of role.
  3. Expansion of customer service training.
  4. Organization-wide training and implementation of AIDET customer service model; increased localized trainings on integration of care with an emphasis on a care team based approach to healthcare and synchronization of services.
  5. Training being developed to align with behavioral health patients in primary care.

Registered Nurses (RNs)

By facility type: 
RNs are the top occupation with exceptionally long vacancies recently reported by

  1. Small acute care hospitals
  2. Home health care services

RNs were also among occupations with long vacancies in:

  1. FQHCs/community clinics
  2. Behavioral health/mental health clinics
  3. Psychiatric/substance abuse hospital
  4. Large acute care hospitals
  5. Schools
  6. Skilled nursing facilities
  7. Specialty medical clinics

By geography: 
RNs were the top ranked occupation with exceptionally long vacancies

  1. July 2016: in 7 of 9 Accountable Communities of Health (ACHs)
  2. Nov. 2016: in 9 of 9 ACHs
  3. April 2017:  in 7 ACHs  (2nd in Better Health Together and 3rd in Greater Columbia)
  4. Oct. 2017: in 4 ACHs (2nd or 3rd in 4 other ACHs)

Examples of reasons for RNs’ exceptionally long vacancies:
RNs in Hospitals

  1. New grads looking for acute care wage and experience; workforce does not meet demand.
  2. Difficulty in recruitment for more rural areas; lack of experienced specialty nurses who wish to come to a rural area.
  3. Nights hard to fill.
  4. Too many open positions elsewhere and traveling companies are scooping up what is out there promising them almost $100 an hour.

RNs in FQHCs/Community clinics

  1. Lack of qualified applicants; some offers turned down because of pay (can't compete with hospitals).
  2. Challenge to find RNs with FQHC or outpatient experience; need RNs with management/supervisory experience.
  3. …seeking candidates that are bi-lingual in English and Spanish.
  4. …far more openings in the local area than there are RNs to fill them, most go to the hospital.

RNs in Long Term Care (home health, skilled nursing, nursing and personal care)

  1. Not enough RN's for all the facilities and hospitals and a new regulation requiring skilled nursing facilities to have 24 hour RN coverage. (SNF)
  2. Nursing homes are unattractive to potential candidates, low candidate pool, competition with local hospital (pay/environment). (NH)
  3. A local hospital opened over 100 RN positions. Severe impact on community. Not enough RNs to fill open positions. (SNF)
  4. Lack of experienced RNs willing to work in this capacity (HH)
  5. Multiple new jobs being opened to RNs. (SNF)
  6. Wage compression from new minimum wage (SNF)

RNs in Behavioral health

  1. Salaries not competitive.
  2. Hardships of working for a community mental health provider.

RNs in Specialty medical clinics

  1. High demand for RNs – newly created positions.

Changes in RNs’ onboarding and training priorities – examples of comments:

  1. EHR training and responsibilities; new EMRs; HIT. (hospital)
  2. Knowledge of quality data tracking. (FQHC)
  3. Customer service. (hospital)
  4. Behavioral training. (multiple facility types)
  5. Dementia knowledge. (SNF)
  6. Ongoing training to support nursing faculty in their roles as instructors. (hospital)
  7. Root cause/SBAR/Assessments/Care plans. (SNF)
  8. Investing in staff by offering more training. (SNF)
  9. Address needs of workers with little prior experience. (SNF)
  10. New grad nurses getting more orientation and training; we are spending more time with new employees during the onboarding/orientation process. (SNF)
  11. Training on new state regulations. (SNF)

Licensed Practical Nurses (LPNs)

By facility type:
LPNs have been highly ranked among occupations (in the top 3) with exceptionally long vacancies in

  1. Home health care services
  2. Nursing and personal care facilities
  3. Schools
  4. Skilled nursing facilities

By geography:

  1. Recently, LPNs were among the top ranked occupations with exceptionally long vacancies in 6 of 9 ACHs, and are listed among those with long vacancies in all ACHs.

Examples of reasons for LPNs’ exceptionally long vacancies:

  1. Not enough qualified LPN applicants -- no local training programs.
  2. Wage compression – not enough LPN applicants.
  3. Low pay compared to more clinical settings.
  4. LPNs are going on to complete RN degree.

Demand for LPNs was mentioned as increasing by Sentinels in all 9 ACHs. However, LPNs were also mentioned as having demand decrease by some Sentinels.

Selected Behavioral Health Occupations

Chemical dependency professionals (CDPs) and substance abuse and behavioral disorder counselors

By facility type:
The combined occupations of chemical dependency professionals (CDPs) and substance abuse and behavioral disorder counselors were the top occupation with exceptionally long vacancies recently reported by:

  1. Large hospitals
  2. Behavioral health clinics
  3. Psychiatric/ substance abuse hospitals

They were also among the top 10 occupations listed with long vacancies at FQHCs.

By geography:

  1. Recently, the combined occupations of chemical dependency professionals (CDPs) and substance abuse and behavioral disorder counselors were the top occupation experiencing exceptionally long vacancies in 3 of 9 Accountable Communities of Health (ACHs). They were in the top 10 professions with long vacancies in the remaining 6 ACHs.

Examples of reasons for exceptionally long vacancies:

  1. Low wages and difficult working conditions.
  2. Increased client acuity and lack of qualified candidates.
  3. Integration with managed care means many new positions do not exclusively require CDP/Substance Abuse skills and there has been a flood of new positions on the market, leading to a shortage.
  4. Many CDPs have obtained dual licensure and have opted to be employed under Mental Health due to higher pay in that area.
  5. Long licensing process, including supervision requirements.

 

Changes in onboarding and training priorities – examples of comments:

  1. The State has increased reporting and documentation requirements (more-so than mental health occupations). In some cases, this has led to turnover, so more emphasis on this in training.
  2. Existing staff is being retrained on how to work directly with primary care.
  3. Have to be able to pass CORE.

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