Expanding the supply of nurses in California through organizational collaboration: Evaluation of the Nurse Workforce Initiative

Objective: California's nursing shortage is among the most severe in the U.S. with over 130,000 job openings for RNs and LPNs by 2014. The objective of this project was to evaluate whether the strategies used in the Nurse Workforce Initiative (NWI) were effective in increasing recruitment and training of nurses.

Design: The NWI (2002-2005) used federal and state Workforce Investment Act (WIA) funds ($24 million) to form 22 regional collaboratives charged with using innovative approaches to increase the supply of nurses. The qualitative and quantitative evaluation included a 15-item participant survey; over 200 key informant interviews; repeated site visits at 4 selected sites; and analysis of data on student enrollment, graduation rates and cost per student.

Findings: Main strategies used by the collaboratives included expansion of slots, improved student retention, increased pass rates for the licensing exam, and creation of career ladders to nursing for other health care workers. The programs' goal to provide financial/academic support to 1,310 students was exceeded by nearly 1200 students. The goal to expand slots of capacity by 1,852 slots was exceeded by about 30 slots. There were 4,623 participants; 33.2 mean age; 43.0% married; 53.3% had children under age 18; 64.3% had prior training in health care primarily as CNA, home health aide, or LPN. Collaboratives with prior existing partnerships were better prepared to address the nursing workforce. In addition to state funding, partners made in-kind contributions of $29.7 million. The WIA model is useful for nursing but needs to be adapted from its traditional short-term training focus. Many students require educational and social support services to be successful.