Florida Health Care Workforce Projections 2022-2037 by Florida Center for Nursing

Florida Health Care Workforce

List of Exhibits

Exhibit

Exhibit 141: Change in Florida Respiratory Therapist Supply Adequacy by Region, 2022 –2037 159

Exhibit 142: Change in Florida Nursing Assistant Supply Adequacy by Region, 2022 – 2037 ........................................................................................................................................................... 160

Exhibit 143: Supply Adequacy by Region & Occupation (2022-2037) 161

Exhibit 144: Specialty Alignment by Comparison Category ....................................................... 172

Exhibit 145: Florida RN Supply Projections, by Scenario ............................................................ 174

Exhibit 146: Florida RN Supply Annual Starting FTE, New Entrants and Retirements 20222037 174

Exhibit 147: Florida LPN Supply Projections, by Scenario .......................................................... 175

Exhibit 148: Florida LPN Supply Annual Starting FTE, New Entrants and Retirements 20222037 ................................................................................................................................................... 175

Exhibit 149: Florida Physician Supply & Demand Projections, by Scenario 176

Exhibit 150: Florida Physician Assistants Supply & Demand Projections, by Scenario 177

Exhibit 151: Florida Nurse Practitioner Supply & Demand Projections, by Scenario ..............

Exhibit

Exhibit 154: Florida Physician Supply Annual Starting FTE, New Entrants and Retirements 2022- 2037 181

Exhibit

Exhibit 159:

Exhibit

Produced for the Florida State Center for Nursing by the GlobalData Health Workforce Consulting Team.

Tim Dall, MS, Executive Director

Clark Ruttinger MPA, MBA, Consulting Director

Patrick Zarek, MS, Consultant

Owen Parker, BA, Consultant

Ryan Reynolds, MS, Principle Scientist

Ritashree Chakrabarti, PhD, Principle Scientist

Suggested citation:

Florida Center for Nursing. (2025). Florida Workforce Projections 2022-2037. Prepared by the GlobalData Health Workforce Consulting Team.

Chapter 1- Florida Health Care Workforce Projections

2022-2037: Executive Summary and Modeling

Overview

Executive Summary

This report covers methodology, projections and a geographic gap analysis for the supply and demand of various healthcare professions in Florida, encompassing registered nurses (RNs), licensed practical nurses (LPNs), physicians, advanced practice registered nurses (APRNs), physician assistants (PAs) pharmacy, allied health, & nursing assistants. With highlights on critical workforce trends, regional disparities, and implications for healthcare delivery across the state.

Nursing

• Registered Nurses: Supply growth aligns closely with demand, maintaining nearequilibrium adequacy (93% by 2037). Regional variations in adequacy are expected.

• Licensed Practical Nurses: A marked decline in supply (–0.9% annually) versus increasing demand (2.3% annually) will lead to a severe statewide shortage, with adequacy falling from 85% in 2022 to 55% by 2037.

Physicians and Advanced Practice Providers (APPs)

• Physicians: A stable workforce is projected, with adequacy nearing equilibrium by 2037. However, regional, and specialty-specific shortages persist.

• APRNs: Sustained growth across categories and NP specialties. APRNs may mitigate some gaps in care for physicians and physician assistants, though this does not imply one-to-one offset, and rural areas may face localized shortages.

• Physician Assistants: Declining adequacy by 2037, particularly in primary care, highlights the need for interventions targeting supply and new entrants.

Pharmacy

• Pharmacists: A growing shortage is anticipated, with supply adequacy declining from 93.5% in 2022 to 74.5% by 2037 due to a 23.4% increase in demand.

• Pharmacy Technicians: Supply exceeds demand, projected to grow from 156.3% adequacy in 2022 to 200.2% by 2037. However, their limited ability to substitute for pharmacists emphasizes the pharmacist shortage's persistence.

Allied Health

• Physical and Occupational Therapists: Statewide shortages will worsen as demand growth outpaces supply, with no region achieving adequacy by 2037.

• Respiratory Therapists: The most critical shortage in allied health, with statewide adequacy projected at 39% by 2037, driven by a 35% demand increase against minimal supply growth.

Nursing Assistants

• Trends: While supply exceeded demand in 2022, significant declines are expected, leading to statewide shortages by 2026 and severe deficits by 2037 across most regions.

• Implications: High attrition rates and growing care needs require urgent workforce retention and expansion strategies.

Introduction

States play a pivotal role in shaping health workforce policies, aiming to ensure an adequately skilled healthcare workforce that meets the unique needs of their populations. This responsibility encompasses the regulation of health professions through state-level licensing, funding for health education programs, and the establishment of policies governing public insurance reimbursement, which dictates the professions authorized to deliver healthcare services. All these activities have an impact on the overall supply and demand for healthcare workers across the country.

This report examines projected trends in the Florida health workforce, analyzing the supply and demand for the following occupation groups: physicians, Advanced Practice Providers (APRNs and physician assistants), nursing (RNs & LPNs), allied health (PTs, OTs, & RTs), and select occupations (Nursing Assistants) from 2022 to 2037. The analysis contained in the report utilizes microsimulation modeling to create projections of the growth in each occupation over a 15 -year period into the future . Microsimulation modeling is a proven economic modeling approach that simulates individual career decisions and healthcare utilization patterns to project future workforce needs. Key factors driving these projections include:

• Population Growth and Aging: Florida's population is expected to grow significantly, with a notable increase in the elderly population, a demographic that utilizes healthcare services at higher rates. This demographic shift is expected to fuel demand for healthcare services.

• Prevalence of Disease and Health Risk Factors: Florida exhibits prevalence rates of disease and health risk factors comparable to national averages. These factors are incorporated into demand modeling, recognizing their influence on healthcare utilization.

• Healthcare Utilization Patterns: National data on healthcare use, adjusted for Florida-specific hospital utilization data, are used to project future demand for healthcare services, which in turn drives the projected demand for various healthcare occupations.

• Health Workforce Characteristics: Comprehensive data from the Florida Department of Health (Florida DOH), including licensure records and surveys conducted by the Florida Center for Nursing (FCN), provide detailed information about the current health workforce, including demographics, education levels, work settings, and hours worked. These data form the basis for supply modeling.

• New Entrants and Attrition: The model accounts for new entrants entering the workforce, as well as healthcare providers leaving due to retirement, out-of-state migration, or career changes (e.g., LPNs becoming RNs). These dynamics are crucial for understanding the evolving compositi on of the Florida health workforce.

The report examines various scenarios, including a Status Quo scenario that assumes the continuation of current trends, as well as alternative scenarios that explore the potential impact of factors such as changes in retirement patterns, increases in new graduates, and reduced barriers to healthcare access.

This detailed analysis provides valuable insights into the future of Florida's health workforce, aiming to inform policy decisions and strategic planning efforts to ensure an adequate supply of clinicians to meet the healthcare needs of the state's growing and aging population.

Methodology

This section provides a brief overview of the approach, data, and assumptions used for demand and supply modeling. Projections span from 2022 to 2037, using 2022 as the baseline year for demand modeling and the starting year for supply projections, due to data availability.

Key Aspects of the Model:

• Demand Modeling: Projects demand for healthcare services across various settings, including office, outpatient, inpatient, emergency, and home health.

• Uses national patterns of healthcare utilization, tailored to Florida's demographics, health conditions, hospital usage, and insurance status.

• Accounts for Floridians receiving care out-of-state and out-of-state residents receiving care in Florida.

• Projects demand for healthcare providers by applying national staffing ratios to the projected demand for healthcare services.

• Incorporates estimated national shortfalls in select specialties.

• Supply Modeling: Projects the supply of healthcare providers by simulating career decisions, including new entrants, attrition (retirement, out-of-state migration, career changes), labor force participation, and hours worked.

• Utilizes data from the Florida Department of Health, including licensure files and surveys conducted by the Florida Center for Nursing (FCN) for APRNs, RNs & LPNs, to determine starting supply, new entrants, and workforce characteristics.

• Applies national data to Florida health workforce demographics estimate retirement patterns, migration, labor force participation, and hours worked.

Scenarios:

• Status Quo Scenario: Assumes the continuation of current trends in both demand and supply.

• Alternative Demand Scenario (Reduced Barriers): Models a scenario where all individuals access care at the rates of the model high utilization comparison group, exploring the potential impact of reduced barriers to healthcare.

• Alternative Supply Scenarios:

o Early Retirement: Simulates healthcare providers retiring two years earlier than current patterns.

o Delayed Retirement: Simulates healthcare providers retiring two years later than current patterns.

o 10% More Entrants: Assumes a 10% increase in annual new entrants entering the workforce.

o 10% Fewer Entrants: Assumes a 10% decrease in annual new entrants entering the workforce.

By comparing projected supply and demand under various scenarios, the model provides insights into potential future adequacy (or shortages) in the Florida health workforce.

Modeling Overview

This study employed a microsimulation approach, meaning individuals are the units of observation. Population demand for services delivered by profession, and the healthcare professionals available to provide those services, is simulated for each person in a representative sample of Florida’s population and then aggregated to county, region, and state levels. Supply of healthcare providers starts with de-identified licensing data and simulates career decisions for each clinician and new clinician entering the Florida workforce. Projections of supply and demand use GlobalData’s workforce demand and supply modeling framework described in reports and academic journals.1–9 These workforce models have been validated through modeling efforts for the federal government, state governments, professional associations, and health systems. Additional information about methods is detailed in the model’s technical documentation.10

The base year for modeling demand is 2022 as this is the latest year for which reliable population data and hospital use data are available. The “projection period” covers 20222037.

Demand modeling starts with a representative sample of the population in each county projected through 2037. The model then simulates demand for healthcare services based on demographics, health risk factors, disease prevalence, hospital usage patterns observed in Florida, and national patterns of healthcare use applied to the state’s population. Projected future demand for healthcare services are used to estimate future demand for healthcare providers.

Supply modeling starts with information from Florida DOH licensure files and surveys from the Florida Center for Nursing on the demographics, labor force participation patterns, and work location of the current health workforce. New entrants to the health workforce are added each year based on recent information on the number, characteristics, and geographic distribution of newly licensed nurses. The model simulates attrition from the workforce each year as individuals leave the workforce through retirement, out of state migration and other attrition from the workforce such as when an LPN becomes an RN or an RN becomes an APRN. Comparison of current and projected future supply to projected demand provides a measure of supply adequacy.

The core demand and supply projections are for a Status Quo scenario. For demand, this scenario models the continuation of national average healthcare use and delivery patterns over the projection period. Projected changes in demand over time are driven by changing demographics and associated prevalence of disease and health risk factors. For supply modeling, the Status Quo scenario models continuation of current numbers and patterns of annual new entrants licensed, labor force participation rates, retirement rates, and crossstate migration patterns. A comparison of Status Quo supply and demand indicates future supply adequacy absent any changes in healthcare delivery or efforts to increase workforce supply.

Undoubtedly, changes from the Status Quo will occur over the projection period, but when and how cannot be known during modeling. As such, alternative or “what-if” scenarios are modeled to assess how projections would be affected by changes to the Status Quo scenario assumptions. The alternative demand scenario models if all people were to access care at the rates of otherwise identical insured, non-Hispanic Whites in metropolitan areas. This Reduced Barriers scenario explores how the demand for health workforce services would change with substantial progress toward healthcare access and equity goals articulated by health policy advocates, Florida state agencies, and federal agencies.11,12 This scenario is not meant to identify individual members of the population who face significant barriers to obtaining care and/or are underserved; nor is it meant to suggest that healthcare usage of insured, non-Hispanic Whites living in metropolitan areas is appropriate or adequate. Rather, this “what-if” scenario yields general insights regarding the relationship between expected workforce adequacy and reducing barriers of access to care.

Alternative supply scenarios model the implications of increases or decreases in the number of new clinicians entering Florida’s workforce, and the implications of earlier or delayed retirement relative to recent national estimates of retirement expectations by work location, age, and sex.

Demand Modeling

Demand modeling entails analyzing relevant characteristics of the Florida population, predicting the amount of healthcare-related services they will use in future years based on these characteristics, and estimating the number of healthcare providers by profession required to deliver these services. These analyses are performed by delivery setting, which include office, outpatient, inpatient, emergency, other clinical, academic, and other nonclinical settings. Demand is projected for each year by accounting for the cross-sectional growth of populations by disease burden and health profile, demographic profile, and socioeconomic characteristics.

Baseline demand for services by profession within Florida is estimated by applying national patterns of healthcare use by profession based on demographics, socioeconomics, health characteristics and insurance status to a population database representative of these characteristics for each county in Florida. Adjustments account for resident Floridian use of hospital-based services and for non-resident use of hospitals in Florida. Demand projections are aggregated across individuals to the county, regional, and state level. Healthcare utilization projections into the future are based on forecasted changes to Florida’s demographics and their associated disease burdens and health risk factors. Demand for services by healthcare profession is then derived from the expected demand for the services each profession provides based on national staffing patterns in healthcare delivery (e.g., observed nurse to hospital day counts or physician-to-patient workload ratios by care setting) adjusted by estimates of national shortfalls in select specialties for which there are published shortfall estimates. The national average is simply a benchmark for comparison among states and does not imply an optimal level of staffing.

Exhibit 1: Overview of the Demand Modeling Framework

This study estimates and projects demand for healthcare services and providers, defined, respectively, as the amount and types of healthcare services patients are willing and able to purchase at prevailing prices and the number of providers by profession and specialty where appropriate, that are willing and able to work at prevailing salary levels. The concept of demand for services differs from need for services, which represents the services that patients would use based on clinical or epidemiological considerations combined with an assessment of the level of care that would be considered appropriate. Likewise, the demand estimates for each profession do not imply an optimal level of staffing for that profession independent of economic and other realities.

Modeling Methods and Data Sources

Understanding the relationship between demographic trends and healthcare demand is crucial for strategic workforce planning and service delivery. Florida’s rapidly growing and aging population underscores the significant role of population dynamics in shaping the demand for healthcare services. Over the next 15 years, the state’s population is expected to increase by 17%, with the largest growth occurring among older adults aged 75 and above—an age group that disproportionately utilizes healthcare services. This section explores the methodologies and data sources used to estimate future healthcare demand, emphasizing the impact of demographic shifts, disease prevalence, and other health risk factors. By leveraging robust population projections and detailed health datasets, we provide insights into the anticipated healthcare needs across Florida’s diverse regions and age groups, setting the stage for targeted policy and workforce interventions.

Population Growth and Aging and Projected Demand for Healthcare Services

Population growth and changing demographics are the primary factors driving the anticipated demand for healthcare services, including the demand for each profession, in the projected period. The impact of aging is particularly significant as older population groups tend to utilize healthcare services at a higher rate compared to younger age groups.

To estimate the demand for healthcare services, we constructed a population database based upon on a representative sample of the resident population in each Florida county from 2022 to 2037. The database includes characteristics used to estimate the demand for healthcare services, such as demographic factors (age, sex, and race/ethnicity), health conditions and risk factors (arthritis, asthma, cardiovascular disease, diabetes, hypertension, history of heart attack, history of cancer, history of stroke, body weight status, and smoking status), household income range, and health insurance status (including insurance coverage, public insurance participation, and membership in managed care plans).

Key data sources used to construct this file are Florida residents’ responses to the 2021 and 2022 American Community Survey (ACS), Florida residents’ responses to the 2021 and 2022 Behavioral Risk Factor Surveillance System (BRFSS), Florida county-specific data on prevalence of health risk factors from the 2022 Centers for Disease Control and Prevention (CDC) Places, and 2019 files from the Centers for Medicare & Medicaid Services (CMS) on the characteristics and prevalence of health risk factors of residents of nursing homes and residential care facilities in Florida.13–17

The population database starts with 2022 ACS data on a de-identified, representative sample of Florida households. For each person represented in the ACS, there is information on demographics, household income, and medical insurance type. The ACS identifies households living in the community, as well as households living in group settings such as nursing homes. The ACS does not, however, collect information on health risk factors and presence of disease. BRFSS, along with CMS surveys of residents in nursing homes and residential care facilities, collects information on health risk factors and presence of disease.

Therefore, each person in the ACS is statistically matched to a person with similar characteristics from sources with health-related information. Individuals in the ACS who live in a community setting are matched to like individuals in BRFSS within the same 5-year age group, sex, race/ethnicity, household income range, and medical insurance type. Individuals in the ACS living in group settings are matched to like individuals in CMS databases on residents in nursing homes and residential care facilities within the same 5-year age group, sex, and race/ethnicity.

County-level population estimates (by demographic) for 2022, published by the U.S. Census Bureau, are used to create a representative sample of the population in each Florida county in 2022. Data from CDC Places is used to calibrate county-level prevalence of disease and health risk factors. The final step in preparing the population database is to apply population growth rates to each person in the representative population. Population growth rates through 2037, by demographic and county, come from the University of Florida’s Bureau of Economics and Business Research.1

Florida’s population of 22 million in 2022 and is projected to reach nearly than 26 million in 2036 growing by about 3.7 million (~17% growth). Population concentrations differentially vary by by region; the East Central and Southwest regions can expect a more sizable increase (22% and 23%) in population over the next fifteen years, whereas other regions can expect a population increase of 19% (Northeast), 18% (West Central), 16% (Southeast), 13% (Northwest), 12% (South), and 11% (North Central).

1 Rayer, Stefan, and Y. Wang. "Projections of Florida population by county, 2025–2050, with estimates for 2021." Florida, USA: Bureau of Economic and Business Research 55 (2022).

Exhibit 2: Expected Population Growth in Florida by Region, 2022-2037

There also exists considerable variation in population growth rates by age group. Most of the growth is among the population aged 75 years or older with a projected increase of 1,403,205 residents (64% growth). The population aged 65-74 is projected to grow by 461,272 residents (18% growth). The projected rapidly growing population of older Floridians is likely to drive high growth in demand for physician specialties that predominantly care for older adults, with slow projected growth in demand for pediatric services.

Exhibit 3: Comparison of Expected Population Growth in Florida and the United States by Age

Group, 2022-2037

Source: GlobalData population projection, 2023

Comparing Florida population growth from 2022 to 2037 shows that Florida has higher overall expected growth than the nation over the next 15 years (average 17% growth in Florida vs 8% growth across the US in the same time period). Florida is expected to see faster growth in older age groups this means that Florida will have greater demand growth for healthcare services utilized by older Americans. Florida also anticipates seeing more growth in the working age population than the nation. This indicates there may be less competition with other industries to recruit and retain available workers in Florida over the time period in comparison to the rest of the nation.

Prevalence of Disease and Health Risk Factors

Demand modeling takes into consideration the prevalence of disease and other health risk factors that affect demand for healthcare services. Florida is comparable to the national average in most of the factors tracked by the CDC (prevalence of disease, smoking, and obesity (Exhibit 6). There is slight variation in prevalence across Florida-designated regions and greater variation across counties, driven by population distribution. The percentage of the population greater than 65 years of age is also higher across Florida than the national average.

Exhibit 4: Comparison of disease burden prevalence and age 65+ group by region in Florida vs the US population, 2022-2037

Source: Centers for Disease Control and Prevention. PLACES: Local Data for Better Health. Published April 2022.

Projected Demand for Healthcare Services

Healthcare demand projections apply prediction equations of healthcare use to the population database. These equations are estimated from national data sources and supplemented with Florida-specific data for hospital use to predict demand for services across care settings and medical specialties. Key data sources are the combined 2017-2021 files of the Medical Expenditure Panel Survey (MEPS), and the 2022 National Inpatient Sample (NIS).

Separate prediction equations exist by type of care delivered and from what specialty that care was receive. Indicators for the office and outpatient settings rely upon office and outpatient visits. Indicators for the inpatient setting rely on inpatient visits and

hospitalizations. Indicators for the emergency setting rely upon emergency visits. Indicators for home health and nursing facility-based care rely upon home health users and nursing home residents. The demand driver for care in other settings academia and “all other” settings are, respectively, new graduates entering the workforce in each profession and overall population growth.

As people age, they tend to use more hospital services (Exhibit 7). For example, a population of 100,000 adults aged 18-44 in Florida has approximately 35,000 ED visits and 27,000 bed days per year. This is in comparison to a population of 100,000 adults aged 6574in Florida who have approximately 52,000 ED visits and 96,000 bed days per year.

While older age is the largest predictor of increased demand for healthcare services, other factors such as the presence of diseases and having medical insurance also play important roles in predicting demand. This is particularly notable for conditions like cardiovascular disease and diabetes, which exhibit strong correlations with heightened demand across all healthcare services. Having cardiovascular disease is particularly associated with an increased demand for cardiology services, while diabetes is linked to elevated demand for endocrinology services.

Exhibit 5: Florida Rate of Annual Use of Hospital-based Care by Population Age Group, 2021

Source: Analysis of Medical Expenditure Panel Survey data for 2017-2021, National Inpatient Sample 2022.

As shown in Exhibit 7, driven by an aging population, Inpatient days and Emergency visits are projected to grow by 27% and 21% respectively. While Florida’s population is expected to grow less rapidly over time at only 17%. Indicating an aging population that will utilize more healthcare services over time.

Exhibit 6: Projected Growth of Florida Inpatient and ED visits vs Florida Population, 2022- 2037

National average levels of provider staffing were applied to projections of healthcare use. For example, demand for nurses in inpatient settings is calculated by multiplying (a) projected Florida inpatient days in each year and (b) the national ratio of nurses per inpatient day. Staffing ratios are calculated and are applied analogously to estimate demand in the inpatient, outpatient, office, and emergency department settings. The total Florida population is assumed to drive demand for providers in “all other” settings. The number of new providers in each profession being trained is the main driver of demand for providers by occupation in teaching/academia. The staffing ratios for these settings are calculated by dividing national estimates of the demand driver by national estimates of FTE providers working in the setting.

The use of these national ratios assumes that at the national level the supply and demand for provider services are in equilibrium, excepting adjustments where there are setting- and specialty-specific estimates of national shortfall. To begin, three settings retain a direct and robust analogue to existing literature, specifically regarding accurate vacancy rates in certain practice settings. A Nursing Solutions Inc. (NSI) report shows that RN vacancy rates

across hospitals remained relatively constant between 8.0 and 9.0 percent from 2020 to 2021, only jumping to 17.0% in 2022. Some of these vacancies in prior years likely were covered by traveling nurses, and some vacancies are the result of time lags between when a nurse leaves a position and when a replacement is found. Therefore, it is assumed that vacancy rates above 8.0% reflect a shortfall—suggesting that the 17.0% vacancy rate is indicative of about a 9.0% headcount shortfall of RNs in hospitals. This 9.0% headcount shortfall indicates an inpatient shortfall of 9.0% and an outpatient FTE shortfall of 9.0%. Additionally, the American Association of Colleges of Nursing (AACN) reports 1,977 full-time faculty vacancies for nursing programs across the country, or a 7.8% vacancy rate. We subtract out the natural rate of unemployment (~4.4%) to yield a national demand shortfall of 3.3%. These national shortfall rates are applied to Florida’s RN estimates.

Across most settings, we cannot establish clear demand shortfalls on account of insufficient or inadequate literature, despite a preponderance of anecdotal and small-scale evidence. A nurse shortage is clearly felt throughout the workforce, but the nursing home and residential care settings do not yield readily available shortfall patterns. Therefore, to model unfilled capacity in the market for nurses brought about by preference shifts and a sticky labor market, we assume that demand for nurses in the nursing home and residential care settings follows its respective population to provider ratios from before COVID. In 2019, 1 nurse worked in the nursing home setting for every 9 nursing home residents or so; likewise, the pre-COVID nurse-to-patient ratio in residential care stood around 1 nurse for every 15 patients. Since 2019, despite nursing home and residential care populations either holding or increasing, ever fewer nurses work in the nursing home and residential care settings. The percent change in nurse-to-patient ratio from the pre-COVID era through 2022 represents a nursing shortfall that will continue to persist as long as the nurse-to-patient ratio remains depressed. We accordingly estimate an RN shortfall of 9.2% in the nursing home setting 15.3% in the residential care setting. These estimates are once again directly applied to Florida’s RN workforce estimates.

LPN shortages were calculated using a similar methodology to their nursing home and residential care RN counterparts. We compared a pre-covid patient to provider ratio against the present patient to provider ratio and identified the difference between the two ratios as a shortfall. Modeling therefore incorporates a 42.1% shortfall in the office setting, a 15.3% shortfall in the home health setting, a 10.6% shortfall in the nursing home setting, and a 28.4% shortfall in the residential care setting. These shortfalls are all applied to Florida’s LPN workforce estimates.

To aid in calibrating the model to Florida, national utilization patterns were applied to Florida’s resident population in 2022 and resulting predicted demand for hospital-based services was compared to actual usage reported in 2022.

Hospital Claims Data Adjustments to the Model

In addition to demand scaling based on workforce shortages, modeling assumptions of care patterns based on population demographics were adjusted to Florida’s inpatient care use

patterns. The Florida Hospital Association (FHA) supplied GlobalData with length of stay (LOS) records by primary diagnosis code for the year 2022. By combining existing projections with the inpatient days observed in the FHA data, workforce estimates can be calibrated to resemble Florida’s observed inpatient LOS baseline rather than relying upon national patterns of care.

These LOS documents provided patient data denoted by year, quarter, patient state, patient county of residence, patient age, and primary ICD-10-CM diagnosis code. For in-state patients, GlobalData attributed all primary diagnosis codes to a set of broad provider categories (e.g. codes associated with cardiac events were assigned to ‘cardiology’ category), then aggregated the LOS associated with each primary diagnosis code by patient county, 5-year age band, and provider specialty. Inpatient days for non-resident patients were aggregated by 5-year age band and provider specialty. Combined LOS across all provider specialties drives demand for inpatient nurses, so inpatient days were summed by county for in-state patients and summed for non-resident patients.

Two separate scalars were derived from the FHA data. First, county-level provider estimates were multiplied by the ratio of each county’s observed LOS to the demand model’s countylevel LOS. This procedure scaled the demand model’s county-level provider estimates to resemble the amount of care provisioned for each Florida county’s population. Subsequent county-level provider estimates were scaled by the ratio of total inpatient days to in-state inpatient days. The resulting provider estimates account for both county-level variation in care provided to resident patients as well as the increase in total LOS resultant from nonresident patients.

Demand modeling predicted 92% of total quantity of inpatient days provisioned in Florida from resident LOS from the FHA data. Demand was therefore adjusted by county to set estimated and observed use of inpatient-based care equal, with the correction carrying forward through the projection period. These differences between initial model demand estimates and actual reported hospital care in 2022 reflect (a) differences in hospital use patterns of Florida residents relative to the national average, (b) cross-state mobility in seeking hospital-based care, and (c) modeling error from using prediction equations based on a sample (n~170,000 patients in the combined 2017-2022 MEPS files). Projections of future demand for hospital services and the resulting demand for each profession assumes that the proportion of care provided in Florida hospitals to out-of-state patients will continue over the projection horizon.

In 2022, approximately 516,000 days of inpatient care in Florida hospitals were provided to patients from out-of-state, or 5.2% of the nearly 14 million total inpatient days delivered in the state. This includes approximately 86,200 inpatient days to patients from Georgia, 39,600 inpatient days to patients from the Alabama, 26,200 inpatient days to patients from New York, 12,500 inpatient days to patients from Pennsylvania, 12,200 inpatient days to patients from Ohio, and 192,000 inpatient days to patients distributed about the other states.

Chapter 2- Florida Health Care Workforce Projections

2022-2037: Supply and Demand Trends for Registered and Licensed Practical Nurses

RN/ LPN Chapter Summary

This chapter examines the projected supply of and demand for registered nurses (RNs) and licensed practical nurses (LPNs) in Florida from 2022 to 2037. Key findings from the analysis include:

• The RN workforce is projected to grow by an average of 1.8% per year through 2037, closely aligning with the projected demand for RN services . The projected adequacy ratio for RNs (supply/demand) remains at 93% throughout the projection period indicating a relatively stable alignment between supply and demand, though falling short of full adequacy.

• The LPN workforce, conversely, is expected to decline by an average of -0.9% per year through 2037, while demand for LPN services is projected to increase at an average annual rate of 2.3% . This divergence in supply and demand will lead to a substantial LPN shortage by 2037. The LPN adequacy ratio is projected to fall from 85% in 2022 to 55% in 2037.

• Regional disparities exist in both the RN and LPN workforces. RN adequacy is projected to improve in some areas while declining in others. LPN adequacy, however, is projected to decline in all regions.

Overall, this analysis provides a comprehensive assessment of the future of Florida's nursing workforce, highlighting the need for proactive measures to ensure an adequate supply of nurses to meet the healthcare needs of the state's growing and aging population.

RN/ LPN Methodology

This section provides an overview of supply modeling methodology specific to RNs and LPNs. A detailed explanation of the demand modeling methodology for the entire study is provided in the executive summary and modeling overview document.

Supply Modeling

According to GlobalData population estimates, in 2022, Florida had 7% of the U.S. population (22.2 M) and 8% of the US population aged 65 or older (4.7 M). According to the Occupational Employment and Wages Statistics (OEWS) survey by the Bureau of Labor Statistics, 6.4% of US employed RNs (196,740) and 5.8% of US employed LPNs (36,380) work in Florida. Analyzing the distribution of Florida RNs and LPNs by setting shows that the nursing population is similarly distributed within settings. Notable differences in distribution between RNs and LPNs in hospital, home health and nursing home settings where there is a lower distribution of LPNs. As well as in school health and academia where there is a larger distribution of RNs. The ratio of RNs to LPNs is similarly even with national averages by setting with the exception of the hospital setting where Florida uses more RNs than LPNs in comparison to the national average. As well as in school health where Florida employs fewer RNs than LPNs in comparison to the national average.

7: Florida RN and LPN Employment Setting Distribution, May 2022 OEWS

The Health Workforce Supply Model creates nurse supply projections by profession using prediction equations and probabilities to simulate career progression decisions for each nurse working in Florida. The major components are: (1) estimating the size and characteristics of the starting year supply; (2) modeling the number and characteristics of new physicians to Florida’s workforce; (3) modeling the labor force participation rate and

Exhibit

weekly hours worked for those in the workforce; and (4) modeling attrition from the workforce including nurses who retire and those who move out of state and nurses moving from being an LPN to an RN and from being an RN to an APRN. Using simulation during each subsequent year of modeling, nurses’ age increases by one-year, weekly hours worked, and retirement probabilities are calculated for these new ages, new entrants are added to the workforce, and attrition is subtracted from the workforce. The methods and assumptions used throughout this process are summarized in this section, with additional details described elsewhere.10

Exhibit 8: Overview of the Supply Modeling Framework

Developing Starting Supply

The Florida Center for Nursing (FCN), in partnership with the Florida Board of Nursing (FBON) and Florida Department of Health Division of Medical Quality Assurance (MQA) has collected nurse workforce data since 2008 via a voluntary workforce survey. The survey is integrated into the online license renewal process for all nursing licenses in the state of Florida. This licensure and survey data maintained by the Florida Department of Health is the basis for both the starting supply and estimates of new entrants to the nursing workforce. The licensure data contains complete or nearly complete information for age, sex, race/ethnicity, and original license date. Survey data contains demographic information, practice setting, number of hours worked. As well as education level and certifications held. The survey also collects information on nurse practice location at the state level with information on multi-state licensure and which state main practice location is located in. These factors (especially age) are important for supply modeling as labor force participation, hours worked, and retirement probabilities are correlated with demographics and nurse experience.

To prepare the licensure data for modeling, and to arrive at a supply number in the workforce from which to begin the projection, individuals outside the age range of 18 to 75 years of age are removed from the dataset. Then, individuals with an inactive license status and those not located in the state of Florida are removed. Next, duplicate entries are removed, keeping the last recorded entry per person. Duplicate records might exist, for example, if a nurse is in the license database as both an RN and an APRN in which case we would keep the record of the nurse being an APRN. Then individuals who are not actively practicing or seeking work as an RN in the state of Florida are removed. This results in a starting supply headcount of 248,830 RNs working in the state of Florida in 2022. Using the average reported hours worked by a nurse in the state from FCN surveys translates to an equal number of FTEs. Published counts from FCN and the federal Bureau of Labor Statistics (BLS) are provided in comparison to the starting supply. The difference between the FCN published count and the model starting supply is due to modeling adjustments to exclude those not actively practicing or seeking work in Florida. The difference between the BLS count and the model starting supply is due to differences in the methodology of the respective studies. The BLS count is the result of an estimate from the Occupational Employment and Wage Statistics, a quarterly survey designed to measure employment over time. It is not a measure of the available workforce in a state drawn from state license records. It is an estimate of the number of employment positions offered in the market at a given time, regardless of FTEs.

Exhibit

9: Florida Registered Nurse 2022

The LPN starting supply is created through the same process only removing duplicate RNs and APRNs. Differences between starting supply and published FCN counts are easily explained. BLS estimates account for 64% of the published FCN counts of RNs and 54% counts of LPNs.

10: Florida Licensed Practical Nurse Starting Supply Development

Overall, the licensure data provided by FDH for registered nurses and licensed practical nurses contains nearly complete demographic information after removing individuals who are not located in Florida or do not have an active license. Exhibit 13 details the available demographic information after removing nurses who are not located in Florida or have an inactive license. Education level was not contained in the initial licensure data and was provided in the 2022-2023 workforce survey data by FCN. After matching the workforce survey data to the licensure data by license number, approximately half of all individuals in the licensure file had an associated education level. We sampled from the available data to complete cases of missing information when applicable.

Exhibit

Exhibit 11: Complete Available Information from FCN Licensure Data After Cleaning

Exhibit 12: Age Distribution of Florida’s Active Health Workforce

Source: GloablData analysis of Florida licensing and survey data

Looking at the age distribution of RNs to LPNs there are clear differences in the ages of the two workforces in Florida. While the average age of RNs and LPNs in Florida differs by less than a year (47 and 46.5 respectively) the distribution of ages provides further insight into how these two occupations will change over time. A larger portion of the LPN workforce is over the age of 50 than the RN workforce (48% of LPNs vs 40% of RNs) This means that the LPN workforce will have more individuals nearing retirement age and leaving the workforce where the RN workforce being younger is likely to maintain more individuals in the workforce over the projection horizon.

Supply Modeling Inputs

Collaboration with state licensing boards and entities collecting supplementary survey data linked to health professional licensing is crucial for providing high-quality supply modeling and producing useful information for policymakers. Microsimulation modeling is most accurate when actual persons are the unit of analysis so that each person’s unique individual combination of characteristics can be modeled based on the combination of probabilities applied to individuals in the categories applicable to each person in each year of the projection. Ultimately, the model generates aggregated FTEs which are reported at a geographic level where total FTEs is above a specified threshold.

Modeling the supply of health workers over time requires an estimate of the number of professionals actively working in the state of Florida, along with eight variables that describe the workforce characteristics of these professionals. Where these variables are unavailable at the individual unit level a synthetic population must be created using distributions of the workforce population by each categorical modeling variable from a sample survey source to run the projection. Exhibit 15 summarizes key variables used in supply modeling and the data source utilized for modeling the nursing workforce in the state of Florida.

Exhibit 13: Sources Used for Variables Required for Modeling Florida’s Nursing Supply

Age Age is derived from birthdate in licensure files received from FDH.

Gender Gender is available in licensure files received from FDH.

Attrition

Entrants

Retirement patterns are derived from the 2022 NSSRN and 2018-2022 ACS for registered nurses and licensed practical nurses respectively. Career change probabilities for nurses under the age of 50 are derived from Current Population Survey (CPS) analyses. Out migration probabilities are derived from 2018-2022 ACS.

Date first licensed in the state can be used to identify new entrants—not distinguishing between new graduates and experienced health professionals moving from another state.

Location

Specialty

Work Status

Hours Worked

Licensure files generally contain an address (or a partial address such as a ZIP or county code), but often do not distinguish between work or home address. For some states, missing address information presents challenges to identify people located in the state or outside the state.

Workforce survey data provided by FCN from 2022-2023 contains information on nurse education which is used to differentiate individuals with a BSN or ADN.

Workforce survey data provided by FCN from 2022-2023 contains information on nurse employment status.

Hours worked patterns are derived from 2022-2023 FCN provided workforce survey data.

New Entrants to the Florida Health Workforce

As the model runs it adds new entrants to the workforce in each year. The number and characteristics of these workers is assumed to be constant across the projection horizon.

Using the year a license was issued in the BON licensure data, the number of annual new entrants to the nursing workforce was estimated as the average annual number of new RN and LPN licenses issued from January 2021 through January 2024. This results in a total of 20,910 new RNs (combining BSN and ADN) and 3,160 new LPNs added annually to the workforce, with this number assumed to remain constant throughout the period under the Status Quo scenario. Ages of new RN and LPN entrants are consistent with the age distribution of newly licensed RNs and LPNs in the 2022 NSSRN and 2018-2022 ACS data, with all other demographics reflective of the distributions of these factors among all Florida RNs and LPNs in these sources. These demographic distributions remain constant when projecting into the future.

Exhibit 14: Number and Characteristics of Annual New Entrants

Source: Analysis of FDH licensure file for individuals licensed from January 2021 through January 2024.

Labor Force Participation and Attrition

RN and LPN retirement patterns are derived from national survey responses from nurses in the 2022 NSSRN and 2018-2022 ACS, respectively. Probability of retiring is based on the age of the nurse. As the modeling process progresses from year to year, a nurse’s probability of retiring will change based on his or her new age, and this probability generally increases with age. Included in this attrition process is the possibility that an LPN becomes an RN, or an RN becomes an APRN. The number of new entrants to the RN workforce each year accounts for LPNs who become RNs.

Nurse migration probabilities are calculated from prediction equations based on age, race/ethnicity, and sex by education level estimated using 2018-2022 ACS data for both RNs and LPNs, and specifically account for the number of nurses leaving Florida each year. Inmigration is also accounted for in the model, but in-migrating nurses are tracked as new entrants to the Florida nurse workforce.

Source: Analysis of FDH licensure file for individuals licensed from January 2021 through January 2024.

Exhibit 15: Probability Nurse Aged 50 is Active Over Time, by Occupation & Education

Hours Worked Patterns

Survey responses from the 2022 NSSRN and the 2018-2022 ACS were used to predict RN and LPN weekly hours worked based on nurse age, sex, race/ethnicity, and education level (associate degree or baccalaureate degree for RNs). An FTE is defined as 36.5 hours/week for RNs and 38.5 hours/week for LPNs reflecting national average hours worked for nurses working at least 8 hours per week.

Drawing on data from the 2018-2022 ACS survey asking the number of hours worked, RNs are estimated to be working slightly fewer hours per week on average than LPNs (an average of 36.5 hours per week for RNs in comparison to 38.5 reported by LPNs)

Source: Analysis of FDH licensure file for individuals licensed from January 2021 through January 2024.

Exhibit 16: Average Hours Worked Per Week of Florida’s Active Health Workforce by Specialty

Supply Scenarios Modeled

The supply modeling described reflects the modeling assumptions for the Status Quo scenario. Several alternative scenarios were modeled to account for uncertainties in future nurse workforce patterns. Two scenarios reflecting changing retirement patterns were modeled the Early Retirement scenario, reflecting nurses retiring two years earlier than they do currently, and the Delayed Retirement scenario, reflecting nurses retiring two years later than they do currently. The former scenario could reflect the possible impact of worsening provider burnout, and the latter could reflect the possible results of efforts by employers to retain senior staff. Similarly, two scenarios were modeled that assume alternately a 10% increase and a 10% decrease in annual new graduates entering the workforce projected into the future (named the 10% More Graduates and 10% Fewer Graduates scenarios, respectively). The former scenario could reflect, for example, the impact of increased efforts within the state to attract and recruit new nurses to the profession, while the latter could reflect the impact of decreased desirability of nursing in the wake of unenviable working conditions.

RN/ LPN Findings

This section outlines the projected trends in Florida's nursing workforce from 2022 to 2037, highlighting distinct challenges and opportunities for Registered Nurses (RNs) and Licensed Practical Nurses (LPNs). The RN workforce is projected to grow steadily under all scenarios, with supply increases closely aligned with population demand, maintaining an adequacy ratio near 93%. However, the LPN workforce faces a more precarious future, with declining supply and rising demand leading to a sharp drop in adequacy from 85% in 2022 to 55% by 2037. Regional disparities further complicate these trends, as RN adequacy improves in some areas while LPN adequacy declines uniformly across all regions. Comparisons to previous projections from 2019 reveal accelerated growth in the RN workforce but a more rapid decline in LPN supply than previously expected, underscoring the need for continual re-assessment of projections and targeted policy interventions to address emerging gaps and ensure an adequate nursing workforce statewide.

Supply and Demand Projections

The number of new RNs entering the Florida workforce starts at 8.5% of the starting supply in the first year of the projection. As the workforce grows the assumed constant number of new entrants shrinks to 6.8% of the starting supply in 2037. Retirements from the workforce initially nearly offset the number of new entrants with 8.2% of starting supply in 2022 retiring in that year. Retirements drop to 5.5% of the starting supply in 2037. Assumed retirements and new entrants by year are summarized in Exhibit 146 in the appendix.

Over the projection period, supply of RNs in Florida is expected to grow by 26% (or 1.8% per year) a total of 65,650 FTE RNs under the Status Quo scenario, with projected growth over the period between 17% (or 43,320 FTE RNs under the 10% Fewer Graduates scenario) and 3% (or 87,940 FTE RNs) under the 10% More Graduates scenario).

Population demand for RN services under the demand Status Quo scenario is projected to increase by 26% (1.7% per year) for a total of 69,300 RN FTEs. Projected demand in the Reduced Barriers scenario increases above the status quo supply by 14% (35,830 FTE RNS) in the first year of the projection and continues to grow at 1.8% per year until it is 45% (75,800 FTE RNs) above the starting year status quo supply in the final year of the projection.

The ratio of supply over demand reflects the extent to which the estimated supply is adequate to meet estimated demand each year. Status Quo RN supply over demand adequacy is at 93% in 2022 and is projected to remain stable overall as supply and demand bother continue to grow over the projection period. Projected RN supply modeling results from all scenarios are summarized in the appendix.

17: Florida Registered Nurses Projections, 2022 - 2037

18: Florida Registered Nurses Adequacy Summary Table

Exhibit

The number of new LPNs entering the Florida workforce starts at 6.9% of the starting supply in the first year of the projection. As the workforce shrinks over time due to expected retirements, the assumed constant number of new entrants grows to 8.0% of the starting supply in 2037. Retirements from the workforce entirely offset the number of new entrants each year with 8.7% of starting supply in 2022 retiring in that year. Retirements fall slowly over the projection to 8.2% of the starting supply in 2037. Assumed retirements and new entrants by year are summarized Exhibit 148 in the appendix.

Over the projection period, supply of LPNs in Florida is expected to shrink by -14% (or -0.9% per year) for a total of 6,400 FTE LPNs under the Status Quo scenario, with projected declines over the period between as much as -20% (or -9,200 FTE LPNs under the 10% Fewer Graduates scenario) and -8% (or -3,760 FTE LPNs) under the 10% More Graduates scenario). Projected LPN supply modeling results from all scenarios are summarized in the appendix.

Population demand for LPN services under the demand Status Quo scenario is projected to increase more rapidly than for RNs over the projection period. Demand for LPNs is projected to increase by 34% (2.3% per year) for a total of 18, 360 LPN FTEs. Projected demand in the Reduced Barriers scenario increases above the status quo supply by 25% in the first year of the projection and continues to grow until it is 68% above the starting year status quo supply in the final year of the projection.

The ratio of supply over demand reflects the extent to which the estimated supply is adequate to meet estimated demand each year. Status Quo LPN supply over demand adequacy is at 85% in 2022 and is projected to decline to and adequacy ratio of 55% by the end of the projection period due to increased population demand for LPN services and declines in the LPN workforce supply. Projected LPN supply modeling results from all scenarios are summarized in the appendix.

19: Florida Licensed Practical Nurses Projections, 2022 - 2037

20: Florida Licensed Practical Nurses Adequacy Summary Table

Exhibit

Strategic Planning Efforts

Projections are useful for measuring the trajectory of a scenario assuming continuation in a similar direction. The Status Quo scenarios presented in this report represents the trajectory of the scenario assuming no intervention. The reduced barriers demand scenario and the entrant and retirement supply scenarios represent where the trajectory of a projection could lead given specific changes in the workforce or policy interventions to increase equal utilization of healthcare services. Setting a goal to close the gap between supply and demand may be a desired goal for policy makers. To close this gap over the current projection horizon would require approximately 5,900 additional RNs and 1,700 additional LPNs per year, above and beyond those already accounted for in the model to join and be retained in the Florida workforce. This is a rough estimate of the required effort to close the gap between the status quo supply and demand scenarios over the projection horizon. It does not consider the age and demographic factors of those hypothetical required additional new entrants as has been done for new entrants in the projection modeling process. In this sense, this is likely a conservative estimate of required additional effort as some of these additions would be lost to attrition each year. A rough estimate is made by simply subtracting the number of FTEs demanded in 2037 from the number of FTEs supplied in 2022 and dividing that by 15 years. Similar estimates may be produced for any of the scenarios by utilizing the tables provided in the appendix.

Regional Adequacy Gap Analysis

The ratio of supply to demand as an adequacy score can be broken down by region and analyzed for geographic change over time. When interpreting such regional values, the adequacy ratio highlights the relative workforce sufficiency in a region at a specific time, serving as a benchmark for understanding current disparities. In contrast, the adequacy change values indicate growth or decline in adequacy over time, allowing for trend analysis and forecasting future needs or challenges. Adequacy values are colored on a gradient from dark blue to dark red with grey indicating 100% adequacy in the middle. The greater the adequacy value is above 100%, the darker blue the county appears. The further below 100% adequacy a county appears the darker red the county appears. Adequacy change values are colored using the same blue to red gradient with the middle set to 0% to reflect how much a county is changing in the positive or negative direction over time. The greater the positive value is, the darker blue the county will appear. The more negative the value is, the more negative the county will appear. Comparing two county maps for any given occupation gives a complete view showing counties that are currently underserved and unlikely to improve, as well as counties that, despite current shortages, are on track for growth. Comparing the two regional maps for different professions (ie: RNs and LPNs) enables a holistic evaluation.

Exhibit 21 reveals that regions on the east coast of Florida will experience declines in Registered Nurse supply to demand adequacy over time varying from -3% to -13%. Whereas, regions along the west coast of Florida, including the Northwest, down to the South region will experience growth varying from 1% to 7%. The region with the largest expected decline is

the Northeast. The region with the most expected growth is the South. A crosswalk of counties to regions is included in the appendix.

21: Florida Registered Nurse Supply Adequacy by Region

Adequacy 2022

Adequacy Change 2022- 2037

Adequacy (2022): Unevenly distributed across the state with highs in the Northeast (142%) and the South (148%) Extremely low adequacy in the Northwest (41%)

Adequacy Change (2022-2037): Slow improvements expected across the west side of the state (between 1% in the Northwest and 7% in the South region). Declines expected over the eastern regions overall, with the a high of -13% in the Northeast region where RNs are most concentrated.

Exhibit

Exhibit 22 shows that LPN supply to demand adequacy will decline in all regions over time varying from declines of -35% in the South region and -34% in the Northwest region on the high end over time -24% in both the Northwest and Southwest regions on the low end.

Exhibit 22: Florida Licensed Practical Nurse Supply Adequacy by Region

Adequacy 2022

Adequacy Change 2022

Adequacy (2022): LPNs are most highly concentrated in the Northeast and North Central regions (101% and 107% adequacy respectively).

Adequacy Change (2022-2037): Significant declines are expected across the entire state for LPNs. The least decline is anticipated in the areas where adequacy is lowest in 2022 (Northwest, Souwest and Southeast).

Comparing regional change in adequacy over time by occupation, there are five regions where RN adequacy change is improving over time and LPN change is declining (North Central, Northwest, South, Southwest, West Central) There are three regions where RN adequacy change over time is also declining (East Central, Northeast, and Southeast). However, LPN adequacy is declining more severely than RN adequacy in all these regions.

Exhibit 23: RN and LPN Regional Comparison Supply Adequacy 2022

Exhibit 24: Change in Florida RN and LPN Supply by Region, 2022 – 2037

RN/ LPN Discussion

This section delves into the implications of projected workforce trends for registered nurses (RNs) and licensed practical nurses (LPNs) in Florida, spanning 2022 to 2037. By examining the key findings, regional variations, and broader workforce dynamics, the analysis provides critical insights into the adequacy of the nursing supply to meet future healthcare demands. These projections highlight both promising developments, such as steady RN growth, and challenges, including significant LPN shortages. The findings serve as a foundation for exploring policy interventions and strategies to ensure an equitable and sufficient nursing workforce statewide.

Key Findings and Implications

This chapter analyzes the projected supply and demand for RNs and LPNs in Florida from 2022 to 2037, revealing divergent trends for these two essential segments of the nursing workforce.

Registered Nurse Workforce:

• Adequate Supply Projected: The RN workforce is projected to experience steady growth, largely keeping pace with population growth and demand for RN services. The adequacy ratio, representing the balance between supply and demand, is projected to remain stable around 93% , indicating near equilibrium between the number of RNs available and the demand for their services.

• Growth Driven by New Entrants: This projected adequacy is attributed to the continuous influx of new RN graduates entering the Florida workforce. The study assumes a constant number of new entrants each year, based on recent licensing data. This assumption plays a significant role in maintaining a balanced supplydemand dynamic.

• Faster Growth Than Anticipated: Comparing current projections to a previous assessment from 2019 reveals an accelerated growth rate in the RN workforce. This positive trend is likely due to efforts by the Florida Center for Nursing to bolster the RN workforce.

• Regional Variations Exist: While overall RN adequacy is projected to be stable, regional disparities exist. Regions on Florida's east coast are projected to experience slight declines in RN adequacy, while regions along the west coast and the southern region are expected to see modest improvements.

Licensed Practical Nurse Workforce:

• Significant Shortages Projected: In contrast to the RN workforce, the LPN workforce faces a challenge to growth in the desired direction, characterized by declining supply and rising demand. The adequacy ratio is projected to plummet from 85% in 2022 to 55% by 2037, signaling a substantial shortage of LPNs relative to the projected need for their services.

• Declining Supply a Key Factor: This projected shortage is primarily driven by a shrinking LPN workforce. The study highlights that retirements among LPNs are

expected to consistently outpace the number of new graduates entering the field, leading to an overall decline in the number of practicing LPNs.

• Faster Decline Than Previously Projected: Comparing the current projections to the 2019 assessment reveals a worsening situation for LPNs. The decline in LPN supply is occurring at a faster rate than anticipated four years ago, suggesting a need for intervention.

• Widespread Regional Declines: Unlike the regional variations observed for RNs, LPN adequacy is projected to decline across all regions of Florida. The most severe declines are anticipated in the Northwest and South regions.

Policy Implications:

These findings underscore the need for targeted policy interventions to address the looming shortage of LPNs in Florida. Potential strategies might include:

• Increasing the Pipeline of New LPN Graduates: This could involve expanding LPN educational programs, providing financial incentives for LPN students, and promoting the LPN profession as a viable and rewarding career path.

• Retaining Existing LPNs in the Workforce: Efforts to improve working conditions, offer competitive salaries and benefits, and provide opportunities for professional development could help retain experienced LPNs.

• Exploring Innovative Models of Care: Task-shifting and other care delivery models that optimize the skills of both RNs and LPNs could help address workforce imbalances.

• Addressing Regional Disparities: Targeted recruitment and retention initiatives in regions facing the most severe shortages could help mitigate geographic imbalances.

Overall, this chapter provides a comprehensive assessment of the future of Florida's nursing workforce, highlighting the need for proactive measures to ensure an adequate supply of nurses to meet the healthcare demands of the state's growing and aging population. Failure to address these challenges could have significant consequences for the quality and accessibility of healthcare in Florida.

Comparison to 2019 Nursing Projections for the Florida Hospital Association

In 2019 the GlobalData health workforce consulting team, under previous ownership of IHS Markit produced projections of Florida’s RN and LPN workforce for the Florida Hospital Association. The same modeling process and sources were utilized in that analysis as have been used in this current projection. Comparing previous projection modeling to current allows for analysis of how workforce growth has continued in expected ways and changed in unexpected ones over the past three years.

Exhibit 25: Florida Registered Nurse Projection Comparison 2019 to 2022

Supply of RNs in Florida has grown faster than anticipated in 2019. There are 8,550 more RNs in the 2022 starting supply of the RN workforce in the current projection than there were anticipated to be in the 2019 projection. Demand also increased by 6,620 above where it was projected to be in 2019. This results in the supply over demand adequacy ratio for the year 2022 moving from 92% in the previous FHA sponsored projection to 93% adequate in this current projection. The RN workforce supply is projected to continue to increase at a faster rate than previously projected in 2019, while population demand for utilization of RN services will remain on a similar growth trajectory to the previous projection. By 2035, (the last year of the previous projection), RN supply will be 20,180 more in the new projection than the previous projection while demand will have grown by only 7,700 more than the previous projection. These changes over a three-year period between studies reflect efforts made by the Florida Center for Nursing to increase the RN workforce in the state of Florida. increase in projected growth rate indicates increases in new and younger nurses entering the state workforce.

Exhibit 27: Florida Licensed Practical Nurse Supply Projection Comparison 2019 to 2022

Exhibit 28: Florida LPN Supply Projection Variation, Previous and Current Projection

The supply of LPNs in Florida conversely has slowed and is now expected to be in decline over the projection rather than the previously expected very slight growth. Supply of LPNs is 530 fewer now than it was projected to be in 2019. By 2035 supply is projected to be 9,570 fewer than it was projected in 2019. The difference in demand is less drastic over time with the previous projection being 660 fewer in 2022 than expected previously. The difference between the projected workforce in 2035 is only 910 between the previous and current projections. The supply to demand adequacy ratio of the LPN workforce was previously projected to be at 85% in 2022 and is currently at the same. However, previously the supply to demand adequacy ratio was projected to fall to 70% by 2035. Now it is projected to decline more rapidly and will be at 57% by 2035. These changes indicate that in the short term, the LPN workforce did continue to grow slightly as previously anticipated, however, it seem that much of this growth may have been from older LPNs moving to Florida rather

than much growth in younger new graduates entering the Florida workforce since the current trajectory of the LPN workforce has shifted downward indicating there are more retirements expected now than previously.

Chapter 3- Florida Health Care Workforce Projections

2022-2037: Supply and Demand Trends for Physicians, Physician Assistants and Advanced Practice Registered Nurses

Physician/ PA /APRN Chapter Summary

This chapter provides projections for the supply and demand of physicians, physician assistants (PAs), and advanced practice registered nurses (APRNs) in Florida from 2022 to 2037. It examines overall projections as well as a breakdown by specialty category and region, analyzing adequacy ratios to identify potential shortages and surpluses. This information can be used for strategic planning and policy initiatives to address potential healthcare workforce challenges in Florida.

Key findings from the chapter include:

Physician Workforce

• The physician workforce is projected to remain relatively stable, with adequacy ratios nearing equilibrium by 2037. A nearly balanced demand and supply situation in 2037 is anticipated, with adequacy rising from 92% in 2022 to 98%.

• Despite this stability, regional disparities are expected to persist, with rural areas facing potential shortages. High total adequacy in South (133%) and Northeast (113%), while the Northwest lags behind the rest of the state (49%). Varying improvements are seen across regions over the projection period, except for declines in Southeast (-5%)

Physician Assistant (PA) Workforce

• The PA workforce is projected to experience declines in adequacy by 2037, with the exception of Primary Care specialties where adequacy is moderate to high in some regions, such as the Northeast (121%) and South (115%) but remains low in Northwest (22%) and North Central (41%).

• Regional supply gaps are expected to widen, particularly in underserved areas like the Northwest region.

Advanced Practice Registered Nurse (APRN) Workforce

• The APRN workforce, including nurse practitioners, nurse anesthetists, and nurse midwives, is projected to experience steady growth , maintaining high adequacy ratios across the projection period.

• Regional disparities are expected to persist, despite strong overall adequacy. Certain rural and underserved regions may face localized shortages, particularly for nurse anesthetists and midwives.

Key Implications

• The projected trends suggest that advanced practice nurses will likely play an increasingly critical role in addressing workforce gaps and ensuring access to care.

• Targeted policy interventions and strategic planning efforts are crucial to address the projected shortages, particularly for PAs and in specific physician specialties.

• Efforts to expand PA deployment in underserved areas and optimize the utilization of NPs across specialties may be necessary.

• The findings emphasize the importance of considering regional disparities in workforce planning and implementing strategies to ensure equitable distribution of healthcare professionals across Florida.

The chapter provides detailed analyses of supply and demand projections by specialty category and region, offering a comprehensive overview of the healthcare workforce landscape in Florida. This information is valuable for stakeholders involved in healthcare workforce planning, policy development, and service delivery.