By Rose O. Sherman, EdD, RN, FAAN
“Everyone is entitled to their own opinions, but they are not entitled to their own facts” ……Daniel Patrick Moynihan
The Future of Nursing report was issued by the Institute of Medicine in December of 2010. The report has 8 recommendations. Recommendation 4 is to increase the proportion of nurses with a baccaulaureate degree to 80% from the current 50% level today by 2020. We are now almost 4 years into working on this recommendation and only six years from the arrival of 2020. So how are we doing? The answer seems to be that we are making slow but steady progress. A new National Nursing Workforce survey released in 2013 indicates that 51% of nurses today have a BSN or higher. New associate degree graduates are returning to school in record numbers for their BSN – partially driven by new hiring practices in many healthcare settings where the BSN is required for initial employment. These numbers are encouraging but many nurses that I talk with are highly skeptical that this will happen. Seasoned nurses point to discussions back in the 1960s about this same issue that were not successful. Others look at the increasing number of associate degree programs and graduates, and wonder if these nurses will return to school in greater numbers than they have in the past once a shortage of staff kicks back in. Some nurses have misinterpreted the report to mean that associate degree nursing programs should be completely eliminated. Emerging nurse leaders need to be prepared to speak to this issue because it is controversial yet important to the future of nursing.
Four Key Points to consider about this recommendation include the following:
1. Highly Complex Environments Require Stronger Knowledge Skill Sets.
The IOM report makes a strong case to support that advances in science and increasing patient complexity have accelerated our need for nurses with the skill and knowledge to manage a challenging and increasingly diverse healthcare environment. Unlike Associate Degree programs, BSN curriculums provide content on evidence-based practice, health policy and finance, interprofessional communication and collaboration, systems leadership, disease prevention and population management. This is program content that nurses need to navigate not only today’s health care environment but also the changes anticipated with health reform.
2. There is Research Evidence to Support that a Higher Percentage of BSN Graduates = Better Patient Outcomes.
One of the strongest arguments to support the need for a higher percentage of BSN prepared nurses is the research evidence that a richer mix of BSN nurses results in better patient outcomes. Work done by Aiken (2003), Estabrooks et al. (2005), Tourangeau et al. (2006), Blegen &Goode (2009) indicates that a higher percentage of BSN prepared nurses lowers patient mortality.
3. Current Education Models Support the Movement of RNs from Associate to Bachelors Degrees.
Historically, it was difficult for nurses from associate or diploma programs to find flexible programs to complete their BSN. Today, there are many options especially with the rising number of online programs. In a number of states, community colleges have moved to become colleges and now offer RN-BSN programs in addition to associate degrees. In response to the IOM report, states like Oregon are moving forward to standardize nursing curriculums and facilitate the pathway for nurses who seek their BSN.
4. Europe has already moved Nursing Education to the BSN Level.
We often think of the US education system as being one of the most progressive. Many nurses don’t realize that as part of the Bologna agreement which was signed over a decade ago, professional nursing education in the European Union shifted to the baccaulaureate level as the standard for professional licensure. Australia and New Zealand also now have BSN preparation as entry into practice. There are a number of states in the United States where there is active lobbying for legislation to require RNs to obtain a BSN for relicensure within an established period of time. These include Missouri, New York, New Jersey, Kansas, Oklahoma and Missouri.
So what happens next?
The arguments about the need for a BSN are likely to continue. Many health care organizations especially those with Magnet designation have already made the BSN a requirement for entry level employment. It is interesting that in my years of teaching RN to BSN students, I have never had a student tell me that earning their BSN was a bad decision. In fact, many sheepishly tell me that they wished they had not spent so many years debating the value of a BSN. I always tell students that you don’t know what you don’t know, until you do. Investing the time and energy to receive a BSN is a personal investment that will open doors. Nurse leaders play an important role in encouraging their staff to continue their education and will be key to nursing achieving an 80% BSN workforce by 2020.
I am interested in your comments and thoughts about this issue.
Read to Lead
Aiken LH, Clarke SP, Cheung RB, Sloane DM, Silber JH. (2003). Educational levels of hospital nurses and surgical patient mortality. Journal of the American Medical Association, 290(12), 1617-1623.
Budden, J.S., Zhong, E.H., Moulton, P. & Cimotti, J.P. (2013). Supplement: The National Council of State Boards of Nursing and the Forum of State Nursing Workforce Centers 2013 National Workforce Survey of Registered Nurses. Journal of Nursing Regulation, 4(2), S1-72.
Blegen, M.A., Goode, C.J., Park, S.H., Vaughn, T. & Spetz, J. (2013, February). Baccalaureate education in nursing and patient outcomes. Journal of Nursing Administration, 43(2), 89-94.
Estabrooks CA, Midodzi WK, Cummings GG, Ricker KL, Giovannetti P. (2005). The impact of hospital nursing characteristics on 30-day mortality. Nursing Research, (2), 74-84.
Goode CJ, Blegen MA. The link between nurse staffing and patient outcomes. ANCC National Magnet Conference; October 2, 2009; Louisville, KY.
Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Washington DC: National Academies Press. Future of Nursing 2010 Recommendations
Tourangeau AE, Doran DM, Hall LM, et al. (2007). Impact of hospital nursing care on 30-day mortality in acute medical patients. Journal of Advanced Nursing, 57(1), 32-44.
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