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Wisconsin Nursing Leads the PACC: Partnerships in Action for Community Care
ACHIEVING 80% BSN by 2020: Gaining & Maintaining Momentum
Wisconsin Center for Nursing, Inc.RWJF State Implementation Program Grant #72504
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Wisconsin Center for NursingMission: Assure an adequate, well-prepared and diverse
nurse workforce for the people of Wisconsin
• Designated 501(c)(3) state nursing workforce center
• Co-lead for the Wisconsin Action Coalition to implement IOM Report recommendations.
• 2 RWJF State Implementation Program grants
• Focus Areas: Educational Advancement, Leadership, Diversity
• Multiple projects w/ stakeholders & partners to advance nursing in Wisconsin
• 2016 Wisconsin RNs = 35.7% ADN, 46.1% BSN, 10.3% MSN and 0.8% Doctorates 2
LEAD - Organization Recognition Program
• Developed recognition program for organizations working to advance education
• Leading by Example to Advance Degrees
• Project Goal: Recognize organizations who are paving the way to advance levels of nursing education
• Project Purpose: Provide platform to recognize & share what orgs are doing around BSN completion or other educational advancement
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‘LEAD’Organization RequirementsFrame the work around IOM recommendations:1. Increase proportion of nurses with baccalaureate degrees
to 80% by 2020.2. Double number of nurses with doctorate degrees by 2020.3. Ensure nurses engage in lifelong learning.
• No set criteria for program specifics• Any organization working on education advancement • Submit brief summary of activities, contact info & photo• Join the ‘gallery’ of organizations w/ their exemplars on
website• http://www.wisconsincenterfornursing.org/WCN_Organizat
ion_Recognition_Program.html4
Leading by Example to Advance Degrees
Two LEAD Organizations in Wisconsin Share Their Stories
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Achieving 80% BSN by 2020: Your Resources & The Bellin Story
Laura Hieb, BSN, MBA, NE-BC
Bellin Health Chief Nursing Officer &
Chief Executive Officer Bellin Health Oconto Hospital
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Resources to help you on your journey!
•WONE website
•http://w-one.org/
•Academic Progression
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The Bellin Story
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Cohort 2 – January 2016
Cohort 1 – August 2015
Bellin Health –Over 3,700 Employees1,007 nurses (65% BSN or Higher)
The Journey
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2010-2011
Read the IOM Report Held focus sessions
2012Understood our gaps –gathered data on our
current state
2013Incorporated into Nursing Professional
Development Council and annual nursing goals
Picked our focus area of 80% BSN by 2020
2014 Held focus sessions again with staff
Partnered with local Bellin College
2015Created a proposal -calculated costs and
developed ROI
Presented to Senior
Leadership
Launched first cohort in
August 2015
Hiring process changed to require BSN
within 5 years
The Journey Continues
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2016 2nd cohort started in January
2017-2019
1 cohort will start in each of the next 3 years
2018-2020
Pay split
Did the Math!
• Number of RN’s that are currently Diploma, ADN, BSN, or higher
• Projected RN turnover through attrition/retirement
• Number of BSN’s versus ADN’s being hired
• Number of currently employed RN’s enrolled in higher degree programs
• Number of RN’s willing to go back to school
• Implementation of new ADN’s needing to obtain a BSN within 5 years of hire
• Calculated if we maintain current education ratios and support enrolling 100 RN’s in the BSN Completion Program, we will hit 80% by 2020
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Return on Investment
• Bellin to cover 70% of students’ tuition and book fees, student to cover remaining 30%
• Bellin’s approximate cost per student is $19,600
• Monetary investment for Bellin = $1.96 million over 5 years (100 nurses)
• Approximate cost of RN turnover today = $50,000
• Students sign a retention commitment of 2-4 years post-graduation, dependent on dollars received
• Projecting to decrease turnover by 40 nurses in 5 years (using current predicted shortages and Bellin data against current state demographic data)
• BSN Completion Program projects are “Bellin” related and focus on our strategic goals, therefore creating benefit to the system
• Continue work to solicit funds from outside sources
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It’s a Win-Win!
• Win for the Employee
• 70% of their tuition and book expenses are covered
• Participating in a Bellin specific program that will optimize work and academic opportunities
• Cohorts consist of their colleagues from across the organization, creating a support system
• Blended curriculum approach of on-line curriculum and classroom to optimize work/life balance
• Win for the Organization
• Enhanced partnership with Bellin College on a unique program that optimizes current work
• Completed projects impact the Quadruple Aim for the system (cost, population health outcomes, experience, and joy in work)
• Assists in a retention strategy for when retirements begin to hit
• Supports achieving IOM recommendations of 80% BSN by 2020 14
Success Stories…..
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The BSN Progression Taskforce Proposal for the Aspirus System
• Deanna Wilson, V.P. Patient Care Services
Aspirus Ontonagon Hospital
• Peggy Ose, V.P. Patient Services & Chief Nursing Officer
Aspirus Riverview Hospital
• Ruth Risley-Gray, SVP, Aspirus System Chief Nursing Officer
• John Heisler, SVP, Chief Human Resource Officer
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8 community directed, non-
profit hospitals and 50+ clinics
serving North Central
Wisconsin and the Upper
Peninsula of Michigan
Headquarters
• Full continuum of healthcare services offered: two acute care
hospitals, six critical access hospitals, over 50 multi-specialty
clinics, ambulatory surgery centers, home health, hospice
care, pharmacies, medical equipment, & skilled nursing
homes
• More than 7,000 employees
Newly Added
Aspirus BSN Progression Taskforce
• Aspirus - more than 7,000 employees in North Central and Northeast WI, and the Western UP
• 8 hospitals in system; 4 in each state. 6 are CAHs.
• CNOs, system CNO, and Directors from PAC and Clinics, meet monthly basis (in-person or via videoconference)
• Goal: Develop system-wide initiatives that all hospitals work on collaboratively
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• CNO Strategic Planning session, identified BSN progression high-priority goal for FY 17, as well as for future
• Determined system lagging in driving BSN prepared nursing education IOM recommends
• Task force selected to move initiative forward.
• Reps from: CNO group, Human Resources, Legal, Finance, Education Services, and Nurse Recruitment.
Aspirus BSN Progression Taskforce
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Aspirus BSN Progression Taskforce
• Step #1 - Gap analysis to determine the current Aspirus nursing educational level.
• Manual, time-consuming process – no effective electronic HR system to easily extract info
• Findings: 56% ADN prepared nurses
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Aspirus System Nurse Education Matrix
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Aspirus BSN Progression Taskforce
• CNOs and HR representatives presented IOM recommendations, along with supporting research, to Corporate Executive Council 12/16/15
• Also provided demographics on the nursing population from information in WONE toolkit
• Provided the Aspirus Nurse Education matrix to show how our system compared to the Wisconsin demographics.
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Aspirus BSN progression Taskforce
• Presented the Why, and the current state of nurse education at Aspirus to lay the groundwork for the Ask.
• At 1/20/16 CEC meeting, we went in with the Ask: a request to increase the tuition amount and the rate of reimbursement for BSN completion, along with rough draft financial information.
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Aspirus BSN Progression Taskforce
• Rough estimate cost to achieve 80% BSN workforce was initially determined to be approximately $6.125 Million for Aspirus.
• A Nursing Tuition reimbursement policy was written & reviewed with the BSN Progression Taskforce
• After revisions, presented to the CEC, as well as the System CNO group in January, to outline the how Aspirus would reimburse for BSN education.
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Aspirus BSN Progression Taskforce
• Increase tuition reimbursement to $12,500 per ADN nurse for BSN completion
• Assumption: average time to complete would be 3 years
• No limitation on $ amount received per year, but must be actual costs. Same reimbursement for FT or PT nurses.
• Repayment following BSN completion would be $2 for every hour worked. If FT (2080 hrs per year), repayment of $4,160 per year. 25
Aspirus BSN Progression Taskforce
• Prepared to go back to the CEC on 3/23/16 to provide a more detailed cost projection over next three years
• Also prepared to address other questions from the CEC. This decision had a huge financial impact to our healthcare system, so an in-depth analysis was necessary.
• Determined the number of nurses each hospital could monetarily support each year
• Determined timeline for achieving 80% BSN nursing staff 26
Projected Costs
Entity
# of
Nurses
1st year
Potential
Total per
EE
$12,500
Year 1 Year 2 Year 3 Year 4 Year 5
5 Year
Projected
Cost
Year 6 Year 7 Year 8 Year 9 Year 10
10 Year
Projected
Cost
AWH 30 12,500 125,000 250,000 375,000 375,000 375,000 1,500,000 375,000 375,000 375,000 375,000 375,000 3,375,000
ARV 10 12,500 41,667 83,333 125,000 125,000 125,000 500,000 125,000 125,000 125,000 125,000 125,000 1,125,000
AKH 6 12,500 25,000 50,000 75,000 75,000 75,000 300,000 75,000 75,000 75,000 75,000 75,000 675,000
ALH 6 12,500 25,000 50,000 75,000 75,000 75,000 300,000 75,000 75,000 75,000 75,000 75,000 675,000
AGV 6 12,500 25,000 50,000 75,000 75,000 75,000 300,000 75,000 75,000 75,000 75,000 75,000 675,000
AMH 6 12,500 25,000 50,000 75,000 75,000 75,000 300,000 75,000 75,000 75,000 75,000 75,000 675,000
AIR 6 12,500 25,000 50,000 75,000 75,000 75,000 300,000 75,000 75,000 75,000 75,000 75,000 675,000
AOH 4 12,500 16,667 33,333 50,000 50,000 50,000 200,000 50,000 50,000 50,000 50,000 50,000 450,000
Totals 74 308,333 616,667 925,000 925,000 925,000 3,700,000 925,000 925,000 925,000 925,000 925,000 8,325,000
Number BSN Completed - - 74 74 74 222 74 74 74 74 74 592
• Five Year Projected Cost $3.7 Million and 222 BSN Graduates• Ten Year Projected Cost $8.3 Million 592 BSN Graduates• Annual Cost of $925K starting Year 3
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Aspirus BSN Progression TaskforceTimeline for Completion
Business Unit
Total RN's # of A.D.N.'s % of A.D.N.'s# of B.S.N.'s or Higher*
% B.S.N.'s or Higher*
# of A.D.N.'s x .80
# of Nurses First Year
Total # of Years
Plus 3 YrsGrand Total #
of Years
CALENDAR YEAR OF
COMPLETION
AGV 93 68 73% 25 27% 54 6 9 12 12 2028
AKH 85 48 56% 37 44% 38 6 6 9 9 2025
ALH 137 89 65% 48 35% 71 6 12 15 15 2031
AMH 131 78 60% 53 40% 62 6 10 13 13 2029
AOH 33 22 67% 11 33% 18 4 4 7 7 2023
AWH 646 307 48% 339 52% 246 30 8 11 11 2027
AIR 56 29 52% 27 48% 23 6 4 7 7 2023
ARH 153 105 69% 48 31% 84 10 8 11 11 2027
ACI 72 33 46% 39 54% 26 N/A N/A N/A N/A N/A
PAC 47 39 83% 8 17% 31 N/A N/A N/A N/A N/A
Total 1453 818 56% 635 44% 74
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Aspirus BSN Progression Taskforce
• The CEC had many questions & needed more information prior to voting on the BSN proposal
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Questions needing Response:1. Should this proposal be limited to nurses pursuing a
BSN or also be offered to nurses pursuing MSN or DNP?
2. How does this impact other staff? What are the tuition reimbursement opportunities for others in the organization? How might this impact morale? Why is nursing getting this bump and not others?
3. What is the actual cost for an ADN to BSN program? Have we canvassed the various schools to get an accurate amount?
4. What % of costs will the proposed tuition reimbursement cover for the student so they have ‘skin in the game’? 30
Questions needing Response, continued
5. What budget impact (now & future) would this initiative have on individual business units?
6. What is the plan to work in synchrony with the clinic’s plan coming forward to incentivize BSNs to get their APNP? How can we do this together to ensure a win/win for both efforts?
7. Why do FT and PT get same amount? Should a pro-rated amount for PT be considered?
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Questions needing Response, continued
8. What is the Nursing Model of Care that this effort is supporting? What’s the end in mind?
9. How will you demonstrate quantifiable benefit and outcomes in terms of improved patient care – quality outcome measures/improved cost of care measures/safety and patient experience measures?
10. How does the differential impact salary/wage to market by BU vs. midpoint?
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After all of the above questions were addressed, the proposal received the approval of CEC. The Aspirus CNOs and HR Leaders then proceeded with implementation.
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The Tuition Reimbursement Policy was reviewed again, some minor modifications were made, and it received final approval.
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As noted previously, built into the policy is a commitment to continue to work for Aspirus after attainment of the BSN.
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For every 1 hour worked, $2.00 of the amount of tuition reimbursement awarded would be forgiven.
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Benefit to the system: Reduce recruitment and other on-boarding costs, including time spent in orientation and preceptor costs.
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In addition, the increased number of BSN prepared nurses in our facilities is anticipated to improve patient outcomes as identified in the IOM report.
One way in which that outcome will be measured is through monitoring our quality metrics over time.
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The topic was added to union negotiation agendas at hospitals with bargaining units.
At hospitals without unions, a computerized learning module was developed and made mandatory for all RNs to complete.
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• The IOM Future of Nursing report with the evidence favoring a BSN degree was presented in the module.
• Also described was our new Tuition Reimbursement Policy.
• Also embedded in the module was a survey which allowed us to update our statistics on current ADN/BSN percentages. 40
After the nursing staff completed the computerized learning module, a “BSN Completion Fair” was scheduled (sample flyer next slide).
The Schools of Nursing, both ADN and BSN, with whom we work most closely were represented at the Fair.
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• A video was included at the Fair, presented by our System CNO, which highlighted why an investment in BSN Completion was being made by the Aspirus System.
• Representatives of Schools of Nursing discussed their program requirements and unique characteristics with prospective students.
• Director of Nursing or the CNO was present throughout the fair to address other questions & clarify policy details
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Candidates for the program completed an application process which included:
• An “Application Form for Tuition Reimbursement”
• The tuition reimbursement policy for BSN Completion
• A template for professional references and a reference/release form
• The document to be completed by the candidates department director indicating his/her support
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The candidate is also requested to include:
• His or her resume
• An essay not to exceed 500 words outlining how the Aspirus facility at which he/she works and the candidate as a professional nurse will benefit from continuing his/her nursing education
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• Application paperwork is submitted to the appropriate nursing director who forwards it to the CNO & Human Resources leader for the business unit.
• Applications are reviewed in their entirety prior to making final decisions about awarding the reimbursements.
• Currently in the process of receiving & reviewing applications for entrance into the first cohort of BSN completion scholars.
• We applaud them for taking this step in their professional career!
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Questions?
• For more info on Wisconsin nursing workforce data & reports: www.wicenterfornursing.org
• To learn how to become a LEAD Organization in Wisconsin:
http://www.wisconsincenterfornursing.org/WCN_Organization_Recognition_Program.html
• Further questions: [email protected] 47
