Deb Zimmermann, RN, MS, NEA-BC

Advances in science and increasing patient complexity have accelerated the need for nurses with better skills and knowledge to manage a challenging and increasingly diverse healthcare environment.

Researchers have demonstrated a significant relationship between higher levels of nursing education and improved patient outcomes (Aiken, Clark, Cheung, Sloane, and Silber, 2003, 2008; Estabrooks, Midozi, Cummings, Ricker, & Giovannetti, 2005; and Tourangeau et al., 2006, Blegen &Goode, 2009).

In 2008, 32 state and national nursing organizations recommended advancing education standards so nurses are well prepared for the future.

Research and Nurse Surveys Support ChangeResearch and Nurse Surveys Support Change As Nurse Education Increases, Patient Mortality DecreasesAs Nurse Education Increases, Patient Mortality Decreases

Education (Percentage of hospital nurses with BS degrees.)

Aiken (2003) JAMA

Dea

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per

100

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omp

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tion

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90 deaths

in 1,000

patients84

deaths in

1,000 patients

76 deaths

in 1,000

patients

Hospitals with a higher proportion of BSN RNs experienced lower rates of 30-day patient mortality

OR 0.81 [95%CI (0.68 - 0.96]

Estabrooks, et al. (2005).

Study of 46, 993 patients Demonstrated 9 fewer deaths per 1000

discharges for every 10% increase in BS prepared nurses

Longitudinal study of 21 US hospitals over 84 quarters

In hospitals with a higher proportion of BS educated nurses:◦ Lower rates of CHF mortality◦ Fewer Hospital Acquired Pressure Ulcers◦ Lower rates of Failure to Rescue◦ Shorter hospitalizations

5,000 RNs: 47% BSN 53% AD 20% received tuition assistance 40% planned to go back to school Twice as likely to remain in job with tuition assistance BS prepared RNs reported higher job satisfaction and

lower job stress BS prepared nurses more than ten years tenure

McGinnis S & Martiniano R. (2008), Estabrooks (2005), Ingersoll (2001)

47% BSN 53% AD 20% received tuition assistance 40% planned to go back to school Twice as likely to remain in job with tuition assistance BS prepared RNs reported higher job satisfaction and

lower job stress BS prepared nurses more than ten years tenure

McGinnis S & Martiniano R. (2008), Estabrooks (2005), Ingersoll (2001)

Much Like Vaccination,

there when you need it

Antecedent Factors

StaffingHPPD

Skill mix

Patient FactorsAgeCMI

DiagnosisCo-morbidity

Nurse CharacteristicsEducation

Age/ ExperienceDiversity

CommunitySONs

Laws/RegulationsEconomyPayers

Healthcare Organization

SizeVolume

SpecialtiesTechnology

Finance Margin

Nurse OutcomesSatisfaction

Years of ServiceTurnoverVacancy

Advancement

Medical staffHospitalistsIntensivists

Cultural BackgroundResidents Patient

OutcomesMorbidity/MortalityPatient Satisfaction

Nurse Sensitive Indicators

Length of Stay

Organizational CulturePolicies/ Benefits

EBP/ResearchGovernance

Leadership/CommunicationCultural Competence

Values and Theoretical Framework

Model of Care Delivery

Causal Factors Moderating Factors

Mediating Mechanisms

Impact

2004 2005 2006 2007 2008

10,582 11,576 13,609 13,456 14,496

New Licenses Issued

266,029 Registered Nurses in NYS

Year 2004 2005 2006 2007 2008

Vacancy 10.1 8.3% 6.3% 8.8% 7.1%

Turnover 15.2 9.7 13.2% 13.% 10.1%

RN Vacancy and Turnover

New York State Dept of Education ( 2009), Healthcare Association New York (2009)

Capacity Graduates

47 RN to BSN Programs in NYS

In a June 2009 survey. NYS Deans reported immediate capacity for 5000 RN to BSN students

NYS Graduates4800 AD3200 BSN8000 AnnuallyOnly 20% go on for BSN

Graduates take NCLEX-RN licensing exam. Tests for minimum technical competency (NCSB,2006)

The average RN salary is $73,000, in rural areas $58,000 (U.S.Department of Labor, 2008)

In Canada, the EU, and Australia enrollment rose after education standards were increased to BSN (Reuters, 2009)

Age of nurses in Canada similar to NYS (Tourangeau, 2009)

The Plan: Provide seamless transition from AD to BSN

programs Reduce financial barriers for baccalaureate

education Increase the number of nursing faculty Standardize education requirements

Provide seamless transition from AD to BSN◦ Standardize admission criteria and application procedures

◦ Endorse common pre-requisites

◦ Develop standard competencies

◦ Concurrently admit students to AD and BSN programs

Reduce financial barriers for BSN education

◦ Establish a statewide endowment for nursing scholarships

◦ Require a year of service for every year of education funded

Increase the number of nursing faculty◦ Establish nursing faculty scholarships through the endowment

◦ Require recipients to complete a service contract at a New York institution of higher education

Standardize education requirements◦ Standardize education requirements through the passage of Bills

A2079B/S4051

◦ This legislation would require acquisition of a baccalaureate degree in nursing within ten years of initial licensure

The IOM found RNs are the profession to intercept medical errors which cost 3.5 billion dollars a year

RNs prevent hospital acquired pneumonia which increase hospital costs 84%

Cost of RN turnover equivalent to a year of RN salary

Medical errors kill more people than breast cancer, AIDs and MVA’s combined

Hassmiller(2009), Institute of Medicine(2004), Jones(2005)

Service Excellence

> Care environment> Collaboration and communication

Quality

6000 fewer surgical deaths annually< Congestive Heart Failure mortality< Hospital acquired pressure ulcers

Financial

< 10% in HAPUs saves $17. 5 million< LOS of .2 days provides capacity for 400,000 patient days< 1% RN turnover saves 12.9 million

Workforce

> Graduation of 8000 RNs annually> RN length of service> Nurse satisfaction> Competency in evidence-based practice, critical synthesis, gerontology> Competency in management of complex patients< Faculty vacancy

Aiken, 2003; Blegen, 2009; Rambur 2005; Tanner,2007; Unruh, 2008)

Statewide meetings between nursing leaders and CEO’s

Implementation of Oregon Model in NYS Continuation of dialogue with legislators Pursue regulatory change vs. legislation Engage national leaders Engage other states Recognize the need for resiliency

Philippines:BSN RequiredSince 1988

Australia:BSN RequiredSince 1992

Canada:New RNs must be BS prepared

European Union:BS required

In Canada, enrollment rose after education standards were increased to the BS level. The average age of an RN in Canada is similar to the United States.

Transformation of Nursing Education

Thailand: BS required