BSN: The Imperative for Professional Practice - Susan Bower Ferres, NYU Langone Medical Center

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Susan Bower Ferres, NYU Langone Medical Center - Speaker at the marcus evans National Healthcare CNO Summit Spring 2012, held in Hollywood, FL, April 26-28, 2012, delivered her prsentation entitled …

Susan Bower Ferres, NYU Langone Medical Center - Speaker at the marcus evans National Healthcare CNO Summit Spring 2012, held in Hollywood, FL, April 26-28, 2012, delivered her prsentation entitled BSN: The Imperative for Professional Practice

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  • 1. The BSN: Imperative for Professional Practice National Healthcare CNO Summit April 27, 2012 Susan Bowar-Ferres, PhD, RN, NEA-BC NYU College of Nursing Former SVP/CNO NYU Medical Center
  • 2. BSN: The Imperative pObjectives: j 1. To describe the historical context ( (Good, bad, and ugly) , , g y) 2. To discuss the Evidence a. Business Case 3. To describe BSN momentum a. IOM Recommendation #4 b. BSN in Ten Legislative Initiatives c. Market-Driven Initiatives 2
  • 3. Rationale for BSNPatient focus Increasing complexity of care Need EBP, collaboration, technology, critical reasoning, care management i t Patient outcomesProfessional focus Knowledge workers Equity among professions Nursing faculty and APN shortages Retention of professional nurses 3
  • 4. BSN Preparation• Scholarship for evidence based practice Scholarship for evidence‐based practice• Information management• Health care policy and finance lh li d fi• Inter‐professional communication and  collaboration• Organizational & systems leadership, vital to  g y p, patient safety• Disease prevention and population health Disease prevention and population health 4
  • 5. BSN Imperative• Educational Drivers – Competencies Essentials of B E i l f Baccalaureate Ed l Education (2008) i Essentials of Associate Degree Education• Practice Drivers Differentiated Practice Hiring / Staffing Some Hospitals settings but not long term care, home care New models of care• Legislative / Codification Drivers• Justice Drivers Difference in settings Difference in color Difference in career advancement 5
  • 6. ANA Chronology o BSN C o o ogy of S1960 Promote baccalaureate programs as the basic education for professional nursing1965 Published Educational Preparation for Nurse Practitioners and Assistants to Nurses All nursing education in an institution of higher learning: BS Entry into practice, AD Nurse the technical nurse.1978 Three resolutions: By 1980 Ensure 2 categories of nursing practice By 1985 Preparation for entry into professional nursing would be the baccalaureate in nursing. By 1988 Establish a mechanism for a comprehensive statement for y p two categories of nursing, actively support career mobility.1983 Establish the BS degree as the educational requirement for p professional nursingg1985 Resolution: Registered Professional Nurse & Assoc/Technical Nurse 6
  • 7. Ot e os t o s Other Positions / Recommendations eco e dat o s1983 Magnet Hospitals2001 National Council Advisory Council on Education & Practice (Report to HHS)2002 Magnet Hospitals Revisited ( g p (2002) )2005 AONE2008 Magnet Nursing Recognition Program (2005, 2008)2010 Carnegie Report (Benner)2010 National Council of State Boards of Nursing (September)2010 Institute of Medicine Report ( p (October) )2010 Tri-Council Endorsement (October) (ANA, AONE, AACN, NLN)2011 Regional Action Coalitions (Implementation of IOM) 7
  • 8. RecommendationsNational Advisory Council on Nurse Education and Practice(2001) urged that two-thirds of the basic nurse workforce hold a baccalaureate or higher degree in nursing by 2010.AONE 2005 Guiding Principles for Future Care Delivery The educational preparation of the nurse of the future should be at the  The educational preparation of the nurse of the future should be at the baccalaureate level:   Prepares the nurse to function as an equal partner, collaborator and  manager of the complex patient care journey envisioned by AONE AND Given that the role in the future will be different, it is assumed that BSN  curriculum will be re‐framed 8
  • 9. RecommendationsANA Resolution (2008) Support initiatives to require registered nurses ( (RNs) to obtain a baccalaureate degree in ) g nursing within ten years after initial licensure, exempting (grand-parenting) those individuals who are licensed or are enrolled as a student in a nursing program at the time legislation is enacted 9
  • 10. RecommendationsNational Council of State Boards of Nursing (2010) NCSBN endorses continued learning at all  levels of nursing and supports the May 2010 Tri‐Council consensus policy statement on the  TiC il li t t t th Advancement of Nursing Education.Tri Council for Nursing Tri‐Council for Nursing (2010) Strong endorsement of the new Institute of  Medicine (IOM) report on The Future of Nursing  and calls for collaboration among stakeholders to  advance the report’s recommendations 10
  • 11. RecommendationsInstitute of Medicine Recommendation # 4 (October 2010)Increase the proportion of nurses with a baccalaureate p pdegree to 80 percent by 2020.These leaders should partner with education accreditingbodies, private and public funders, and employers toensure funding, monitor progress, and increase thediversity of students to create a workforce prepared to meetdi it f t d t t t kf dt tthe demands of diverse populations across the lifespan. 11
  • 12. 12
  • 13. EvidenceAiken et al (2003)• Cross-sectional analyses of outcomes data• 232,342 general, orthopedic, and vascular , g , p , surgery patients discharged from 168 Pennsylvania hospitals during 18 months• Odd of 30 day mortality and f il Odds f d t lit d failure t rescue to were reduced 5% with every 10% increase of BSN by 10% decrease in both likelihood of mortality within 30 days and the odds of failure to rescue were reduced 5% in surgical pts 13
  • 14. 14
  • 15. EvidenceEstabrooks et al (2005)• Cross-sectional analyses of outcome data• 18 000 patients in 49 Canadian hospitals 18,000• Those with a higher proportion of BSN-prepared nurses were associated with Lower rates of 30-day patient mortality in medical pat e ts (AMI, Stroke, CHF, OPD, ed ca patients ( , St o e, C , O , Pneumonia) 15
  • 16. EvidenceTourangeau et al (2006)• 46,993 medical patients (MI, stroke, pneumonia, septicemia) in Canadian hospitals p ) p• Those hospitals with a higher percentage of BSN prepared nurses were associated with p p Lower mortality within 30 days Lower failure to rescue rates 16
  • 17. EvidenceGoode & ege ( 009)Goode & Blegen (2009)• Longitudinal study of 21 US hospitals over 84  q quarters• Those hospitals with a higher proportion of BSN  educated nurses found to have  Lower rates of CHF mortality Hospital‐acquired pressure ulcers (HAPUs),  Failure to rescue Length of inpatient stay. 17
  • 18. EvidenceMcGinnis (2008) ( )• 5000 New York RNs survey• BSN prepared nurses compared to AD nurses Scored higher in job satisfaction related  to job autonomy and growth, Job stress and demands J b t dd d More likely to have been in their jobs  more than 10 years more than 10 years 18
  • 19. EvidenceKendall‐Gallagher, Aiken, Sloan & Cimiotti (2011)• A 10% increase in hospital proportion of baccalaureate  and certified baccalaureate staff decreased the odds of  adjusted inpatient 30 day mortality by 6% and 2% adjusted inpatient 30‐day mortality by 6% and 2%• Nurse specialty certification is associated with better  patient outcomes; effect on mortality and failure to  rescue in general surgery patients is contingent upon  rescue in general surgery patients is contingent upon baccalaureate education.• Specialty certification of nurses was also associated with lower mortality and failure to rescue, but only among nurses with BSN or higher education 19
  • 20. Evidence & CostAnalysis for New York when 60% RNs are BSN  a ys s o e o e 60% s a e Sprepared: g y• 6000 fewer surgical deaths annually• 10% reduction in 200,000 HAPUs annually  ( (additional 3.98 days LOS, $17.5M savings) y ,$ g)• Reduction in LOS by 0.2 days = 400,000 additional  patient days• Every 1% reduction in nurse turnover = $12.9M  annually 20
  • 21. Fueling the Workforce: Creating the Pipeline for Faculty! th Pi li f F lt !New graduates (New York) 60% AD, 36% BSN, 3% DiplomaOf 60% AD AD, Less than 20% get BSN, only 12% get MSOf 36% BSN 40% get MS BSN,New nursing education models needed AD to MS Oregon AD programs offering BSN 21
  • 22. Oregon Model & ReplicationsOregon Health & Science University 5 main campuses, 8 community colleges Share competency-based curriculum Seamless transition AD in 3, + 1 BSNReplications Hawaii, New York, North Carolina New Mexico – uniform curricula shared faculty pool curricula,California 22
  • 23. Regional Action Coalitions Appointed by RWJF/AAPR Campaign for Action - 2011 Map 23
  • 24. Regional Action Coalitions Regional Action Coalitions• Grown to 48 as of March 2012  • Pending…OR, AL, DC Champion Nursing Coalitions Ch i N i C liti• 43 Member organizations Champion Nursing Councils• 23 National Organizations to implement strategies• AACN‐AONE Academic‐Practice Partnership  24
  • 25. Graduates from basic nurse baccalaureate programs are over 3 times more likely to obtain g y graduate degrees g Initial I iti l BSN Graduates G d t Initial I iti l ADN G d t GraduatesAdapted from: Aiken, Cheung, Olds. 2009. Health Affairs 28(4)
  • 26. BSN in Ten Models BSN in Ten Models• New York Bills A1977, S1223 reintroduced by their sponsors in April 2011; gathering momentum• New Jersey Similar Bills introduced; waiting for budget• Rhode Island Bill introduced in assembly in 2011; withdrawn for more work• Oklahoma 2008 Action Plan; apparently deferred 26
  • 27. BSN in Ten ModelNew York Bills• Would require registered nurses to attain a bachelor s bachelor’s degree in nursing within ten years of their initial licensure as a requirement for re registration re-registration to practice in NY.• Grandparents in all existing RNs, students enrolled in programs at the time of the legislation, or accepted into such programs. 27
  • 28. NY BSN in Ten Transition Issues• Applies to future educated grads of AD and diploma programs• Preserves all levels of education• Grandparenting will not intensify any potential shortage.• Future AD and diploma graduates would have 10 years from initial licensure to complete BSN degree• No licenses would be removed. New RNs not meeting the requirement would have “hold” placed on their license with provision for extenuating circumstances• If passed in 2012 and signed by the Governor earliest that a Governor, licensee would be placed on any “hold” would be in 2024. 28
  • 29. Organizational DriversNYU Langone Medical Center (2005) Required BSN for hire (CNO approval for exceptions)North Shore LIJ Health System (2010) Requires BSN or if hired with AD, must enroll within 24 months, and earn BSN within 5 years of hire f hiHudson Valley, Cortland, NYVirginia Magnet Hospitals (5) require BSN within 5Military and VA require BSN for practiceMagnet Structural Outcomes – Initial & Redesignation 29
  • 30. Magnet© Recognition ProgramBSN Requirements: q• Effective 1/1/2013 (at time of application)  100% Nurse  Managers and Nurse Leaders• Since 2008, applicants must set targets for staff nurse  BSN completions, and graph trends over 2 years and  demonstrate meeting or exceeding targets demonstrate meeting or exceeding targets• Effective 6/1/2013, applicants must provide an action  plan and set a target, which demonstrates evidence of  progress toward having 80% of direct care nurses  obtain a baccalaureate degree in nursing or higher by  2020. 30
  • 31. Magnet© Recognition ProgramBSN Requirements: S equ e e ts:Effective 2008 For direct care nurses:• A stated goal or goals (a number or percentage) A stated goal or goals (a number or percentage)  for improvement of BSN for any group of nurses  in the organization • Goal can be for the entire 2‐year period prior to  submission  or for each year • Each goal that is stated must be met or exceeded• Each goal must show 2 years of graphed data 31
  • 32. Nurses Move Mountains! 32
  • 33. ReferencesAiken, L. H. (2010). Nurses for the future. New England Journal of Medicine, December 15, 2010 (10.1056-11639)Aiken, L. H., Clarke, S. P., Cheung, R. B., Sloane, D. M., & Silber, J. H. (2003). Educational levels of hospital nurses and surgical patient mortality. JAMA, 290(12), 1617-1623. JAMA 290(12) 1617 1623Aiken, L. H., Clarke, S. P., Sloane, D. M., Lake, E. T., & Cheney, T. (2008). Effects of hospital care environments on patient mor-tality and nurse outcomes. JONA, 38(5) 223-229 outcomes JONA 38(5), 223 229.American Nurses Association. (2008). Compendium of ANA Education Positions, Position Statements, and DocumentsAmerican Nurses Credentialing Center ( g (2008). Application Manual: Magnet© ) pp g recognition program, ANCC, Silver Spring, MDAONE.(2005). Education and Practice Partnership for the Future. Resolution of the voting body at 2005 Annual Meeting.Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical transformation. San Francisco, CA: Jossey-Bass. 33.
  • 34. ReferencesBoyd, T. (2010). It’s academic: studies spur push to BSN-in-10, Nursing Spectrum pBoyd, T. (2010). Hospitals begin to require BSN, Not Waiting for BSN in 10 Legislation. Nursing Spectrum.Budden, J. (2011). A survey of nurse employers on professional and practice issues affecting nursing, Journal of Nursing Regulation, 1(4), 17-25.Estabrooks, C. A., Midodzi, W. K., Cummings, G. G., Ricker, K. L., & Giovannetti, P. (2005). The impact of hospital nursing char-acteristics on 30-day mortality. Nursing Research, 54(2), 74-84.Everett, L. & Swider, S. (2012). Academic-Practice Partnerships: If not now, when? AONE Annual Meeting, Boston, MA.Goode,C. Blegen, M Th li k b tG d C Bl M. The link between nurse staffing and patient outcomes. t ffi d ti t t ANCC Nartonal Magnet Conference; October 2,2009, Louisville, KT.Ingersoll, G., Olsan, T., Drew-Cates, J, Devinney, B, Davies, J. (2002). Nurses job ti f ti j b satisfaction, organizational commitment, and career i t t JONA i ti l it t d intent, JONA, 32(5), 250-263. 34
  • 35. ReferencesKendall-Gallagher, D., Aiken, L., Sloane, D., & Cimiotti, J.  (2011). Nurse specialty  certification, inpatient mortality,  and failure to rescue, Journal for Nursing  Scholarship, 43(2), 188‐194.Larson, J. Major changes proposed in nursing education. Nursing News, (January 7, 2011).National Council of State Boards of Nursing (NCSBN®) Policy Position Statement (2010).National Advisory Council on Nurse Education and Practice. (2001). Nursing: A strategic asset f th h lth of th nation. Fi t report to the secretary t t i t for the health f the ti First t t th t of Health and Human Services and the Congress. Bethesda, MD: Health Resources Services Administration Education.Tanner, C.Tanner C The Oregon Model cited in the IOM Report Model, Report.Tri-Council for Nursing. (2010). Educational advancement of registered nurses: A consensus position, Nurse Leader, 8(5),19-22. 35
  • 36. ReferencesTourangeau, A. E., Doran, D. M., McGillis Hall, L., O’Brien Pallas, L., Pringle, D., Tu, J. V., Cranley, L. A. (2006). D Tu J V & Cranley L A (2006) Impact of hos pital nursing care hos-pital on 30-day mortality for acute medical patients. Journal of Advanced Nursing, 57(1), 32-44.Van Den Heede, K., Lasaffre, L., Diya, L., Vleugels, A., Clarke, , , , , y , , g , , , S. P., Aiken, L. H., & Sermeus, W. (2009). The relationship between inpatient cardiac surgery mortality and nurse numbers and educational level: Analysis of administrative data. International Journal of N i St di f Nursing Studies, 46(6) 796 803 46(6), 796–803.Zimmerman, D., Cooney-Miner, D., Zittel, B. (2010). Advancing the Education of nurses, JONA, 40 (12), 529-533.Zimmerman, D. & Cain, J. (2012). Changing winds: Forecasting and moving your organization to an 80% BSN-prepared workforce, AONE Annual Meeting, Boston, MA. 36
  • 37. ReferencesZittel, B. (2012). Advancing the education of registered nurses: The New York initiative, Journal of Nursing Regulation, 2(4), 10-15.Zittel, B. (2011). Statutory & regulatory mandates for change, Stewart Conference, New York, NY.Personal communications with Nurse Leaders of Regional Action Coalitions 37