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

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
p
Objectives:
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 BSN
Patient focus
Increasing complexity of care
Need EBP, collaboration, technology, critical
reasoning, care management
i t
Patient outcomes
Professional 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 S
1960 Promote baccalaureate programs as the basic education for
professional nursing
1965 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 nursingg
1985 Resolution: Registered Professional Nurse & Assoc/Technical Nurse
6

7. Ot e os t o s
Other Positions / Recommendations
eco e dat o s
1983 Magnet Hospitals
2001 National Council Advisory Council on Education & Practice
(Report to HHS)
2002 Magnet Hospitals Revisited (
g p (2002)
)
2005 AONE
2008 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. Recommendations
National 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. Recommendations
ANA 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. Recommendations
National 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. Recommendations
Institute of Medicine Recommendation # 4
(October 2010)
Increase the proportion of nurses with a baccalaureate
p p
degree to 80 percent by 2020.
These leaders should partner with education accrediting
bodies, private and public funders, and employers to
ensure funding, monitor progress, and increase the
diversity of students to create a workforce prepared to meet
di it f t d t t t kf dt t
the demands of diverse populations across the lifespan.
11

12. 12

13. Evidence
Aiken 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. Evidence
Estabrooks 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. Evidence
Tourangeau 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. Evidence
Goode & 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. Evidence
McGinnis (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. Evidence
Kendall‐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 & Cost
Analysis for New York when 60% RNs are BSN
a ys s o e o e 60% s a e S
prepared:
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% Diploma
Of 60% AD
AD,
Less than 20% get BSN, only 12% get MS
Of 36% BSN 40% get MS
BSN,
New nursing education models needed
AD to MS
Oregon AD programs offering BSN
21

22. Oregon Model & Replications
Oregon Health & Science University
5 main campuses, 8 community colleges
Share competency-based curriculum
Seamless transition AD in 3, + 1 BSN
Replications
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
Graduates
Adapted 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 Model
New 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 Drivers
NYU 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 hi
Hudson Valley, Cortland, NY
Virginia Magnet Hospitals (5) require BSN within 5
Military and VA require BSN for practice
Magnet Structural Outcomes – Initial & Redesignation
29

30. Magnet© Recognition Program
BSN 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 Program
BSN 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. References
Aiken, 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 1623
Aiken, 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 Documents
American Nurses Credentialing Center (
g (2008). Application Manual: Magnet©
) pp g
recognition program, ANCC, Silver Spring, MD
AONE.(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. References
Boyd, T. (2010). It’s academic: studies spur push to BSN-in-10, Nursing
Spectrum
p
Boyd, 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 t
G 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. References
Kendall-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. References
Tourangeau, 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. References
Zittel, 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