The Case for Increasing BSN Prepared Nurses SUNCOAST

The Case for Increasing BSN Prepared Nurses SUNCOAST NURSING ACTION COALITION

Initiative on the Future of Nursing: History • Robert Wood Johnson Foundation (RWJF) and Institute of Medicine (IOM) partnership • IOM Committee was tasked with an action-oriented blueprint for the future of nursing

Key Messages from the IOM Report EIGHT RECOMMENDATIONS RESULTED IN FOUR KEY MESSAGES

Key Messages from the IOM Report KEY MESSAGE 1 Nurses should practice to the full extent of their education and training.

Key Messages from the IOM Report KEY MESSAGE 2 Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. GOAL: Increase the proportion of nurses with BSN degrees to 80% by 2020

Key Messages from the IOM Report KEY MESSAGE 3 Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States.

Key Messages from the IOM Report KEY MESSAGE 4 Effective workforce planning and policy making require better data collection and an improved information infrastructure.

Campaign for Action: Guiding implementation of the Future of Nursing report • • Center to Champion Nursing in America RWJF and AARP Initiative

Suncoast Nursing Action Coalition (SNAC) SNAC Composition: • Nursing leaders, educators, and community members from four county area: • Charlotte, De. Soto, Manatee & Sarasota Development of a triad model approach with specific focus areas: • Academic • Community • Employer

SNAC Accomplishments Strong community partnerships: • The Patterson Foundation • Community Foundation of Sarasota County • Ringling College of Art & Design Development of Nurse Education Navigator (NEN) • Structure & process for role • Grant proposal for funding Logic Model completion

SNAC Accomplishments Employer presentations • Partnering with Ringling College of Art & Design • Doctoral project in progress to evaluate the effectiveness of an educational session and resource guide in affecting the extent of activities nursing leaders utilize to achieve the IOM recommendations of 80% BSN prepared nurses by 2020. • Resource guide developed for healthcare employers within the 4 county area

EVIDENCE Supporting BS Education SHARE the reason behind the change

As Nurse Education Increases, Patient Mortality Decreases Aiken (2003)

Additional Supporting Evidence in Patient Outcomes Validated earlier study of 2003: each 10% increase in BSN proportion of nurses associated with 4% decrease in risk of patient death (Aiken, et al, 2008). Reduction in surgical mortality of 2. 12 deaths/1000 patients with a 10 -point increase in BSNs (Kutney-Lee, 2013). Lower lengths of stay, lower rates of heart-failure related mortality, decreased chance of post-op deep vein thrombosis or pulmonary embolism (Blegen, et al, 2014).

Benefits from Education for Nurses & Employers RNs twice as likely to remain in job with tuition assistance BSN prepared nurses reported higher job satisfaction and lower job stress BSN prepared nurses more than ten years of tenure Ingersoll et al, 2002; Mc. Ginnis & Martiniano, 2008; Megginson, 2008; Rambur et al. , 2005.

AD vs BS: Added Value? AD Programs introduce the following concepts; BS Programs advance the concepts to a higher level: • Scholarship for evidence based practice • Information management • Inter-professional communication & collaboration • Organizational & systems leadership • Disease prevention & population health

Financial Incentives with Higher BSN Percentages Improved patient outcomes = better CMS reimbursement Reputation for high quality patient outcomes = higher market share Improved nursing satisfaction with educational support & professional development = lower turnover rates & associated savings.

Financial Incentives with Higher BSN Percentages Recent study on the economic analysis of meeting an 80% BSN workforce: 6 month study of 8, 526 patients & 1, 477 direct care nurses BSN proportion associated with lower mortality, lower readmission rates & shorter length of stay (1. 9%) Yakusheva, O. , et al (2014)

Tuition Reimbursement Financial Incentives for Nurses Professional Advancement Programs Salary Differential

Communication Strategies Benefit to Patients Benefit = to Nurses Communicate the Case for Change IOM Recommendations

Benefits of BSN Degree to Nurses Satisfaction and pride from goal achievement Benefits of BSN Degree to Nurses Recognition and credibility Career expansion opportunities Broader understanding of the nursing profession Fosters skills beyond basic patient care • Systems-thinking • Continuum of care • Leadership

Communication Strategies Presentations Open forums Develop a communication strategy Small group sessions Blogs, newsletters Surveys CLINICAL INPUT IS CRUCIAL!

Messaging Strategies Turn the negative into the positive: “Studies show that nurses with BSN degrees provide better care than nurses who only have an ADN” VERSUS: “Hospitals with more BSN prepared nurses have lower rates of mortality and post-surgery complications, and shorter patient stays”

Messaging Strategies “We need to convince nurses that they should be lifelong learners, so they can improve their skills” VERSUS: “We need to make it easier and more affordable for nurses to continue their education so they can do even more to provide high quality care and promote health”

Communication Strategies “Technology has made our health care system more complicated and the Affordable Care Act has brought more people into it. Nurses need to have BSNs to provide high quality care in this changing environment” VERSUS: “Technology has made our health care system more complicated and the Affordable Care Act has brought more people into it. BSN programs equip nurses with the critical thinking skills and experiences they need to provide care in this increasingly complex environment”

Communication Strategies • • Gear your message to the audience Tell stories that highlight the message Video clip: Real-life stories of nurses who returned to school to achieve BSN. http: //campaignforaction. org/video/ inspiration-aspirations-school-again • • Acknowledge/discuss the barriers to education Focus on professional growth and enhanced patient outcomes.

Partner with BSN programs Serve on advisory boards Academic Partnerships Fosters skills beyond basic patient care • Reassign nurse to teach clinicals • Reassign nurse to teach coursework • Support nurses in adjunct faculty employment Engage faculty in agency nursing and QI committees

Select two or three pertinent pieces of data to share Gear the data to the respective audience Share the Data Use anecdotes to illustrate the importance of the data

Partner with BSN programs Serve on advisory boards Academic Partnerships Develop innovative agreements for clinical and classroom faculty • Reassign nurse to teach clinicals • Reassign nurse to teach coursework • Support nurses in adjunct faculty employment Engage faculty in agency nursing and QI committees

Benefits of BSN Degree to Nurses Engage faculty in employer nursing and QI committees Academic Partnerships Create innovation ways to enhance nursing student experiences Support Action Coalition activities • Ask Action Coalition representative to provide ongoing feedback on current activities

Organizational Infrastructure Workforce Analysis Financial Incentives SUMMARY Communication Strategies Academic Partnering Promote the message of increasing the educational level of our nurses

THANK YOU for your participation in this very important initiative to enhance the profession of nursing!

References Aiken, L. , Clarke, S. , Cheung, R. , Sloane, D. , & Silber, J. (2003). Educational Levels of Hospital Nurses and Surgical Patient Mortality. Journal of the American Medical Association, 290 (12), 1617 -1623. Aiken, L. , Clarke, S. , Sloane, D. , Lake, E. , & Cheney, T. (2008). Effects of Hospital Care Environment on Patient Mortality and Nurse Outcomes. Journal of Nursing Administration, 38 (5), 223 -229. Andrews, N. (2014). Advancing Toward an 80% BSN Workforce by 2020. American Nurse Today, 9 (1), 36. BSN Update/Review Committee (2012, August 10). Hospital Policy: The BSN Plan. Tampa, Florida. Blegen, M. , Goode, C. , Park, S. , Vaughn, T. , & Spetz, J. (2013). Baccalaureate Education in Nursing and Patient Outcomes. The Journal of Nursing Administration, 43 (2), 89 -94. Davis, K. (2014). One Employer’s Approach to Increasing the Academic Preparation of Nurses. (Power. Point Slides).

References Duffy, M. , Friesen, M. A. , Speroni, K. , & Swengros, D. (2014). BSN Completion Barriers, Challenges, Incentives, and Strategies. The Journal of Nursing Administration, 44 (4), 232 -236. Folan, P. , Tarraza, M. , Delaney, M. , Fardellone, C. , Leners, C. , Ross, E. , & Fitzpatrick, J. (2012). Leadership Initiatives to Disseminate the Institute of Medicine’s Future of Nursing Report. Policy, Politics & Nursing Practice, 13 (1), 38 -44. Future of Nursing Campaign for Action (2014, May 29). Campaign Overview. Retrieved June 22, 2014 from: http: //campaignforaction. org/sites/default/ Future of Nursing Campaign for Action (2014, June 11). Speaking of Academic Progression. Retrieved September 18, 2014 from: http: //campaignforaction. org/webinar/speaking-academic-progression Gerardi, T. , Smith, S. , & Davis, K. (2014). Successful Practices to Support Academic Progression in Nursing in the Employer Setting. In American Organization of Nurse Executives Annual Conference, Orlando, Fl. Hasmiller, S. (2013). The RWJF’s Investment in Nursing to Strengthen the Health of Individuals, Families, and Communities. Health Affairs, 32 (11), 2051 -2055. Ingersoll, G. , Olsan, T. , Drew-Cates, J. , De. Vinney, B. , & Davies, J. (2002). Nurses Job Satisfaction, Organizational Commitment, and Career Intent. Journal of Nursing Administration, 32 (5), 250 -263.

References Institute of Medicine (2010, October). IOM Report. Retrieved January 6, 2014 from: http: //www. iom. edu/Reports/2010/The-future-of-nursing-leading-change-advancing health. aspx Kendall-Gallagher, D. , Aiken, L. , Sloane, D. , & Cimiotti. J. (2011). Nurse Specialty Certification Inpatient Mortality, and Failure to Rescue. Journal of Nursing Scholarship, 43 (2), 188 -194. Kovner, C. , Brewer, C. , Katigbak, C. , Djukic, M. , & Fatehi, F. (2012). Charting the Course for Nurses’ Achievement of Higher Education Levels. Journal of Professional Nursing, 28 (6), 333 -343. Kutney-Lee, A. , Sloane, D. , & Aiken, L. (2013). An Increase in the Number of Nurses with Baccalaureate Degrees is Linked to Lower Rates of Post Surgery Mortality. Health Affairs, 32 (3), 579 -586. Mc. Ginnis, S. , Martiniano, R. (2008). The Hospital Workforce in New York: Findings from a Survey of Hospital Registered Nurses. Rensselaer, NY: Center for Health Workforce Studies, School for Public Health, SUNY Albany. Megginson, L. (2008). RN-BSN Education: 21 st Century Barriers and Incentives. Journal of Nursing Management, 16, 47 -55. doi: 10. 1111/j/1365 -2934. 2007. 00784. x

References Net. MBA Business Model Center (2010). Scenario Planning. Retrieved May 9, 2014, from http: //www. netmba. com/strategy/scenario/ Pittman, P. , Herrera, C. , Horton, K. , Thompson, P. , & Ware, J. (2013). Healthcare Employers Policies on Nurse Education. Journal of Healthcare Management, 58 (6), 399 -410. Rambur, B. , Mc. Intosh, B. , Palumbo, V. , & Reiner, K. (2005). Education as a Determinant of Career Retention and Job Satisfaction among Registered Nurses. Journal of Nursing Scholarship, 37 (2), 192 -195. Robert Wood Johnson Foundation (2011, August). Charting Nurses’ Future: Reports on Policies that can Transform Patient Care. Retrieved May 14, 2014, from http: //www. rwjf. org/content/dam/farm/reports/issue_briefs/2011/rwjf 70968 Swearington, C. , Clarke, P. , Gatua, M. , & Sumner, C. (2013). Diffusion of a Nursing Education Innovation. Nurse Educator, 38 (4), 152 -156. Yakusheva, O. , Lindrooth, R. , & Weiss, M. (2014). Economic Evaluation of the 80% Baccalaureate Nurse Workforce Recommendation: A Patient-Level Analysis. Medical Care, 52 (10), 864 -869. Yucha, C. , Smyer, T. , & Strano-Perry, S. (2014). Sustaining Nursing Programs in the Face of Budget Cuts and Faculty Shortages. Journal of Professional Nursing, 30 (1), 5 -9. Zimmerman, D. , & Cain, J. (2013). Forecasting and Moving Your Organization to an 80% BSN Workforce (Power. Point slides).