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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BSN: The Imperative for Professional Practice - Susan Bower Ferres, NYU Langone Medical Center
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 evidenceâbased practice
⢠Information management
⢠Health care policy and finance
lh li d fi
⢠Interâprofessional communication andÂ
collaboration
⢠Organizational & systems leadership, vital toÂ
g y p,
patient safety
⢠Disease prevention and population health
Disease prevention and population health
4
5. BSN Imperative
⢠Educational Drivers â 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 theÂ
The educational preparation of the nurse of the future should be at the
baccalaureate level: Â
Prepares the nurse to function as an equal partner, collaborator andÂ
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 BSNÂ
curriculum will be reâframed
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
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
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
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
20. Evidence & Cost
Analysis for New York when 60% RNs are BSNÂ
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 annuallyÂ
(
(additional 3.98 days LOS, $17.5M savings)
y ,$ g)
⢠Reduction in LOS by 0.2 days = 400,000 additionalÂ
patient days
⢠Every 1% reduction in nurse turnover = $12.9MÂ
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 â uniform curricula shared faculty pool
curricula,
California
22
24. Regional Action Coalitions
Regional Action Coalitions
⢠Grown to 48 as of March 2012 Â
⢠PendingâŚOR, AL, DC
Champion Nursing Coalitions
Ch i N i C liti
⢠43 Member organizations
Champion Nursing Councils
⢠23 National Organizations to implement
strategies
⢠AACNâAONE AcademicâPractice PartnershipÂ
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
bachelorâs 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 âholdâ 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 âholdâ 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 â Initial & Redesignation
29
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: MagnetŠ
) 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). Itâs 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 specialtyÂ
certification, inpatient mortality,  and failure to rescue, Journal for NursingÂ
Scholarship, 43(2), 188â194.
Larson, J. Major changes proposed in nursing education. Nursing News,
(January 7, 2011).
National Council of State Boards of Nursing (NCSBNÂŽ) 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., OâBrien 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), 796â803.
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