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 BSN: The Imperative for Professional Practice


  • 1. The BSN: Imperative for ProfessionalPracticeNational Healthcare CNO SummitApril 27, 2012 Susan Bowar-Ferres, PhD, RN, NEA-BC NYU College of Nursing Former SVP/CNO NYU Medical Center

2. BSN: The ImperativepObjectives:j 1. To describe the historical context((Good, bad, and ugly) ,, g y) 2. To discuss the Evidencea. Business Case 3. To describe BSN momentuma. IOM Recommendation #4b. BSN in Ten Legislative Initiativesc. Market-Driven Initiatives2 3. Rationale for BSNPatient focusIncreasing complexity of careNeed EBP, collaboration, technology, criticalreasoning, care management itPatient outcomesProfessional focusKnowledge workersEquity among professionsNursing faculty and APN shortagesRetention of professional nurses3 4. BSN Preparation Scholarshipforevidence basedpracticeScholarship for evidencebased practice Informationmanagement Healthcarepolicyandfinance lhlid fi Interprofessionalcommunicationandcollaboration Organizational&systemsleadership,vitalto g yp,patientsafety Disease prevention and population healthDiseasepreventionandpopulationhealth 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 DriversDifference in settings Difference in color Difference in career advancement5 6. ANA Chronology o BSNC 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 Nurse6 7. Ot e os t o sOther Positions / Recommendations ecoe dat o s1983Magnet Hospitals2001National Council Advisory Council on Education & Practice (Report to HHS)2002Magnet Hospitals Revisited (gp(2002) )2005AONE2008Magnet Nursing Recognition Program (2005, 2008)2010Carnegie Report (Benner)2010National 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 GuidingPrinciplesforFutureCareDelivery Theeducationalpreparationofthenurseofthefutureshouldbeatthe The educational preparation of the nurse of the future should be at the baccalaureatelevel: Preparesthenursetofunctionasanequalpartner,collaboratorand managerofthecomplexpatientcarejourneyenvisionedbyAONE AND Giventhattheroleinthefuturewillbedifferent,itisassumedthatBSN curriculumwillbereframed8 9. RecommendationsANA Resolution (2008)Support initiatives to require registered nurses((RNs) to obtain a baccalaureate degree in ) gnursing within ten years after initial licensure,exempting (grand-parenting) those individualswho are licensed or are enrolled as a student ina nursing program at the time legislation isenacted9 10. RecommendationsNationalCouncilofStateBoardsofNursing(2010) NCSBNendorsescontinuedlearningatalllevelsofnursingandsupportstheMay2010TriCouncilconsensuspolicystatementontheTiCilli t tt thAdvancementofNursingEducation.Tri CouncilforNursingTriCouncil for Nursing (2010) StrongendorsementofthenewInstituteof Medicine(IOM)reportonTheFutureofNursing andcallsforcollaborationamongstakeholdersto advancethereportsrecommendations10 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 meetdiit f t d t t t kfdttthe 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 168Pennsylvania hospitals during 18 months Odd of 30 day mortality and f ilOdds f d t litd failure t rescuetowere reduced 5% with every 10% increase ofBSN by 10% decrease in both likelihood ofmortality within 30 days and the odds of failureto 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 hospitals18,000 Those with a higher proportion of BSN-preparednurses 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 hospitalsp )p Those hospitals with a higher percentage ofBSN prepared nurses were associated with p p Lower mortality within 30 days Lower failure to rescue rates16 17. EvidenceGoode & ege ( 009)Goode&Blegen(2009) Longitudinalstudyof21UShospitalsover84qquarters ThosehospitalswithahigherproportionofBSNeducatednursesfoundtohave LowerratesofCHFmortality Hospitalacquiredpressureulcers(HAPUs), Failuretorescue Lengthofinpatientstay. 17 18. EvidenceMcGinnis(2008) ( ) 5000NewYorkRNssurvey BSNpreparednursescomparedtoADnurses Scoredhigherinjobsatisfactionrelated tojobautonomyandgrowth, Jobstressanddemands J b tdd d Morelikelytohavebeenintheirjobs morethan10years more than 10 years18 19. EvidenceKendallGallagher,Aiken,Sloan&Cimiotti(2011) A10%increaseinhospitalproportionofbaccalaureateandcertifiedbaccalaureatestaffdecreasedtheoddsofadjustedinpatient30 daymortalityby6%and2%adjusted inpatient 30day mortality by 6% and 2% Nursespecialtycertificationisassociatedwithbetterpatientoutcomes;effectonmortalityandfailuretorescueingeneralsurgerypatientsiscontingentuponrescue in general surgery patients is contingent uponbaccalaureateeducation. Specialtycertificationofnurseswasalsoassociatedwithlowermortalityandfailuretorescue,butonlyamongnurseswithBSNorhighereducation19 20. Evidence & CostAnalysisforNewYorkwhen60%RNsareBSN a ys s o e oe 60% s a e Sprepared: gy 6000fewersurgicaldeathsannually 10%reductionin200,000HAPUsannually((additional3.98daysLOS,$17.5Msavings) y ,$g) ReductioninLOSby0.2days=400,000additionalpatientdays Every1%reductioninnurseturnover=$12.9Mannually20 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 BSN21 22. Oregon Model & ReplicationsOregon Health & Science University5 main campuses, 8 community collegesShare competency-based curriculumSeamless transition AD in 3, + 1 BSNReplications Hawaii, New York, North Carolina New Mexico uniform curricula shared faculty pool curricula,California22 23. Regional Action Coalitions Appointed by RWJF/AAPR Campaign for Action - 2011Map23 24. RegionalActionCoalitions Regional Action Coalitions Grownto48asofMarch2012 PendingOR,AL,DCChampionNursingCoalitionsCh i N i C liti 43Memberorganizations ChampionNursingCouncils 23NationalOrganizationstoimplementstrategies AACNAONEAcademicPracticePartnership 24 25. Graduates from basic nurse baccalaureate programs are over 3 times more likely to obtain g y graduate degreesg Initial I iti l BSN Graduates G d tInitialI iti l ADN G d tGraduatesAdapted from: Aiken, Cheung, Olds. 2009. Health Affairs 28(4) 26. BSNinTenModels BSN in Ten Models New YorkBills A1977, S1223 reintroduced by their sponsorsin April 2011; gathering momentum New JerseySimilar Bills introduced; waiting for budget Rhode IslandBill introduced in assembly in 2011; withdrawn for more work Oklahoma2008 Action Plan; apparently deferred26 27. BSN in Ten ModelNew York Bills Would require registered nurses to attain abachelor sbachelors degree in nursing within ten yearsof their initial licensure as a requirement forre registrationre-registration to practice in NY. Grandparents in all existing RNs, studentsenrolled in programs at the time of thelegislation, 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 frominitial licensure to complete BSN degree No licenses would be removed. New RNs not meeting therequirement would have hold placed on their license withprovision for extenuating circumstances If passed in 2012 and signed by the Governor earliest that aGovernor,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 ProgramBSNRequirements: q Effective1/1/2013(attimeofapplication) 100%NurseManagersandNurseLeaders Since2008,applicantsmustsettargetsforstaffnurseBSNcompletions,andgraphtrendsover2yearsanddemonstratemeetingorexceedingtargetsdemonstrate meeting or exceeding targets Effective6/1/2013,applicantsmustprovideanactionplanandsetatarget,whichdemonstratesevidenceofprogresstowardhaving80%ofdirectcarenursesobtainabaccalaureatedegreeinnursingorhigherby2020.30 31. Magnet Recognition ProgramBSNRequirements: S equ e e ts:Effective2008Fordirectcarenurses: A stated goal or goals (a number or percentage) Astatedgoalorgoals(anumberorpercentage) forimprovementofBSNforanygroupofnurses intheorganization Goalcanbefortheentire2yearperiodpriorto submissionorforeachyear Eachgoalthatisstatedmustbemetorexceeded Eachgoalmustshow2yearsofgrapheddata 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). Its academic: studies spur push to BSN-in-10, NursingSpectrumpBoyd, T. (2010). Hospitals begin to require BSN, Not Waiting for BSN in 10Legislation. Nursing Spectrum.Budden, J. (2011). A survey of nurse employers on professional and practiceissues 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-acteristicson 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 ffid ti t tANCC Nartonal Magnet Conference; October 2,2009, Louisville, KT.Ingersoll, G., Olsan, T., Drew-Cates, J, Devinney, B, Davies, J. (2002). Nursesjob ti f tij b satisfaction, organizational commitment, and career i t t JONAi ti lit tdintent, JONA,32(5), 250-263.34 35. ReferencesKendall-Gallagher,D.,Aiken,L.,Sloane,D.,&Cimiotti,J.(2011).Nursespecialty certification,inpatientmortality,andfailuretorescue,JournalforNursing Scholarship,43(2),188194.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 secretaryt 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., OBrien Pallas, L., Pringle,D., Tu, J. V., Cranley, L. A. (2006).D Tu J V & Cranley L A (2006) Impact of hos pital nursing carehos-pitalon 30-day mortality for acute medical patients. Journal of AdvancedNursing, 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 betweeninpatient cardiac surgery mortality and nurse numbers andeducational level: Analysis of administrative data. International Journalof N i St dif Nursing Studies, 46(6) 796 80346(6), 796803.Zimmerman, D., Cooney-Miner, D., Zittel, B. (2010). Advancingthe Education of nurses, JONA, 40 (12), 529-533.Zimmerman, D. & Cain, J. (2012). Changing winds: Forecasting andmoving 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 Coalitions37