It might not yet be a trend, but there certainly is a movement among health care employers to hire more nurses with at least a BSN degree and to urge existing staff to pursue higher degrees.
Nurse executives noted that they value what all their nurses bring to patient care. But they want to ensure staff can meet the challenges that continue to come their way.
“At the end of the day for us, it all comes down to patient outcomes,” said Jackie Somerville, PhD, RN, the chief nursing officer and senior vice president of Patient Care Services at Brigham and Women’s Hospital in Boston and a member of the Massachusetts Association of Registered Nurses. “What the literature was telling us is that having baccalaureate-prepared nurses positively impacts patient outcomes.”
Given that research, Brigham and Women’s, like other health care facilities, has created policies and programs to boost the number of nurses on staff with BSN or higher degrees, including through hiring practices. They also cite the Institute of Medicine’s report, The Future of Nursing: Leading Change, Advancing Health, as a further basis for their actions.
“We’re facing the most fundamental change in health care in the United States,” Somerville said. “I believe nurses are essential [to positively influencing health care] because of our unique perspective on health and illness. Having greater education gives nurses a tool to move forward with confidence to sit at the tables where health care is being addressed and articulate what we do that impacts care.”
Added American Organization of Nurse Executives (AONE) President Laura Caramanica, PhD, RN, CENP, FACHE, “A well-educated nurse is better able to meet the future challenges of health care — to improve patient outcomes, advance innovation and technology, and provide evidence-based care.”
A closer look at hiring practices and incentives in Philly
In 2008, suburban Philadelphia’s Main Line Health system formed a task force, composed mostly of nurses in various roles, to examine trends in nursing, data on patient outcomes, and the educational levels of its nursing workforce. The group also reviewed nurses’ job descriptions with an eye toward standardizing them.
“We found a lot of variation when it came to educational requirements for certain positions,” said Claire Baldwin, MSN, RN, vice president for nursing at Bryn Mawr Hospital, part of the Main Line Health system and a Magnet® hospital. “For example, we found a nurse coordinator position in the ER didn’t require a BSN, but a coordinator in the OR did.”
The task force initially recommended that Main Line Health, as part of its strategic goals, increase the number of its nurses having at least a BSN to 70 percent by 2016 — from a level of between 48 and 59 percent at its hospitals. Following the release of the Future of Nursing report, facility leaders decided to align their goal with its recommendations — aiming for 80 percent by 2020.
To reach that percentage, Main Line Health created a policy requiring that all new managers and higher-level positions, such as nurse coordinators and educators, have at least a BSN. They also required nurses already in those positions to obtain their BSN within three years, according to Baldwin, a Pennsylvania State Nurses Association member.
In 2009, Main Line Health began hiring only BSN-prepared new graduate nurses. Under consideration is an approach that new hires and nurses transferring to open positions should have a BSN degree except in certain hard-to-fill positions, such as in the OR. Important during any transition is balancing change with consistent support of current staff and recognition of varying goals at certain life points, according to Baldwin.
Main Line Health also is strongly encouraging all nurses currently on staff to pursue at least a BSN, which translates generally to one course a semester over three years.
“We really believe it will make our profession stronger,” Baldwin said.
To assist nurses, Main Line Health offers $6,000 a year in tuition reimbursement, and several of its academic partners offer their programs at nurses’ worksites. Several of the universities also offer up to 25 percent off their tuition, Baldwin added.
Main Line Health is well ahead in meeting its workforce goal.
“We’re a large health system so there is a lot of collaboration with academic programs in our area,” Baldwin said. About 2,000 students a year come to us for clinical rotations, and some are accepted into our nurse residency program — which also has helped increase our percentage of BSN-prepared nurses.
Main Line Health further supports nurses’ efforts to get master’s and other degrees. Already serving as a clinical rotation site for students in area nurse practitioner programs, the health care system hopes to use this connection to hire more NPs.
Currently 69.2 percent of staff nurses at Brigham and Women’s have a BSN or higher degree, but hospital leaders also are aiming for 80 percent by 2020.
One way Brigham and Women’s has increased its BSN workforce is by hiring only new grads who have their BSN degree — an employment practice that began about four to five years ago, Somerville said. Experienced nurses who don’t have a BSN degree can still be hired for certain clinical positions.
That said, there are strong incentives in place for nurses to go back to school.
“We want all of our nurses to engage in lifelong learning, so we are constantly looking at opportunities that can help nurses advance their education,” Somerville said. “We also want to make it as easy as possible, because they already have so many challenges with work and their personal lives.”
Currently, Brigham and Women’s offers $2,600 a year for tuition reimbursement, and has flexible work scheduling to assist in accommodating coursework.
Since 2009, more than 125 nurses have become involved in RN-to-BSN programs, and 30 of those nurses graduated this year.
As for how patient care is being affected by having an increased BSN-prepared workforce, Somerville said there are more bedside nurses asking questions about how they can improve care clinically and wanting to pursue projects that can test improvement strategies.
In Florida and beyond…
Sarasota Memorial Hospital, a Magnet® facility in Florida, also wants to be in line with the Future of Nursing 2020 goal. The hospital has about 1,300 RNs and LPNs, and at least 30 percent of the RNs have a BSN degree.
“We know what we have to do to get there,” said Jan Mauck, MSHSA RN, CNOR, chief nursing officer of Sarasota Memorial Health Care System and a Florida Nurses Association member. “To increase our BSN staff on the front end, we prefer to hire nurses who already have their degree.
“But we know in our area that many nurses have gone to community college. So any nurses we do hire who don’t have a BSN, must enroll in a BSN program and complete it within three years.
“On the back end, we encourage our current RNs to return to school.”
To assist nurses in overcoming one of the biggest barriers to advancing their education — its cost — Sarasota Memorial pre-pays 100 percent of nurses’ tuition costs at state schools. (They get that same amount if they choose to go to a private school.) Sarasota Memorial also pays toward tuition costs for nurses seeking their master’s and doctoral degrees.
“We also offer scholarships to cover other expenses, such as books and travel,” said Mauck, who serves on Florida’s Action Coalition for the Future of Nursing and is co-chair of its education section.
Another financial incentive is that salaries for nurses with a BSN are 3 percent higher than those without that degree. Nurses with a master’s degree earn 5 percent more than their colleagues in similar positions, and nurses with doctoral degrees, 7 percent more.
From a national perspective, Caramanica said tuition reimbursement and salary differentials are strategies that many hospitals are using to encourage nurses to obtain their BSN.
“We want nurses to continue to pursue advanced degrees and grow in their knowledge of nursing,” Caramanica said. “We want all nurses to be lifelong learners.”
Employers are not alone in looking at a greater BSN-prepared workforce.
• Since 1965, the American Nurses Association (ANA) supported nurses having at least a bachelor’s degree to begin practicing as a registered nurse. And at the 2008 meeting of the ANA House of Delegates, nurse leaders from around the nation approved a resolution to back legislative efforts requiring newly licensed nurses to obtain their BSN in 10 years.
• The American Organization of Nurse Executives (AONE) in 2005 issued a statement advocating for the baccalaureate degree as the appropriate preparation for nurses, and for groups to work collaboratively to achieve this goal.
• The 2010 report of the Institute of Medicine, The Future of Nursing: Leading Change, Advancing Health, calls for nurses to achieve higher levels of education and training and be able to practice to the full extent of their education and training. Specifically, the report calls for the percentage of nurses in the workforce with a BSN degree or higher to be 80 percent by 2020, along with a doubling of nurses with doctorates.
• The American Nurses Credentialing Center’s (ANCC) Magnet Recognition Program® has criteria that require nurse managers and leaders to have a degree in nursing at either the baccalaureate or graduate level. Effective June 2013, Magnet applicants also will be required to provide an action plan and set a target demonstrating their progress toward having 80 percent of direct care RNs obtain a baccalaureate degree in nursing or higher by 2020.
• Research, such as a study conducted by Linda Aiken, PhD, RN, FAAN, and her colleagues at the University of Pennsylvania and another study by a University of Toronto team, have shown that having more bachelor’s prepared nurses providing patient care reduces patient mortality.
• ANA and AONE, as members of the Tri-Council for Nursing, along with the National League for Nursing and the American Association of Colleges of Nursing, are collaborating on a new project funded by the Robert Wood Johnson Foundation. Called Academic Progression in Nursing, it is an effort to help nurses across the country progress in their education, supporting state action coalitions to enhance the capacity for RNs to more easily pursue baccalaureate and higher degrees in nursing while remaining in the workforce.
— Susan Trossman is the senior reporter for The American Nurse.