Barbara Zittel, RN, Ph.D.

LEGISLATING ACADEMIC PROGRESSION The ‘BSN in 10’ Initiative in New York  

NYSED Nursing Survey

0%

20%

40%

60%

80%

100%

Before 1960 1960s 1970s 1980s 1990s 2000s

Diploma Associate's Bachelor's/Master's

Trends in Nursing Education

Each year, out of 100 RNs seekingNYS licensure, 62 are Associate and

38 are Baccalaureate Graduates

Graduates from basic nurse baccalaureate programs are over

3 times more likely to obtain graduate degrees

Initial BSN Graduates

Initial ADN Graduates

Adapted from: Aiken, Cheung, Olds. 2009. Health Affairs 28(4)

Average Age of RNs Working in New York State

38

39

40

41

42

43

44

45

46

47

48

1989 1995 2002

Ag

e

Survey Data10% of NYS RN workforce is 60 years or

older.

This group represents almost 27% of all RNs with doctoral

degrees

RESEARCH FINDINGS

Multiple Researchers have demonstrated a significant relationship

between nursing education and improved patient outcomes

65

70

75

80

85

90

95

20% 40% 60%

As Nurse Education Increases, As Nurse Education Increases, Patient Patient MortalityMortality Decreases. Decreases.

Dea

ths

per

100

0 p

atie

nts

wit

h c

omp

lica

tion

s

Education (Percentage of hospital nurses with BS degrees.) 232,342 patients from 168 PA non-federal adult general hospitals.

Aiken, 2003, JAMA

90 deaths

in 1,000

patients

84 deaths

in 1,000

patients76

deaths in

1,000 patients

Hospitals with a higher proportion of BSN RNs experienced lower rates of 30-day patient mortality

Replication of Aiken study in 18,142 patients in 49 hospitals in Alberta, Canada

with identical results

Estabrooks, et al. (2005)

• Study of 46, 993 patients

• Demonstrated 9 fewer deaths per 1,000 discharges for every 10% increase in BS prepared nurses

Tourangeau (2007)

• Longitudinal study of 21 US hospitals over 84 quarters

• In hospitals with a higher proportion of BS educated nurses:– Lower rates of CHF mortality– Fewer Hospital Acquired Pressure Ulcers– Lower Rates of Failure to Rescue– Shorter Hospitalizations

Blegen & Goode (2009)

Kendall-Gallagher, Aiken, Sloane & Cimiotti (2011)

•Specialty certification was associated with better patient outcomes, •BUT•Such outcomes were associated only when care was provided by nurses with baccalaureate level education. •The authors conclude that “…no effect of specialization was seen in the absence of baccalaureate education.”

Aiken (February 26, 2014)

•A large-scale study conducted in nine European countries…•An increase in a nurse’s workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7%•Every 10% increase in BS prepared nurses was associated with a decrease in this likelihood by 7%

Changes in the Health Care Environment

*Advances in science *Increasingly diverse population *Shorter length of stays….

have resulted in increased patient complexity which has accelerated the need for nurses

with better skills and knowledge to manage a challenging and increasingly diverse healthcare environment.

Philippines:BSN RequiredSince 1988

Australia:BSN RequiredSince 1992

Canada:New RNs must be BS prepared European

Union:BS required

Transformation of Nursing Education

Thailand: BS required

Turkey:BSN requiredsince 1997

RN Athletic Training

Diploma/Associate

BS Master’s Doctorate

Midwifery

Nurse Practitioner

Occupational Therapy

Speech Lang. Path.

Audiology

Lic. Clin. Soc. W.

Lic. Masters Soc. W.

Lic. Mental Hlth Couns.

Physical Therapist

Medicine

Dentistry

Podiatry

Psychology

Pharmacy

Minimum Entry-Level Education Requirements for

Select Licensed Health Professions

National Advisory Council on Nursing Education and Practice

in 2001 and 2009recommended 66.6% of workforce be baccalaureate prepared nurses

2010 Carnegie Foundation reportEducating Nurses: A Call for

Radical Transformation (Patricia Benner, et al.) calls for

the BS degree in nursing for licensure

2008-RWJF-IOM Collaboration

Chaired by former

Department of Health and Human Services Secretary Donna Shalala

2010- Release of the Report

October 2010 Report Recommends that 80% of RNs be prepared with the BS degree by

2020.

Question 1.

The “BS in 10” proposal would close associate degree programs. 1.True2.False

Question 2.

The “BS in 10” proposal would require every currently licensed RN to obtain a BS degree within 10 years after the bill is passed into law.

1.True2.False

PROPOSAL

    

   

Opportunity for an extension beyond 10 years, for extenuating circumstances, as determined by the Department.

Grand-parenting of all currently licensed (RNs);

Time to permit all students on a waiting list or enrolled in associate or diploma programs to complete their studies and be grand-parented

Provisions that would place a Registered Nurse’s license on “hold” if the baccalaureate degree is not obtained in 10 years.

Perceived Problems/Concerns

STATEMENT RESPONSEIf I get my BS, I will be removed from bedside nursing.

I’m content at what I’m doing why should I go on to the BS degree?

I’m just as good as any BS prepared nurse!

Current Status of the Board’s Motion

Assembly Bill # 3945; Morelle Senate Bill # 2145; Flanagan

NYONEL takes Lead in Seeking Legislative Support

NYS 2015Assembly overwhelmingly voted in favor of this bill;

out of 140, 127 voted Y, 8 N, 5 were excused

excused.reasons (ER), one was absent (AB) and 8 voted against (NO).5

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1

                                                                                                                                                                             

The Plight of New Graduates

Many hospitals are responding to research and Magnet expectations by requiring their nursing staff to

hold the BS in Nursing degree.

RNs are hired without BS but must complete it in a # of years to stay employed

RNs with an AS degree are not hired

BS prepared RNs are preferentially hired

Only RNs with BS degrees are hired

Only RNs with 1 year of experience are hired

Only RNs are hired, not new graduates

RN Hiring Practices of NY Hospitals

BS is required for management positions

BS is included in site’s career ladder

New hires must advance to BS

All RNs must obtain a BS in Nursing degree

Managers without BS with lose their position

Tuition assistance is available for BS study

Tuition assistance is available for MS+ study

Flexible hours for RNs pursuing BS

Higher pay for RNs with BS degree

On-site classes for BS degree attainment

Other

Employer Incentives to Encourage RNs to Obtain the BS in Nursing

*Project 6,000 fewer surgical deaths annually when 60% of nurses are prepared at the BS level.

*Project a 10% reduction in the 200,000 hospital acquired pressure ulcers each year. The published additional length of stay from hospital acquired pressure ulcers is 3.98 days, thus the potential savings is 17.5 million dollars annually.

*Higher number of BS prepared nurses results in less turnover. Every 1% reduction in RN turnover saves $12.9 million, statewide..

Benefits to New York

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CANE “Friday’s Update”

New Models of Nursing Education Are Needed

New Models of Nursing Education Are Needed

1+2+1

2+2Oregon Model RN to MS Programs

Encouragement of RN applicants to pursue the BS as the initial degree.

…and others???

SUNYCUNY Private Colleges