CGEAN Position Statement on the Educational Preparation of Nurse Executives and Nurse Managers*

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1 CGEAN Position Statement on the Educational Preparation of Nurse Executives and Nurse Managers* Background The Council on Graduate Education for Administration in Nursing (CGEAN) is focused on advancing knowledge through education, practice, and research for nursing administration and leadership. Its members represent education, research and service sectors throughout the United States and several international communities. The vision of CGEAN is to achieve a dynamic, highly qualified nursing workforce prepared to lead, manage, and influence healthcare for positive outcomes. The CGEAN core values are innovation, intellectual inquiry, lifelong learning, relationships, stewardship, and wisdom. Given CGEAN s expertise in education for nursing administration and its commitment to advance healthcare systems through strong nursing leadership, CGEAN is pleased to offer this position statement on the desired educational preparation of nurse executives and nurse managers.* The significant challenge of promoting access to high quality healthcare to improve the nation s health has been increasingly acknowledged by a wide array of policy makers, providers and consumers. With passage of the Patient Protection and Affordable Care Act (Public Law March, 2010), the contribution of nurses to improving healthcare services across settings has been widely acknowledged. This, in turn, has focused attention on the educational preparation of nurses for entry and advanced practice roles. Recent publications have highlighted the impact of nurses education on several important aspects of quality and safety in care (Aiken et. al., 2003; Estabrooks et al., 2005). The increasing complexity of individuals health status and healthcare systems requires more advanced levels of education for nurses to achieve desired performance and outcomes. Nurse leaders with graduate degrees are also more likely to be included in executive roles and policy or governing bodies where they can contribute their expertise grounded in actual clinical care to improve healthcare systems. The focus on educational levels required for nurses in a variety of roles has been long debated both within and outside of the profession. In May, 2010, the Tri Council for Nursing** issued a new consensus policy encouraging all registered nurses, regardless of entry point into the profession, to advance their education in baccalaureate, master s, and doctoral programs in the interest of enhancing quality and safety across healthcare settings. The Tri Council further noted that without a more educated nursing workforce, the nation s health will be further at risk. A recent report issued by the Institute of Medicine on the Future of Nursing (October, 2010) included a similar conclusion, recommending that nurses achieve higher levels of education with a goal of 80% [1]

2 of registered nurses prepared with a minimum of a bachelor s degree by The rationale for this recommendation included awareness that nurses are required to utilize technological tools and analyze and synthesize complex and expanding information; additionally, nurses must collaborate with many health care professionals who hold master s and doctoral degrees to achieve optimal care. Both the Tri Council and IOM Future of Nursing panel called for enhancing education programs and access along with a strong focus on continuing competency through lifelong learning. While there is not full consensus across the nursing profession, the American Nurses Association (ANA) and the American Association of Colleges of Nursing (AACN) remain committed to the bachelor s degree as the desired minimal education for entry into practice. National nurse leaders have identified the increased need for knowledgeable and skilled nurses in first line, midlevel and executive management positions in the healthcare system (Russell & Scoble, 2003). When availability allows, most hospitals prefer to hire baccalaureate prepared nurses in first line positions, including charge nurse roles. Charge nurses have delegated authority from nurse managers and serve as role models for staff in a variety of complex care settings. Many hospitals use either a differentiated practice model or a clinical ladder to distinguish the practice and pay of a baccalaureate prepared nurse. In mid level positions, nurse executives value the acquisition of a master s degree as essential for nurse manager performance (Kleinman, 2003). As Kleinman noted, the domain of nursing knowledge has exploded, scope of practice has increased dramatically... and the roles of the nurse manager and nurse executive have evolved significantly in response to changes in the healthcare industry (p.451). Increasingly, graduate preparation in nursing management, business knowledge, and leadership skills are needed for success in the complex healthcare environment. This is consistent with AONE s position statement that as nurse leaders assume more responsibility for specific units, departments, service lines or system level roles, the minimum educational preparation should be at the master s level. Further, as access to Doctor of Nursing Practice (DNP) programs with leadership focus has evolved, increasing numbers of nurse managers and executives have pursued achievement of this credential. The American Organization of Nurse Executives (AONE) released a position statement on the educational preparation of nurse leaders that included recognition of nursing administration as an advanced practice nursing role, a position that is congruent with the opinion published by the American Association of Colleges of Nursing (AACN). AONE supports a minimum of a baccalaureate preparation for nurse leaders; suggests a minimum of master s preparation for nurse leaders with unit/department/service line/systems roles; and encourages nurse executives to seek doctoral preparation. The AONE position statement also called for continuation and expansion of master s degree leadership education programs to assure the desired nurse leader workforce. Current data suggests that there is a significant gap in desired versus actual educational preparation of nurse leaders. In one large national study (National Sample Survey of Registered Nurses/HRSA, 2008) approximately 50% of nurses reporting titles suggesting leadership positions from across the US reported having less than a bachelor s degree as their highest educational credential. In a smaller study focused on charge nurses in acute care settings across 10 hospitals in South Florida (Sherman, Schwarzkopf, & Kiger, In Press), more than half of the sample (55%) listed an associate degree or diploma in nursing as their highest level of education. [2]

3 CGEAN Position Statement on the Educational Preparation of Nurse Executives and Nurse Managers To achieve the goal of leading healthcare teams and organizations in delivering high quality, safe, and costeffective care services, the following goals and expectations have been endorsed and should be vigorously pursued: 1. Nurse managers should be minimally prepared at the baccalaureate or preferably the master s in nursing level. Given their delegated authority by nurse managers and status as role models, charge nurses should also be minimally prepared at the baccalaureate level. 2. As nurse leaders assume more responsibility for specific units, departments, service lines or system level roles, the minimum educational preparation should be at the master s degree level, with a preference for programs that offer students a strong focus on nursing knowledge and roles within healthcare. 3. Master s degree programs that focus on nursing leadership and management should be expanded to promote access to high quality programs. 4. Nurse executives are encouraged to seek educational preparation at the doctoral level to enhance their roles and contributions to improving healthcare outcomes and systems. 5. The foundational knowledge for nursing leadership degree programs should reflect approved competencies for the field and promote seamless opportunities to advance from master s through doctoral preparation. 6. CGEAN supports the implementation of the Doctor of Nursing Practice (DNP) as a post master s terminal degree option with an aggregate/systems/organizational focus in administration, healthcare policy, informatics, and population based specialties as detailed in the DNP Essentials document (AACN, October 2004). 7. CGEAN embraces the role of nurses prepared through Doctor of Philosophy (PhD) programs to expand knowledge development in relevant leadership and administrative areas to enhance practice effectiveness and outcomes. *As there are myriad nursing leadership titles in various healthcare settings and organizational structures, the term Nurse Executive refers to senior level administrative positions while Nurse Manager encompasses positions with responsibility for one or more organizational units **The Tri Council for Nursing consists of the American Association of Colleges of Nursing (AACN), the American Nurses Association (ANA), the American Organization of Nurse Executives (AONE), and the National League for Nursing (NLN). [3]

4 References 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. Journal of the American Medical Association (JAMA), 290, American Association of Colleges of Nursing (AACN). (2004). The Essentials of Doctoral Education for Advanced Nursing Practice. American Organization of Nurse Executives (AONE). (ND). AONE Position Statement on the Educational Preparation of Nurse Leaders. Cheung, R.B. & Aiken, L.H. (2006). Hospital initiatives to support a better educated workforce. Journal of Nursing Administration (JONA), 36(7 8), Council on Graduate Education for Administration in Nursing (CGEAN). Estabrooks C.A., Midodzi W.K., Cummings G.G., et al. (2005). The impact of hospital nursing characteristics on 30 day mortality. Nursing Research, 54(2): Institute of Medicine. (2011). The Future of Nursing: Leading Change, Advancing Health. Kleinman, C. S. (2003). Leadership roles, competencies, and education: How prepared are our nurse managers? Journal of Nursing Administration (JONA), 33 (9); HRSA. (2008). National Sample Survey of Registered Nurses. Russell, G. & Scoble, K. (2003). Vision 2020, part 2: Educational preparation for the future nurse manager. Journal of Nursing Administration (JONA), 33 (7 8); Schwarzkopf, R., Sherman, R.O. & Kiger, A. (in press). Taking charge: Frontline nurse leader development. The Journal of the Continuing Education in Nursing. Sherman, R.O., Schwarzkopf, R. & Kiger, A. (in press). Charge nurse perspectives on frontline leadership in acute care environments. International Scholarly Research Network: Nursing. CGEAN Task Force on Academic Educational Preparation Adopted by the Executive Committee October 3, 2011 [4]

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