ADN to BSN Educational advancement for Associates Degree nurses. A view from the national perspective

Transcription

1 ADN to BSN Educational advancement for Associates Degree nurses A view from the national perspective

2 Nursing's long struggle with professional autonomy and control is related to educational levels of practitioners Donley & Flaherty, 2002

3 What do we know about the Associates Degree of Nursing? Not really a 2 year degree One or two years of pre requisites & application ADNs enter with average of 3.69 years of education (Orsolini Hahn, 2008) Entry point for large numbers of RNs including a a diverse spectrum of students from a wide geographic area, including rural and remote Economically flexible pathway into nursing

4 Patient Outcomes: 1988 A meta analysis by Johnson evaluated 139 studies analyzing nurse performance for 3 categories of education (AD, diploma, BS) and found significant differences for BSNs in communication skills, knowledge, problem solving, and professional role. The effect diminished but did not disappear with increasing years of nursing experience.

5 Patient Outcomes: 1991 Young, Lehrer, & White reviewed frequency of nursing functions performed by educational degree and found BSN nurses performed high skill functions more frequently than nurses educated through other pathways (higher education affected nature of work activities, not skill with which they were practiced).

6 Patient Outcomes: 2001 Sometimes the evidence is conflicting! Blegen, Vaughn & Goode evaluated rates of medication errors and patient falls at the hospital unit level and found lower rates with more experienced nurses but no reduction in rates based on nursing educational level

7 Patient Outcomes: But often conflicts are resolved with further study Aiken, Clarke, Cheung, Stone & Silber (2003) demonstrate higher proportions of BSN nurses within an acute care hospital are associated with lower post surgical mortality & failure to rescue

8 Why was Aiken s 2003 study so important? ~300 patients across 168 hospitals in PA Credible funding (National Institutes of Health, Robert Wood Johnson Foundation, Agency for Healthcare Research and Quality, National Institute for Nursing Research) Credible peer reviewed publication JAMA

9 Patient Outcomes 2005: Canadian researchers evaluated more than 18,000 patients at 149 Hospitals in Alberta, and found higher nurse education was associated with lower 30 day mortality 2007: Tourangeau et al: A second Canadian study shows that a higher percentage of BSN prepared nurses is associated with lower 30 day mortality in hospitals

10 Patient Outcomes 2008: Friese et al. evaluated >25K oncology patients and found nursing education level of BSN or higher was linked to lower failure to rescue and lower mortality rates Kutney Lee & Aiken studied surgical patients with serious mental illness & found shorter LOS in hospitals with a higher proportion of BSN nurses

11 Patient Outcomes 2011: Kendall Gallagher et al. demonstrated improved outcomes in mortality and failure to rescue rates in patients cared for by BSN nurses w/ specialty certification [no improved outcomes seen when nurses without the BSN had certification] 2012: review of data from 655 hospitals in four states showed increasing percentage of BSNs was associated with lower mortality and failure to rescue rates Aiken, Cimiotti, Sloane, Smith, Flynn & Neff, 2012

12 Patient Outcomes: 2013 Review of 21 hospitals found those with higher percentage of BSN educated nurses had shorter lengths of stay, lower CHF mortality, decubitus rates, failure to rescue, and post op DVT or pulmonary embolus Blegen, Goode, Park, Vaughn & Spetz, 2013

13 Remember, NONE of this data describes individual nurses performance, or directly compares an ADN nurse to a BSN nurse Research has looked at outcomes within populations of patients, not at individual abilities Association is not causality

14 Support for the BSN goes beyond patient outcomes: Job satisfaction Nurses with BSN and higher consistently report higher levels of job satisfaction Krugman & Preheim 1999 BSN nurses have highest levels of job satisfaction among 140 nurses across inpatient and home care settings Zurmehly, 2008 BSNs rated higher satisfaction related to professional autonomy, job stress, and organizational security Rambur, McIntosh, Palumbo, & Reinier, 2005

15 Support for the BSN goes beyond job satisfaction: Interdisciplinary teamwork Changing health care model from silos to teams Call for nursing to take on a leadership role in these teams, due to inter disciplinary focus Nurses with (by far) the lowest educational level among professional team members Physicians, dentists, podiatrists, mental health providers, hospital administrators, dieticians, laboratory technicians, physical therapists, pharmacists, chiropractors, occupational therapists, insurance underwriters, optometrists, social workers, speech therapists all have requirements for higher levels of education

16 Interdisciplinary teamwork Interdisciplinary teamwork requires education on organizational structure, communication, leadership, information management, health care policy, finance and regulatory frameworks. BSN has mandatory content on each of these topics AACN, 2008

17 The view from nursing executives In a study of 43 Chief Nursing Officers from academic health center hospitals, 71% perceived a difference in practice between AD/diploma graduates and BSN graduates, related primarily to critical thinking skills, professional behavior, leadership skills, more focus on continuity of care & outcomes. Goode et al., 2001

18 and nurse managers Qualitative study done in 2011, nurse managers noted that the BSN did not have much impact on technical care giving but still considered the degree very important in fostering critical thinking, ability to see the big picture and professionalism Weinberg, Cooney Miner, Perloff, & Bourgoin, 2011)

19 Environmental factors driving acceptance of academic progression Market shift to a (temporary) oversupply of RNs Impact of Magnet status designation Increasing acceptance by new nurses Pattern of change from urban to rural

20 Changing the Game A recognition of the need for academic progression in nursing Acknowledging role of the ADN entry point

21 Who supports the call for a more highly educated nursing workforce? National Advisory Council on Nurse Education and Practice (advisory body to U.S. Congress) recommended minimum of 2/3 of nurses in the workforce have a baccalaureate) American Organization of Nurse Executives has called for all RNs to be educated at the baccalaureate level

22 Who supports the call for a more highly educated nursing workforce? Council on Physician and Nurse Supply call for national effort to increase the proportion of BSNs & for a shift in Federal funding to support American Nurses Association continues to call for mandatory BSN for entry to professional nursing practice American Association of Colleges of Nursing (representing 4 year institutions) recommends differentiated levels of professional practice for nurses with higher levels of education

23 Who supports the call for a more highly educated nursing workforce? 2012 Joint statement in support of academic progression in nursing is endorsed by American Association of Colleges of Nursing American Association of Community Colleges Association of Community College Trustees National League for Nursing National Organization for Associate Degree Nursing

24 Barriers to academic progression in nursing

25 Ethical context: Autonomy vs. common good How do we do the right thing by our nurses, our patients, our society? Logistics: Who will pay? How will students get access? Should experienced nurses receive credit for their expertise?

26 Economics: Can we afford to raise the cost of nursing education? Can we afford not to? Should employers pay? Attitudes: It won t change my practice It won t change my pay I know some great ADN nurses I know some terrible BSN nurses

27 Supportive frameworks: Academia Increase capacity Increase flexibility Increase focus on market needs

28 Supportive frameworks: Policy & Practice Policy options Recognize & highlight benefits Employer mandates Employer support

29 Deliberate decisions: Tuition Variable based on system characteristics Complete support equitably applied Complete support for selected individuals Partial support Symbolic support Promote support by others

30 Deliberate decisions: Tuition Promote the options you do have Include any from health system Research and present financial support options from others Know your facility eligibility (FHQC, HPSA, etc.)

31 Deliberate decisions: Incentives Pay scales reflect educational level Pay scales based on differentiated practice or clinical ladders Hiring or advancement preferences

32 Non financial support Create and foster a culture that emphasizes academic progression but respects individuals Flexible scheduling options for those in school Protection of benefit status with a temporary reduction in hours Use of facility resources Mentorship, preceptorship

33 Non financial support Think creatively what do your nurses tell you? EX: Focused support: gateway courses Gateway courses represent a disproportionate barrier to advancement, especially statistics Can a facility (or several) group together to hire a tutor?

34 Partnerships Academic practice Practice practice cohorts do not have to be facility or system specific customize a cohort for nurse executives Acute care long term care home care Facility specific: Human resources, education, IT, nurse managers

35 Partnerships with staff Communicate respect and professionalism Reframe the discussion from entry point or individual worth to the benefits of a more highly educated workforce Acknowledge dynamic professional standards as well as the impact on dignity and self worth Provide accurate non judgmental information about national trends

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