Topics

• American Nurses Association
• The Carnegie Reports
• The IOM
• BSN in Ten
• References

NURS 410 - Health Care Delivery Systems & Informatics

Module 3: Major Reports Influencing the Healthcare Delivery System

BSN in Ten

Research links a BSN-prepared workforce and better patient outcomes (Trossman, 2008). This research evidence has been the driving force behind state legislation requiring associate prepared nurses to complete their bachelor’s degree within 10 years of attaining their initial licensure. When acute care hospitals staff units with a higher proportion of Bachelor of Science (BSN) or Master of Science in Nursing (MSN) prepared nurse, unit productivity and patient outcomes are improved (Aiken, Clarke, Cheung, Sloane, & Silber, 2003; Aiken, Clarke, Sloane, Lake, & Cheney, 2008; Curtin, 2003; Estabrooks, Midodzi, Cummings, Ricker, & Giovannetti, 2005; Tourangeau et al., 2007). Quality nursing care is achieved not just by reducing the number of errors committed, but also by reducing errors of omission, those instances when evidence-based nursing care is not provided, and that statistic relates directly to educational preparation of nurses. Studies have shown that every 10 percent increase in the proportion of BSN nurses in a hospital’s staff is associated with a 4 percent decrease in risk of death (National Advisory Council on Nurse Education and Practice, 2010). At a time when care delivery systems must improve outcomes to assure adequate reimbursement, educational preparation of nurses is a critical factor for hospitals to consider as is the process to meet the call to have 80% of nurses prepared at the BSN level….by 2020. Now laws are being passed to encourage RNs to return to school thereby increasing the likelihood the nation will achieve the 80% goal.

Why legislate? We are witnessing many changes and other potential changes on the horizon impacting our delivery care. This includes many aspects such as education, specialization, demands for technology and much more; of our healthcare workforce. Declining reimbursement rates have had a great influence on staffing patterns with providers employing fluctuating staffing patterns. In many instances patterns have reflected reduced RNs and more non-nurse providers at the bedside. In response to changes some states have mandated staffing patterns (with legislation) for more RNs than unlicensed personnel. Yet, we continue to see nurse extenders (assistive personnel) in positions that once were relegated for RNs only; even with the continuing increase in complex patient needs. We realize education and associated competencies required in the changing healthcare environment are needed for these changes.

In entering the nursing workforce, an incremental approach permits those choosing to enter the profession with a diploma or associate degree to pursue additional skill sets while strengthening entry level competencies: moving from novice to expert. Nursing education advancement with work experience can result in greater relevance for the learner. In taking steps to meet the increasing complexity of care the baccalaureate nursing education is designed to impart a deeper understanding of the cultural, political, economic, social issues that affect patients, and political change influencing health care delivery (to meet the increasing complexity of care delivery). Coursework offered at the baccalaureate level includes such areas as healthcare economics, health informatics, health policy, leadership, and research. In fact, some states have introduced legislation to require a BSN as entry level into practice such as New Jersey and Rhode Island. These states are considering such bills as well and the Boards of Nursing in each state are backing the legislation.