SUNCOAST NURSING ACTION COALITION The Case for Increasing BSN Prepared Nurses

Robert Wood Johnson Foundation (RWJF) and Institute of Medicine (IOM) partnership IOM Committee was tasked with an action-oriented blueprint for the future of nursing Initiative on the Future of Nursing: History

EIGHT RECOMMENDATIONS RESULTED IN FOUR KEY MESSAGES Key Messages from the IOM Report

Nurses should practice to the full extent of their education and training. 1 KEY MESSAGE Key Messages from the IOM Report

KEY MESSAGE Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. GOAL: Increase the proportion of nurses with BSN degrees to 80% by Key Messages from the IOM Report

KEY MESSAGE Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States. 3 Key Messages from the IOM Report

KEY MESSAGE Key Messages from the IOM Report Effective workforce planning and policy making require better data collection and an improved information infrastructure. 4

Campaign for Action: Guiding implementation of the Future of Nursing report Center to Champion Nursing in America RWJF and AARP Initiative

Suncoast Nursing Action Coalition (SNAC) SNAC Composition: Nursing leaders, educators, and community members from four county area: Charlotte, DeSoto, Manatee & Sarasota Development of a triad model approach with specific focus areas: Academic Community Employer

SNAC Accomplishments Strong community partnerships: The Patterson Foundation Community Foundation of Sarasota County Ringling College of Art & Design Development of Nurse Education Navigator (NEN) Structure & process for role Grant proposal for funding Logic Model completion

SNAC Accomplishments Employer presentations Partnering with Ringling College of Art & Design Doctoral project in progress to evaluate the effectiveness of an educational session and resource guide in affecting the extent of activities nursing leaders utilize to achieve the IOM recommendations of 80% BSN prepared nurses by Resource guide developed for healthcare employers within the 4 county area

EVIDENCE Supporting BS Education SHARE the reason behind the change

As Nurse Education Increases, Patient Mortality Decreases Aiken (2003)

Additional Supporting Evidence in Patient Outcomes Validated earlier study of 2003: each 10% increase in BSN proportion of nurses associated with 4% decrease in risk of patient death (Aiken, et al, 2008). Reduction in surgical mortality of 2.12 deaths/1000 patients with a 10-point increase in BSNs (Kutney-Lee, 2013). Lower lengths of stay, lower rates of heart-failure related mortality, decreased chance of post-op deep vein thrombosis or pulmonary embolism (Blegen, et al, 2014).

Benefits from Education for Nurses & Employers RNs twice as likely to remain in job with tuition assistance BSN prepared nurses reported higher job satisfaction and lower job stress BSN prepared nurses more than ten years of tenure Ingersoll et al, 2002; McGinnis & Martiniano, 2008; Megginson, 2008; Rambur et al., 2005.

AD vs BS: Added Value? AD Programs introduce the following concepts; BS Programs advance the concepts to a higher level: Scholarship for evidence based practice Information management Inter-professional communication & collaboration Organizational & systems leadership Disease prevention & population health

Financial Incentives with Higher BSN Percentages Improved patient outcomes = better CMS reimbursement Reputation for high quality patient outcomes = higher market share Improved nursing satisfaction with educational support & professional development = lower turnover rates & associated savings.

Yakusheva, O., et al (2014) Financial Incentives with Higher BSN Percentages Recent study on the economic analysis of meeting an 80% BSN workforce: 6 month study of 8,526 patients & 1,477 direct care nurses BSN proportion associated with lower mortality, lower readmission rates & shorter length of stay (1.9%)

Tuition Reimbursement Salary Differential Professional Advancement Programs Financial Incentives for Nurses

Communication Strategies = Benefit to Patients Benefit to Nurses IOM Recommendations Communicate the Case for Change

Broader understanding of the nursing profession Fosters skills beyond basic patient care Systems-thinking Continuum of care Leadership Career expansion opportunities Satisfaction and pride from goal achievement Recognition and credibility Benefits of BSN Degree to Nurses

Blogs, newsletters Surveys Small group sessions Presentations Open forums Develop a communication strategy Communication Strategies CLINICAL INPUT IS CRUCIAL!

Turn the negative into the positive: “Studies show that nurses with BSN degrees provide better care than nurses who only have an ADN” VERSUS: “Hospitals with more BSN prepared nurses have lower rates of mortality and post-surgery complications, and shorter patient stays” Messaging Strategies

“We need to convince nurses that they should be lifelong learners, so they can improve their skills” VERSUS: “We need to make it easier and more affordable for nurses to continue their education so they can do even more to provide high quality care and promote health”

“Technology has made our health care system more complicated and the Affordable Care Act has brought more people into it. Nurses need to have BSNs to provide high quality care in this changing environment” VERSUS: “Technology has made our health care system more complicated and the Affordable Care Act has brought more people into it. BSN programs equip nurses with the critical thinking skills and experiences they need to provide care in this increasingly complex environment” Communication Strategies

Gear your message to the audience Tell stories that highlight the message Acknowledge/discuss the barriers to education Focus on professional growth and enhanced patient outcomes. inspiration-aspirations-school-again Communication Strategies Video clip: Real-life stories of nurses who returned to school to achieve BSN.

Fosters skills beyond basic patient care Reassign nurse to teach clinicals Reassign nurse to teach coursework Support nurses in adjunct faculty employment Partner with BSN programs Serve on advisory boards Academic Partnerships Engage faculty in agency nursing and QI committees

Select two or three pertinent pieces of data to share Share the Data Gear the data to the respective audience Use anecdotes to illustrate the importance of the data

Develop innovative agreements for clinical and classroom faculty Reassign nurse to teach clinicals Reassign nurse to teach coursework Support nurses in adjunct faculty employment Partner with BSN programs Serve on advisory boards Academic Partnerships Engage faculty in agency nursing and QI committees

Support Action Coalition activities Ask Action Coalition representative to provide ongoing feedback on current activities Engage faculty in employer nursing and QI committees Academic Partnerships Benefits of BSN Degree to Nurses Create innovation ways to enhance nursing student experiences

Communication Strategies Academic Partnering Financial Incentives Organizational Infrastructure Workforce Analysis SUMMARY Promote the message of increasing the educational level of our nurses

THANK YOU for your participation in this very important initiative to enhance the profession of nursing!

References Aiken, L., Clarke, S., Cheung, R., Sloane, D., & Silber, J. (2003). Educational Levels of Hospital Nurses and Surgical Patient Mortality. Journal of the American Medical Association, 290 (12), Aiken, L., Clarke, S., Sloane, D., Lake, E., & Cheney, T. (2008). Effects of Hospital Care Environment on Patient Mortality and Nurse Outcomes. Journal of Nursing Administration, 38 (5), Andrews, N. (2014). Advancing Toward an 80% BSN Workforce by American Nurse Today, 9 (1), 36. BSN Update/Review Committee (2012, August 10). Hospital Policy: The BSN Plan. Tampa, Florida. Blegen, M., Goode, C., Park, S., Vaughn, T., & Spetz, J. (2013). Baccalaureate Education in Nursing and Patient Outcomes. The Journal of Nursing Administration, 43 (2), Davis, K. (2014). One Employer’s Approach to Increasing the Academic Preparation of Nurses. (PowerPoint Slides).

References Duffy, M., Friesen, M. A., Speroni, K., & Swengros, D. (2014). BSN Completion Barriers, Challenges, Incentives, and Strategies. The Journal of Nursing Administration, 44 (4), Folan, P., Tarraza, M., Delaney, M., Fardellone, C., Leners, C., Ross, E., & Fitzpatrick, J. (2012). Leadership Initiatives to Disseminate the Institute of Medicine’s Future of Nursing Report. Policy, Politics & Nursing Practice, 13 (1), Future of Nursing Campaign for Action (2014, May 29). Campaign Overview. Retrieved June 22, 2014 from: Future of Nursing Campaign for Action (2014, June 11). Speaking of Academic Progression. Retrieved September 18, 2014 from: Gerardi, T., Smith, S., & Davis, K. (2014). Successful Practices to Support Academic Progression in Nursing in the Employer Setting. In American Organization of Nurse Executives Annual Conference, Orlando, Fl. Hasmiller, S. (2013). The RWJF’s Investment in Nursing to Strengthen the Health of Individuals, Families, and Communities. Health Affairs, 32 (11), Ingersoll, G., Olsan, T., Drew-Cates, J., DeVinney, B., & Davies, J. (2002). Nurses Job Satisfaction, Organizational Commitment, and Career Intent. Journal of Nursing Administration, 32 (5),

References Institute of Medicine (2010, October). IOM Report. Retrieved January 6, 2014 from: health.aspx Kendall-Gallagher, D., Aiken, L., Sloane, D., & Cimiotti. J. (2011). Nurse Specialty Certification Inpatient Mortality, and Failure to Rescue. Journal of Nursing Scholarship, 43 (2), Kovner, C., Brewer, C., Katigbak, C., Djukic, M., & Fatehi, F. (2012). Charting the Course for Nurses’ Achievement of Higher Education Levels. Journal of Professional Nursing, 28 (6), Kutney-Lee, A., Sloane, D., & Aiken, L. (2013). An Increase in the Number of Nurses with Baccalaureate Degrees is Linked to Lower Rates of Post Surgery Mortality. Health Affairs, 32 (3), McGinnis, S., Martiniano, R. (2008). The Hospital Workforce in New York: Findings from a Survey of Hospital Registered Nurses. Rensselaer, NY: Center for Health Workforce Studies, School for Public Health, SUNY Albany. Megginson, L. (2008). RN-BSN Education: 21 st Century Barriers and Incentives. Journal of Nursing Management, 16, doi: /j/ x

References NetMBA Business Model Center (2010). Scenario Planning. Retrieved May 9, 2014, from Pittman, P., Herrera, C., Horton, K., Thompson, P., & Ware, J. (2013). Healthcare Employers Policies on Nurse Education. Journal of Healthcare Management, 58 (6), Rambur, B., McIntosh, B., Palumbo, V., & Reiner, K. (2005). Education as a Determinant of Career Retention and Job Satisfaction among Registered Nurses. Journal of Nursing Scholarship, 37 (2), Robert Wood Johnson Foundation (2011, August). Charting Nurses’ Future: Reports on Policies that can Transform Patient Care. Retrieved May 14, 2014, from Swearington, C., Clarke, P., Gatua, M., & Sumner, C. (2013). Diffusion of a Nursing Education Innovation. Nurse Educator,38 (4), Yakusheva, O., Lindrooth, R., & Weiss, M. (2014). Economic Evaluation of the 80% Baccalaureate Nurse Workforce Recommendation: A Patient-Level Analysis. Medical Care, 52 (10), Yucha, C., Smyer, T., & Strano-Perry, S. (2014). Sustaining Nursing Programs in the Face of Budget Cuts and Faculty Shortages. Journal of Professional Nursing, 30 (1), 5-9. Zimmerman, D., & Cain, J. (2013). Forecasting and Moving Your Organization to an 80% BSN Workforce (PowerPoint slides).