NURSE MANAGER EDUCATION LEVEL Pilot Study Proposal Jerusalem Walker, BA, RN, BSN

Chorus of calls for advanced nursing education American Association of the Colleges of Nursing The American Nurses Credentialing Center The American Nurses Association State Nursing Associations Institute of Medicine The White House Health care agencies

The Evidence Aiken et al. (2003) Hospital-level data from late 1990’s Voluntary, mailed survey instrument Cited 893 times! Sales et al (2008) Unit-level data from Veterans Health Administration hospitals Collected within the hospital Cited only 36 times

Aiken et al. (2003) Hospitals stratified by size, teaching status, and technology usage Problem: endogeneity bias or missing variables Serious threat to validity Example: University of Pennsylvania and Temple University Hospitals

Sales et al. (2008) No association between level of RN education and patient outcomes RN education aggregated to the hospital level VHA hospitals already provide “seamless academic progression” advocated by IOM’s “Future of Nursing”

Magnet Status 100% of nurse managers must have at least a BSN by January 2013 Anecdotal evidence that ADN and diploma RN managers are losing their jobs because of this requirement

The Evidence There are no studies linking manager education level to unit-level outcomes There is evidence that nursing education has been commoditized: “Nursing continuing education is required in some nursing jobs, but is also beneficial to your career. For example, a graduate degree or certificate in a specific area of continuing education may help you get a raise or a promotion to a higher position. Your new knowledge will not only impress your managers, but it will also improve your resume and potentially increase your salary.”graduate degree

Study Proposal Nurse manager experience and educational levels Unit-level outcome data Nursing skill mix and hours per patient day

POPULATION CHARACTERISTICS AND ENABLING FACTORS Demographic characteristics Years of Nursing Experience Years of management experience Years on current unit Years in current position Education level and type MODIFYING FACTORS Nursing hours per patient day Skill mix OUTCOME VARIABLES Falls prevalence Restraint prevalence Voluntary turnover DETERMINANTS OF NURSING CARE OUTCOMES

References Aiken, L.H., Cimiotti, J. P., Sloane, D. M., Smith, H. L., Flynn, L., & Neff, D. F. (2011). Effects of Nurse Staffing and Nurse Education on Patient Deaths in Hospitals With Different Nurse Work Environments. Medical Care, 49(12), 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. JAMA: the journal of the American Medical Association, 290(12), 1617–1623. Aiken, L.H., Clarke, S. P., Sloane, D. M., Lake, E. T., & Cheney, T. (2008). Effects of hospital care environment on patient mortality and nurse outcomes. The Journal of nursing administration, 38(5), 223. Aiken, L.H., Sloane, D. M., Clarke, S., Poghosyan, L., Cho, E., You, L., Finlayson, M., et al. (2011). Importance of work environments on hospital outcomes in nine countries. International Journal for Quality in Health Care, 23(4), 357–364. Aiken, Linda H, Clarke, S. P., Cheung, R. B., Sloane, D. M., & Silber, J. H. (2003). Educational levels of hospital nurses and surgical patient mortality. JAMA: The Journal of the American Medical Association, 290(12), 1617–1623. doi: /jama ANCC Magnet Recognition Program. (n.d.). Retrieved February 15, 2012, from Andrews, D. R., & Dziegielewski, S. F. (2005). The nurse manager: job satisfaction, the nursing shortage and retention. Journal of Nursing Management, 13(4), 286–295. Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the I. of M., & Medicine, I. of. (2011). The future of nursing: Leading change, advancing health. Natl Academy Pr. Goode, C. J., Blegen, M. A., Park, S. H., Vaughn, T., & Spetz, J. (2011). Comparison of Patient Outcomes in Magnet® and Non-Magnet Hospitals. Journal of Nursing Administration, 41(12), 517. Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. National Academy Press. Kitson, A. L. (2009). The need for systems change: reflections on knowledge translation and organizational change. Journal of Advanced Nursing, 65(1), 217–228. Kleinman, C. S. (2003). Leadership roles, competencies, and education: how prepared are our nurse managers? Journal of Nursing Administration, 33(9), 451. Kurtzman, E. T., & Corrigan, J. M. (2007). Measuring the contribution of nursing to quality, patient safety, and health care outcomes. Policy, Politics, & Nursing Practice, 8(1), 20–36. Lovik, E. G. (n.d.). Temple: The Story of an Urban University.

References Mark, B. A. (2006). Methodological issues in nurse staffing research. Western Journal of Nursing Research, 28(6), 694–709. Mathena, K. A. (2002). Nursing manager leadership skills. Journal of Nursing Administration, 32(3), 136. McHugh, M. D., Kutney-Lee, A., Cimiotti, J. P., Sloane, D. M., & Aiken, L. H. (2011). Nurses’ widespread job dissatisfaction, burnout, and frustration with health benefits signal problems for patient care. Health Affairs, 30(2), 202–210. Newman, M. A. (2007). Transforming presence: The difference that nursing makes. FA Davis Company. Phillips, B., Ball, C., Sackett, D., Badenoch, D., Straus, S., Haynes, B., & Dawes, M. (2001). Oxford centre for evidence-based medicine levels of evidence. Verfügbar unter: cebm. net/levels_of_evidence. asp. Polit, D. F., & Beck, C. T. (2008). Nursing research: Generating and assessing evidence for nursing practice. Lippincott Williams & Wilkins. Romano, P. S., & Mark, D. H. (1994). Bias in the coding of hospital discharge data and its implications for quality assessment. Medical Care, 32(1), 81–90. Sales, A., Sharp, N., Li, Y. F., Lowy, E., Greiner, G., Liu, C. F., Alt-White, A., et al. (2008). The association between nursing factors and patient mortality in the Veterans Health Administration: The view from the nursing unit level. Medical care, 46(9), 938. Savitz, L. A., Jones, C. B., & Bernard, S. (2005). Quality indicators sensitive to nurse staffing in acute care settings. DTIC Document. Savitz, L. A., Jones, C. B., & Bernard, S. (n.d.). Quality indicators sensitive to nurse staffing in acute care settings. Sherman, R., & Pross, E. (2010). Growing future nurse leaders to build and sustain healthy work environments at the unit level. OJIN: The Online Journal of Issues in Nursing, 15(1). Shobbrook, P., & Fenton, K. (2002). A strategy for improving nurse retention and recruitment levels. Professional nurse (London, England), 17(9), 534. US Department of Veterans Affairs. (1998, December 18). VA Commits $50 Million to New National Nursing Initiative - Public and Intergovernmental Affairs. Retrieved March 28, 2012, from Van den Heede, K., Lesaffre, E., Diya, L., Vleugels, A., Clarke, S. P., Aiken, L. H., & Sermeus, W. (2009). The relationship between inpatient cardiac surgery mortality and nurse numbers and educational level: analysis of administrative data. International journal of nursing studies, 46(6), 796–803.