Barbara Zittel, RN, Ph.D. LEGISLATING ACADEMIC PROGRESSION The ‘BSN in 10’ Initiative in New York

NYSED Nursing Survey

Trends in Nursing Education

Each year, out of 100 RNs seeking NYS licensure, 62 are Associate and 38 are Baccalaureate Graduates

Graduates from basic nurse baccalaureate programs are over 3 times more likely to obtain graduate degrees Initial BSN Graduates Initial ADN Graduates Adapted from: Aiken, Cheung, Olds Health Affairs 28(4)

Average Age of RNs Working in New York State Age

Survey Data 10% of NYS RN workforce is 60 years or older. This group represents almost 27% of all RNs with doctoral degrees

RESEARCH FINDINGS Multiple Researchers have demonstrated a significant relationship between nursing education and improved patient outcomes

As Nurse Education Increases, Patient Mortality Decreases. As Nurse Education Increases, Patient Mortality Decreases. Deaths per 1000 patients with complications Education (Percentage of hospital nurses with BS degrees.) 232,342 patients from 168 PA non-federal adult general hospitals. Aiken, 2003, JAMA 90 deaths in 1,000 patients 84 deaths in 1,000 patients 76 deaths in 1,000 patients

Hospitals with a higher proportion of BSN RNs experienced lower rates of 30-day patient mortality Replication of Aiken study in 18,142 patients in 49 hospitals in Alberta, Canada with identical results Estabrooks, et al. (2005)

Study of 46, 993 patients Demonstrated 9 fewer deaths per 1,000 discharges for every 10% increase in BS prepared nurses Tourangeau (2007)

Longitudinal study of 21 US hospitals over 84 quarters In hospitals with a higher proportion of BS educated nurses: –Lower rates of CHF mortality –Fewer Hospital Acquired Pressure Ulcers –Lower Rates of Failure to Rescue –Shorter Hospitalizations Blegen & Goode (2009)

Kendall-Gallagher, Aiken, Sloane & Cimiotti (2011) Specialty certification was associated with better patient outcomes, BUT Such outcomes were associated only when care was provided by nurses with baccalaureate level education. The authors conclude that “…no effect of specialization was seen in the absence of baccalaureate education.”

Aiken (February 26, 2014) A large-scale study conducted in nine European countries… An increase in a nurse’s workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7% Every 10% increase in BS prepared nurses was associated with a decrease in this likelihood by 7%

Changes in the Health Care Environment *Advances in science *Increasingly diverse population *Shorter length of stays…. have resulted in increased patient complexity which has accelerated the need for nurses with better skills and knowledge to manage a challenging and increasingly diverse healthcare environment.

Philippines: BSN Required Since 1988 Australia: BSN Required Since 1992 Canada: New RNs must be BS prepared European Union: BS required Transformation of Nursing Education Thailand: BS required Turkey: BSN required since 1997

RN Athletic Training Diploma/ Associate BS Master’sDoctorate Midwifery Nurse Practitioner Occupational Therapy Speech Lang. Path. Audiology Lic. Clin. Soc. W. Lic. Masters Soc. W. Lic. Mental Hlth Couns. Physical Therapist Medicine Dentistry Podiatry Psychology Pharmacy Minimum Entry-Level Education Requirements for Select Licensed Health Professions

National Advisory Council on Nursing Education and Practice in 2001 and 2009 recommended 66.6% of workforce be baccalaureate prepared nurses

2010 Carnegie Foundation report Educating Nurses: A Call for Radical Transformation (Patricia Benner, et al.) calls for the BS degree in nursing for licensure

2008-RWJF-IOM Collaboration Chaired by former Department of Health and Human Services Secretary Donna Shalala Release of the Report

October 2010 Report Recommends that 80% of RNs be prepared with the BS degree by 2020.

Question 1. The “BS in 10” proposal would close associate degree programs. 1.True 2.False

Question 2. The “BS in 10” proposal would require every currently licensed RN to obtain a BS degree within 10 years after the bill is passed into law. 1.True 2.False

PROPOSAL Opportunity for an extension beyond 10 years, for extenuating circumstances, as determined by the Department. Grand-parenting of all currently licensed (RNs); Time to permit all students on a waiting list or enrolled in associate or diploma programs to complete their studies and be grand-parented Provisions that would place a Registered Nurse’s license on “hold” if the baccalaureate degree is not obtained in 10 years.

Perceived Problems/Concerns STATEMENTRESPONSE If I get my BS, I will be removed from bedside nursing. I’m content at what I’m doing why should I go on to the BS degree? I’m just as good as any BS prepared nurse!

Current Status of the Board’s Motion Assembly Bill # 3945; Morelle Senate Bill # 2145; Flanagan NYONEL takes Lead in Seeking Legislative Support

NYS 2015Assembly overwhelmingly voted in favor of this bill ; out of 140, 127 voted Y, 8 N, 5 were excused excused. reasons (ER), one was absent (AB) and 8 voted against (NO)

The Plight of New Graduates

Many hospitals are responding to research and Magnet expectations by requiring their nursing staff to hold the BS in Nursing degree.

RNs are hired without BS but must complete it in a # of years to stay employed RNs with an AS degree are not hired BS prepared RNs are preferentially hired Only RNs with BS degrees are hired Only RNs with 1 year of experience are hired Only RNs are hired, not new graduates RN Hiring Practices of NY Hospitals

BS is required for management positions BS is included in site’s career ladder New hires must advance to BS All RNs must obtain a BS in Nursing degree Managers without BS with lose their position Tuition assistance is available for BS study Tuition assistance is available for MS+ study Flexible hours for RNs pursuing BS Higher pay for RNs with BS degree On-site classes for BS degree attainment Other Employer Incentives to Encourage RNs to Obtain the BS in Nursing

*Project 6,000 fewer surgical deaths annually when 60% of nurses are prepared at the BS level. *Project a 10% reduction in the 200,000 hospital acquired pressure ulcers each year. The published additional length of stay from hospital acquired pressure ulcers is 3.98 days, thus the potential savings is 17.5 million dollars annually. *Higher number of BS prepared nurses results in less turnover. Every 1% reduction in RN turnover saves $12.9 million, statewide.. Benefits to New York

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New Models of Nursing Education Are Needed

Oregon Model RN to MS Programs Encouragement of RN applicants to pursue the BS as the initial degree. …and others??? SUNY CUNY Private Colleges