As more hospitals seek the American Nurses Credentialing Centers coveted Magnet recognition, a recent but quiet trend has been slowly making its way into the nursing world: hospitals are requiring their nurses to either return to school for their bachelors degrees or have a BSN before applying.
Hospitals are not waiting for the outcome of the highly publicized BSN in 10 bills S4051/A2079B in New York and S620 (nee S2529)/A3768 in New Jersey that are still awaiting closure in both legislatures, it seems, and are taking it upon themselves to get the ball rolling.
This July, Long Island, N.Y.s North Shore-LIJ Health System shattered the silence by announcing its BSN in 5 plan. Newly hired RNs would be required to possess a BSN degree or enroll in a BSN program within 24 months of their date of hire and obtain one within five years.
As patient care becomes more complex and high tech, there is growing evidence that developing a more highly educated nursing workforce improves patient safety and leads to higher-quality, more cost-effective patient care, said Michael Dowling, North Shore-LIJs president and CEO, in the health systems news release announcing the requirement. According to Dowling, the new requirement is based on research that shows a significant relationship between higher levels of nursing education and improved quality outcomes, lower mortality and fewer adverse events.
Although the formal requirement is new, the quest to have North Shore-LIJs professional nursing staff be baccalaureate-prepared is not.
The NSLIJ Health System has been looking at educational requirements for registered nurses for more than a decade, says Maureen T. White, RN, MBA, NEA-BC, the health systems senior vice president and chief nurse executive. Similar to Dowlings thoughts, White says the complex health needs of todays patients contributed to the health systems decision to put a formal mandate in place.
The catalyst for us to make this change at this time had to do with the changing demographics of our patient population, the increasing complexity of their healthcare needs and the studies done by Linda Aiken and others which showed higher educational preparation of the registered nursing staff at the bedside translated into decreased mortality, improved quality outcomes and reduced adverse events, White says. This was truly a decision based on the current and future needs of our patients and our commitment to delivering the highest quality of care possible.
Like North Shore-LIJ, administration at Hudson Valley Hospital Center in Cortlandt Manor, N.Y., always has stressed the need for higher education for its nurses. Although its currently employed nurses are not mandated to have a bachelors, it does require any nurse who is hired into its graduate program to possess a BSN degree.
Our education director notes that she has seen distinct differences in the critical thinking skills between new AD grads and BSN grads, says Kathy Webster, RN, MSN, NEA-BC, vice president of patient services. This was the rationale for requiring new grads to have a BSN.
Meridian Health, a multihospital health system in New Jersey, does not require those who apply for employment to have a BSN degree. However, according to Richard Hader, RN, PhD, FAAN, senior vice president and CNO, they are receiving priority in hiring, particularly with new graduates.
Someone Has to Pay
Whether hospitals are requiring their nurses to get a BSN or simply encouraging them, nurses must have to want it and be able to afford it. Monetary and time-off incentives are crucial when a nurse goes back to school. As such, all three facilities provide tuition reimbursement for their nurses. At Hudson Valley Hospital Center, Webster says a nurse can receive up to $5,000 in reimbursement for tuition expenses annually. According to White, North Shore-LIJs reimbursement policy applies to current and new employees.
Hader says Meridian Health also provides reimbursement to nurses. We also give out about $250,000 per year in nursing scholarships, he says. Meridian and Hudson Valley also provide $1 per hour differential to nurses who have a BSN degree.
Giving nurses the time off they need also is a major consideration when requiring or encouraging nurses to further their education. Managers make special scheduling arrangements with staff in school, Webster says. Nurses may request specific days off to accommodate a class schedule, and managers make all attempts to do this.
At Meridian Health, supervisors try to make every effort to arrange schedules according to whats best for the employee, Hader says. Most of the nurses are on 12-hour shifts so it can be easily accommodated.
At North Shore-LIJ, the only facility requiring its nurses to go back, White doesnt foresee any problems with the new mandate. We always try to accommodate the needs of our employees for a variety of reasons, and we expect to continue this practice, she says.
Education and Better Patient Care
Proponents of the BSN in 10 bills note that nursing is essentially taking a backseat to other health professions by not requiring a bachelors degree as the minimal requirement for licensure. Nursing is the only healthcare profession that does not require the BS as the first professional degree, Webster says. Pharmacists, for example, have recently required the doctorate as a requirement for practice, and physical therapists are prepared at the masters level.
Education can only improve the quality of the care, Hader says. All nurse leaders should be encouraging their staff to attain a minimum of a BSN. It is necessary for the profession as well as for the quality of care provided.
As more hospitals seek Magnet status, a staff of nurses who have at least a BSN degree is something that is coveted and may even quicken the route to making the bachelors degree the minimum for licensure. However, its about much more than that, Webster says.
Research has demonstrated that in hospitals with higher proportions of nurses educated at the baccalaureate level or higher, surgical patients experienced lower mortality and failure-to-rescue rates, she says. Death rates were nearly twice as high at hospitals where less than 10% of nurses had bachelors degrees as they were at hospitals where over 70% did.
North Shore-LIJs White says quality care is why the health system chose to make the BSN the minimum educational degree for its nurses. Basically, she says, we thought it was the right thing to do for our patients.