The Robert Wood Johnson Foundation and Institute of Medicines report The Future of Nursing: Leading Change, Advancing Health calls for 80% of nurses to hold baccalaureate degrees by 2020, but is this goal attainable? Across the country, that answer varies, but the push to bring the numbers upward is happening in individual states.
The RWJF and IOM report recommended increasing the proportion of nurses with bachelors degrees from the current national average of 50% to 80%. Commonly referred to as Recommendation No. 4, it also calls for accrediting bodies, employers and private and public funding sources to plan to meet this goal.
With the onset of healthcare reform, the calls to action aim to prepare nurses to meet the challenges of the rapidly changing healthcare system and ensure safer care for patients.
Spurred by the IOMs recommendation, action coalitions have been formed in nearly 40 states. The coalitions are considered the driving forces to make the IOM recommendations a reality at local, state and regional levels.
Action coalitions gained credibility and strength after key organizations like the American Organization of Nurse Executives and the American Association of Colleges of Nursing backed the IOM goals and linked nursing leaders with leaders outside the industry to work on strategies.
Although the IOM goal is viewed on a national scale, states are implementing strategies to increase BSN nurses, as well as track progress. Some states will meet that 80% goal by 2020, based on the schools available, the relationships between those schools and how far they are now, said Larry Strassner, RN, PhD, NEA-BC, a member of the Maryland Regional Action Coalition and president of the Maryland Organization of Nurse Executives. I think other states will struggle and not hit it.
Strategies that work
Strassner also is vice president for patient care and CNO at Franklin Square Hospital Center in Baltimore, which is perhaps ahead of the curve for BSNs at the bedside. Seven years ago, 9% of nurses had BSNs and that has increased to 50% today. Strassner attributes that jump to serious support for professional development and selective hiring. Within the last year, the center is bringing on board primarily BSNs; but any RNs hired with associate degrees must commit to begin a BSN program within 12 to 18 months. Franklin Square also is diligent about offering financial support.
In addition, Strassner added a masters-educated nurse to the team as a professional development coordinator to ensure BSN and MSN candidates are successful via coaching and tutoring.
Nurse leaders say community colleges are critical to meeting IOM goals because they must encourage two-year graduates to continue straight through school and earn BSNs. Texas answer to this is dual-enrollment programs in which students enroll in a community college and a university at the same time. Different than an articulation agreement, a dual-enrollment program is a pathway program that allows students to complete their associates degree and move on to the university to complete their baccalaureate, provided they meet requirements.
Students have privileges at the university while they are studying for their two-year degree, which allow them to acclimate to the university early.
Alexia Green, RN, PhD, FAAN, co-leader of Texas Action Coalition, says 48% of the states RNs are licensed at baccalaureate or higher levels. She adds that Texas has healthy BSN numbers because of longstanding cooperation between schools and the state to lower the price of a nursing degree through online courses and financial assistance.
For instance, the cost for an online BSN degree at an accredited four-year university can be as little as $5,000 to $7,000 and the nursing portion of the degree can be finished in two semesters if candidates have fulfilled prerequisites.
An ongoing effort also aims to streamline nursing education requirements in schools throughout the state so candidates dont lose time getting their BSN because of differing requirements at schools across the state. Do I think we can achieve the IOM goal? Absolutely, Green said.
Online options vital
States like Wyoming with a limited number of nursing schools and vast miles in between, count on online education. The University of Wyoming, the states only university, has a successful RN-to-BSN program in which students never have to set foot on campus. The state has six community colleges, all of which strongly advocate baccalaureate degrees.
Mary Burman, APRN, BC, PhD, FAANP, co-leader for Wyomings Action Coalition and dean of the Fay W. Whitney School of Nursing at the university, said about 30% of RNs in the state have BSNs or higher and 70% have two-year degrees. She adds that, given those numbers, the state will not reach the 80% IOM goal by 2020.
There is just no way we are going to be able to turn the ship that quickly, but we are taking this goal very seriously, she said.
Accordingly, Wyoming just received funding over three years from the RWJF Partners Investing in Nursings Future for the initiative REvolutionizing Nursing Education in Wyoming. Through RENEW, nurse leaders will establish a common curricula between two- and four-year schools and improve the tracking system to monitor students progress toward BSN. The ability to do so makes intervention possible with students who may be having trouble.
The states action coalition will partner with community colleges to ensure representatives are on site to advise and teach RN-to-BSN programs. Some faculty may come from the university so students can experience baccalaureate-level instructors in person before they formally start BSN studies.
Economy, needs dictate BSN goals
Magnet hospitals must fulfill their commitments to cultivate BSNs. However, in the current economy, non-Magnet hospitals may be less likely to grow BSNs. For those that have identified it as a goal, they are offering some incentives, said Mary Lou Brunell, RN, MSN, co-leader of the Florida Action Coalition. But if its not a goal for the facility, I dont know that we are seeing that much incentive because right now its an employers market.
She adds that if the economy turns around and BSNs no longer get preferential treatment, more two-year-degreed RNs probably will enter the workforce. Compared to other states, Floridas varied mix of hospitals, skilled nursing facilities, public health and community health systems have disparate needs for nurses at different skill levels. A substantial number of facilities have not made increasing the number of baccalaureate nurses a goal, according to Brunell.
But online learning and dual-enrollment programs have increased the number of BSNs, Brunell said. Approved community colleges can award BSN degrees, and nearly half of the states community colleges are doing so in order to accelerate BSNs. However, it would be next to impossible for the states education system to turn out the 129,000 baccalaureate graduates needed to make the IOM goal by 2020 when it currently sits at 30.2%.
I just dont think its realistic, she said. I think that maybe a national average of 80% is realistic.