Nurse Manager Education Level

1. Nurse Manager Education Level Pilot Study Proposal Jerusalem Walker, BA, RN, BSN

2. 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

3. 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

4. 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

5. 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”

6. 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

7. 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.” http://www.allnursingschools.com/nursing-careers/nursing-continuing-education/nursing-continuing-education

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

9. 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 • OUTCOME VARIABLES • Falls prevalence • Restraint prevalence • Voluntary turnover • MODIFYING FACTORS • Nursing hours per patient day • Skill mix DETERMINANTS OF NURSING CARE OUTCOMES

10. 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), 1047. • 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:10.1001/jama.290.12.1617 • ANCC Magnet Recognition Program. (n.d.). Retrieved February 15, 2012, from http://www.nursecredentialing.org/Magnet.aspx • 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.

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