The Impact of Nursing Education on Patient Outcomes: A Call for Increased Bachelor's Degree Preparation

1. BSN in 10-What Every Nurse Needs to Know Barbara Zittel, RN, Ph.D.

2. 100% Diploma Associate's 80% Bachelor's/Master's 60% 40% 20% 0% Before 1960 1960s 197 0s 1980s 1990s 2000s Trends in Nursing Education

3. Each year, out of 100 RNs seekingNYS licensure, 62 are Associate and 38 are Baccalaureate Graduates

4. 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. 2009. Health Affairs 28(4)

5. RESEARCHFINDINGS Multiple Researchers have demonstrated a significant relationship between nursing education and improved patient outcomes

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

7. NYS Thirty Day Surgical Mortality Preventable with each 10% Increase in BS Prepared Nurses NYS 30 day mortality surgical discharges Percentage of Decreased Deaths with each 10% increase in BS Prepared Nurses

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

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

10. Blegen & Goode (2009) • 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

11. Changes in the Health Care Environment *Advances in science *Increasingly diverse population *Care over continuum - medical homes *Value Based Purchasing – paying for outcomes These factors have resulted in increased patient complexity, accelerating the need for nurses with broader skills and knowledge to manage & coordinate care of more diverse and challenging populations across all settings.

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

13. Minimum Entry-Level Education Requirements for Select Licensed Health Professions 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 Athletic Training RN Diploma/Associate Master’s Doctorate BS

14. 2010 Carnegie Foundation report Educating Nurses: A Call for Radical Transformation (Patricia Benner, et al.) calls for the BS degree in nursing for licensure

15. 2008-RWJF-IOM Collaboration Chaired by former Department of Health and Human Services Secretary Donna Shalala 2010-Release of the Report

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

17. Question 4. • The “BS in 10” proposal would close associate degree programs because every RN would need to obtain a BS degree after the bill is passed into law. • True • False

18. Question 5. • 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. • True • False

19. PROPOSAL Would permit persons with a diploma or associate degree in nursing, seeking future licensure, to obtain that licensure but, would require such applicants to obtain a BS degree in nursing 10 years after that initial licensure.

20. PROPOSAL 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 Opportunity for an extension beyond 10 years, for extenuating circumstances, as determined by the Department. Provisions that would place a Registered Nurse’s license on “hold” if the baccalaureate degree is not obtained in 10 years.

21. Current Status of the Board’s Motion NYONE takes Lead in Seeking Legislative Support Assembly Bill # ?? Sponsor?? Senate Bill # ?? Sponsor??

22. Benefits to New York *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. *With the reduction of the Length of Stay (LOS) by 0.2 days there is a potential capacity for 400,000 additional patient days. *Every 1% reduction in RN turnover saves $12.9 million statewide.

23. The Plight of New Graduates

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

25. Perceived Problems/Concerns