deb zimmermann, rn, ms, nea-bc. advances in science and increasing patient complexity have...
TRANSCRIPT
Deb Zimmermann, RN, MS, NEA-BC
Advances in science and increasing patient complexity have accelerated the need for nurses with better skills and knowledge to manage a challenging and increasingly diverse healthcare environment.
Researchers have demonstrated a significant relationship between higher levels of nursing education and improved patient outcomes (Aiken, Clark, Cheung, Sloane, and Silber, 2003, 2008; Estabrooks, Midozi, Cummings, Ricker, & Giovannetti, 2005; and Tourangeau et al., 2006, Blegen &Goode, 2009).
In 2008, 32 state and national nursing organizations recommended advancing education standards so nurses are well prepared for the future.
Research and Nurse Surveys Support ChangeResearch and Nurse Surveys Support Change As Nurse Education Increases, Patient Mortality DecreasesAs Nurse Education Increases, Patient Mortality Decreases
Education (Percentage of hospital nurses with BS degrees.)
Aiken (2003) JAMA
Dea
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per
100
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omp
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90 deaths
in 1,000
patients84
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
OR 0.81 [95%CI (0.68 - 0.96]
Estabrooks, et al. (2005).
Study of 46, 993 patients Demonstrated 9 fewer deaths per 1000
discharges for every 10% increase in BS prepared nurses
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
5,000 RNs: 47% BSN 53% AD 20% received tuition assistance 40% planned to go back to school Twice as likely to remain in job with tuition assistance BS prepared RNs reported higher job satisfaction and
lower job stress BS prepared nurses more than ten years tenure
McGinnis S & Martiniano R. (2008), Estabrooks (2005), Ingersoll (2001)
47% BSN 53% AD 20% received tuition assistance 40% planned to go back to school Twice as likely to remain in job with tuition assistance BS prepared RNs reported higher job satisfaction and
lower job stress BS prepared nurses more than ten years tenure
McGinnis S & Martiniano R. (2008), Estabrooks (2005), Ingersoll (2001)
Much Like Vaccination,
there when you need it
Antecedent Factors
StaffingHPPD
Skill mix
Patient FactorsAgeCMI
DiagnosisCo-morbidity
Nurse CharacteristicsEducation
Age/ ExperienceDiversity
CommunitySONs
Laws/RegulationsEconomyPayers
Healthcare Organization
SizeVolume
SpecialtiesTechnology
Finance Margin
Nurse OutcomesSatisfaction
Years of ServiceTurnoverVacancy
Advancement
Medical staffHospitalistsIntensivists
Cultural BackgroundResidents Patient
OutcomesMorbidity/MortalityPatient Satisfaction
Nurse Sensitive Indicators
Length of Stay
Organizational CulturePolicies/ Benefits
EBP/ResearchGovernance
Leadership/CommunicationCultural Competence
Values and Theoretical Framework
Model of Care Delivery
Causal Factors Moderating Factors
Mediating Mechanisms
Impact
2004 2005 2006 2007 2008
10,582 11,576 13,609 13,456 14,496
New Licenses Issued
266,029 Registered Nurses in NYS
Year 2004 2005 2006 2007 2008
Vacancy 10.1 8.3% 6.3% 8.8% 7.1%
Turnover 15.2 9.7 13.2% 13.% 10.1%
RN Vacancy and Turnover
New York State Dept of Education ( 2009), Healthcare Association New York (2009)
Capacity Graduates
47 RN to BSN Programs in NYS
In a June 2009 survey. NYS Deans reported immediate capacity for 5000 RN to BSN students
NYS Graduates4800 AD3200 BSN8000 AnnuallyOnly 20% go on for BSN
Graduates take NCLEX-RN licensing exam. Tests for minimum technical competency (NCSB,2006)
The average RN salary is $73,000, in rural areas $58,000 (U.S.Department of Labor, 2008)
In Canada, the EU, and Australia enrollment rose after education standards were increased to BSN (Reuters, 2009)
Age of nurses in Canada similar to NYS (Tourangeau, 2009)
The Plan: Provide seamless transition from AD to BSN
programs Reduce financial barriers for baccalaureate
education Increase the number of nursing faculty Standardize education requirements
Provide seamless transition from AD to BSN◦ Standardize admission criteria and application procedures
◦ Endorse common pre-requisites
◦ Develop standard competencies
◦ Concurrently admit students to AD and BSN programs
Reduce financial barriers for BSN education
◦ Establish a statewide endowment for nursing scholarships
◦ Require a year of service for every year of education funded
Increase the number of nursing faculty◦ Establish nursing faculty scholarships through the endowment
◦ Require recipients to complete a service contract at a New York institution of higher education
Standardize education requirements◦ Standardize education requirements through the passage of Bills
A2079B/S4051
◦ This legislation would require acquisition of a baccalaureate degree in nursing within ten years of initial licensure
The IOM found RNs are the profession to intercept medical errors which cost 3.5 billion dollars a year
RNs prevent hospital acquired pneumonia which increase hospital costs 84%
Cost of RN turnover equivalent to a year of RN salary
Medical errors kill more people than breast cancer, AIDs and MVA’s combined
Hassmiller(2009), Institute of Medicine(2004), Jones(2005)
Service Excellence
> Care environment> Collaboration and communication
Quality
6000 fewer surgical deaths annually< Congestive Heart Failure mortality< Hospital acquired pressure ulcers
Financial
< 10% in HAPUs saves $17. 5 million< LOS of .2 days provides capacity for 400,000 patient days< 1% RN turnover saves 12.9 million
Workforce
> Graduation of 8000 RNs annually> RN length of service> Nurse satisfaction> Competency in evidence-based practice, critical synthesis, gerontology> Competency in management of complex patients< Faculty vacancy
Aiken, 2003; Blegen, 2009; Rambur 2005; Tanner,2007; Unruh, 2008)
Statewide meetings between nursing leaders and CEO’s
Implementation of Oregon Model in NYS Continuation of dialogue with legislators Pursue regulatory change vs. legislation Engage national leaders Engage other states Recognize the need for resiliency
Philippines:BSN RequiredSince 1988
Australia:BSN RequiredSince 1992
Canada:New RNs must be BS prepared
European Union:BS required
In Canada, enrollment rose after education standards were increased to the BS level. The average age of an RN in Canada is similar to the United States.
Transformation of Nursing Education
Thailand: BS required