More Nurses Seeking BSN Degrees

A greater emphasis on quality of care and public policy recommendations are contributing to a rise in the number of registered nurses seeking baccalaureate degrees. Hospital leaders can help knock the barriers out of the way.

A half-century ago, the American Nurses Association issued its 1965 position paper advocating for the baccalaureate degree as the minimum standard of education preparation for professional registered nurses. Fifty years later, there's still no consensus that the BSN has become the entry level degree for RNs.

Yet, while no mandate on BSN-preparedness has ever been made, the number of RNs going on to pursue baccalaureate degrees is on the rise.

Carole Stacy, RN, MSN, program director for nursing at Lansing Community College in Lansing, MI, and Mary Lou Wesley, RN, MSN, senior vice president for care services and chief nursing officer at Sparrow Health System in Lansing, MI attribute the shift to factors such as employer preference, greater emphasis on quality outcomes, Magnet designation criteria, and recommendations from the Institute of Medicine.

Two BSN-preparedness Drivers
The nursing profession currently holds a mixed bag of degrees, according to HRSA's 2013 report, "Nursing Workforce Trends in Supply and Education:"

• 6.9% have an RN diploma
• 37.9% have an ADN
• 44.6% have a BSN
• 10.6% have graduate-level degrees

Data from the American Association of Colleges of Nursing's fall 2014 survey of baccalaureate and graduate nursing programs, however, shows a 10.4% increase in enrollment in RN-to-BSN programs, which marks the twelfth year of enrollment increases. "The two forces that really brought [BSN-preparedness] to the forefront were the Magnet designation and then the IOM report," says Stacy.

Magnet Designation is Meaningful, but Not Magical

In 2010 the IOM, in partnership with the Robert Wood Johnson Foundation, issued a landmark report recommending that 80% of RNs be prepared with BSNs by the year 2020. The American Nurses Credentialing Center piggybacked on those recommendations, and in 2013 began requiring that hospitals seeking the ANCC's Magnet designation provide action plans for achieving a nursing workforce made up of 80% BSN-prepared RNs within their organizations.

"It's always a goal with a Magnet organization to increase your percentage of BSN nurses," Wesley says.

Magnet recognition aside—Sparrow achieved Magnet designation in 2009 and again in 2014—Wesley is a proponent of BSN-prepared nurses.

Her affinity for them is not just based on personal preference, but rather on years of available research and data on how nurses' levels of education affect patient outcomes. This research—most notably that of University of Pennsylvania nurse researcher Linda Aiken, PhD, RN, FAAN, FRCN—is another reason BSN preparation is becoming increasingly sought by nurses and employers.

"There are very compelling studies out there that go right down to the individual nurse level and are able to demonstrate huge decreases in mortality if 85% of your care was provided by a BSN-prepared nurse," Wesley says. "There's significant improvement in length of stay, decrease in serious safety events, better adherence to quality and safety initiatives and core measures when you have the majority of your care provided by a bachelor's-prepared nurse."

As we know, patient outcomes are of utmost importance in today's healthcare environment and employers expect that BSN-prepared RNs will provide the quality nursing care to needed to achieve them.

Millions Invested in Nursing Education
Despite the research that demonstrates improved patient outcomes when care is provided by BSN-prepared nurses, many RNs list loss of income, cost of tuition, time, or family commitments as barriers to furthering their education.

Currently, Sparrow's RN workforce is made up of 47% BSN nurses and Wesley says there are plans to increase that to 80% as recommended by the IOM, RWJF, and the ANCC Magnet program.
Sparrow has taken steps including financial assistance, professional support, and organizational recognition to make this happen.

"We still hire associate degree nurses and we love our associate degree nurses," Wesley says. "But we've just put into place a requirement that as we hire associate degree nurses they sign a compact with us that says that they will complete their BSN within four years."

In exchange for the RNs' commitment to continue their education, Sparrow funds 100% of the tuition dollars for BSN completion.

Wesley has established an environment that is supportive of nurses who return to school. This includes providing flexible schedules, assistance finding mentors, and leadership rounds that include recognizing RNs who are going to school or who have completed their BSNs.

"It becomes something the whole organization gets its arms around and knows why we're supporting it," Wesley says of this approach. "We wouldn't be investing in our ADN nurses if we didn't believe they were the best nurses we could have. This is millions of dollars of investment."

Simplifying the Pursuit
Having education partners like Lansing Community College is critical to developing a majority BSN workforce, says Wesley. In addition to the barriers mentioned above, nursing school capacity can also be a roadblock to a baccalaureate education. Stacy says that the University of Michigan takes only 50 students once or twice a year while LCC takes 160.

"We always know the day Michigan State posts who got into their regular, traditional program or their accelerated program," Stacy says, "Our phones ring off the hook because we're the next game in town."

LCC has an agreement with Michigan State University for concurrent enrollment. When students are accepted into the LCC program, they may also enroll in MSU's BSN completion program. LCC students may take BSN-completion classes during the summers between ADN semesters. "If they do everything right," Stacy says, "when they finish with their associate's degree, they really just have the five cognate courses left for their BSN."

Wesley advises CNOs who want to boost the number of BSN-prepared nurses at their respective organizations to develop partnership with education providers and then put together a compelling case to convince the executive team that the initiative needs to be supported.

"I feel like it's a moral imperative because the data is so strong," Wesley says. "For us to ignore that, I think is not being good providers of patient care."