Bachelor Of Science In Nursing Degree Research Articles

Perceived Barriers and Strategies to Increasing the BSN-Prepared Nursing Workforce.

Care provided by Bachelor of Science in Nursing (BSN)-prepared Registered Nurses (RNs) has been shown to lead to more positive patient outcomes compared to care provided by non-BSN-prepared RNs. A Fall 2021 study explored barriers of requiring a BSN degree of staff nurses from the perspective of hospital and long-term care facility nurse leaders in Tennessee (N = 89), strategies to increase the number of nurses with BSNs, and association between leadership goals and the number of BSN-prepared nurses in the facilities. Seven barriers to requiring the BSN and nine strategies to increase BSNs were identified. Significant association was found between having plans to increase the number of BSN nurses and the percentage of nurses in the facility with BSN degrees.

Independent Practice as a Nursing Practitioner in Pakistan: “Opportunities and Misconceptions

Pakistan is the fifth most populous country in the world, third in Asia, and second among Muslim countries. According to World Bank data, the poverty rate was 39.3% in 2020–21 and is expected to remain at that level in 2021–22 [1]. The health care system of Pakistan includes public, private, and trust hospitals. The World Health Organization estimates that there are 7.8 doctors for every 10,000 people and 3.8 nurses and midwives for every 10,000 people [2]. The number of doctors and nurses is below the required level, and many health professionals travel to developed countries in search of a better future and professional development. In the past 5 years, the increasing number of nursing colleges in the country indicates satisfaction for the healthcare industry to overcome the deficiencies. A nurse practitioner is a specialized program of nursing practice that performs independent practice within certain limits [3]. Nursing practitioner (NP) practices were first authorized in 1960 due to a physician shortage, and in Pakistan, only Aga Khan University hospitals have begun a two-year advanced practice nursing program.  The concept of health and practices in developing countries were influenced by the United States, where 26 states have fully authorized nurse practitioners and 24 states require nurse practitioners to work under the supervision of physicians. In order to task-share with physicians in the UK, mid-level practitioners (MLPs), such as physician associates (PAs) and advanced nurse practitioners (ANPs) have been employed [4]. In a developing country like Pakistan, the national assembly makes an amendment to the Pakistan Nursing Council Act, 1973, in Section 2(m) that provides an opportunity for nursing practitioners to practice independently. On one side, the news has a feeling of motivation and happiness among the nurses; instead of welcoming such a revolutionary act, unfortunately, the other health professionals have seriously criticized this act and considered this amendment "legal cover for the quacks". A misconception is created through social media that every nurse has given the status of (NP) “Nursing practitioner”, while the amendment is very clear regarding the independent practice of nursing practitioners: they have a two-year degree in (MSN) Master of Science in nursing specialized in nursing practitioner, with a valid license from (PN&MC) Pakistan Nursing and Midwifery Council for independent practice. To provide care and practice in hospitals, nurses require a license from PN&MC, which requires a minimum qualification of a 4-year BSN (Bachelor of Science in Nursing) degree with one year of internship from a tertiary care hospital or teaching hospital. During hiring in health departments, nurses have a 4-year degree and a 1-year internship and are hired in 16 grades. They have the same qualifications as other health care professionals who have a 4-year degree and a 1-year house job and are hired in 17 grades. In the majority of health universities, nursing and other health degrees are completed under the umbrella of one administration and examination department, and each profession has its own curriculum and goals, while they also perform their clinical in the same affiliated hospitals, so how does this professional discrimination occur that one profession is superior and the other is inferior? Since independence, the majority of the nurses have been hired and retired in the same grade without promotion from government hospitals and face this professional grading discrimination. In the clinical setting, nurses work and provide care to patient’s shoulder-to-shoulder with other professionals from entry to discharge; moreover, they travel and work in the Middle East and developed countries. So how can a nurse care for and work in developed countries? It is very important to accept the existence and importance of each profession and to use our advocacy and time for patient outcomes instead of wasting energy criticizing other professions. In the last 10 years, a boom in the nursing profession has seemed to be a result of the importance of nursing at the international and national levels, which has attracted the attention of students as well as their parents towards nursing. These efforts came as a result of the active participation of nursing associations in all provinces and the sincere efforts and struggles of the regulatory authorities, but still, many steps are incomplete and require immediate attention. In the future, nursing will be among the top professionals who work overseas and become an asset to the country in their contribution to development. The authorities should permit nurses practitioners to practice independently under the supervision of the Pakistan Nursing Council and a special task force in a limited area while taking help from international organizations or nursing regulatory bodies. Currently, the world is facing a shortage of not only nurses but all healthcare workers, which does not mean restricting the nursing profession from moving forward but should increase the capacity of nursing production under the theme of "no compromise on the quality of education and clinical practice." Pakistan has a good tendency to increase the capacity of nursing professionals and can be a good contributor to the country's finances. 

Students\u2019 perspectives of factors related to delayed completion of online RN-BSN programs

BackgroundThere are multiple educational programs for individuals to become registered nurses (RNs), and the transition from an associate degree or diploma to a Bachelor of Science in Nursing (BSN) degree is vital to healthcare. This study examined the factors contributing to delayed completion or withdrawal from online RN-BSN nursing programs from students’ perspectives.MethodThematic content analyses were conducted on qualitative data obtained from semi-structured interviews (N = 26).ResultsComplex factors contributed to delayed completion of online RN-BSN programs, including student-, institutional-, and faculty-related factors.ConclusionThis study validated and extends previous studies without delineating students in fully online programs from hybrid and face-to-face programs. Students, faculty, and institutions all have a role to play in facilitating on-time program completion. Recognizing and mitigating the barriers that delay on-time program completion is required to foster nurses to obtain a BSN degree.

A National Survey of RN-to-BSN Programs: Are They Reaching Rural Students?

Increased representation of Bachelor of Science in Nursing (BSN)-prepared nurses improves health and reduces costs. Fewer rural U.S. nurses have BSN degrees compared with the national average. RN-to-BSN programs provide an opportunity to increase the number of BSN-prepared rural nurses. However, the number of these programs targeting rural students is unknown. Directors of RN-to-BSN programs were surveyed regarding program characteristics and efforts to target rural learners. Using mail and online return options, the response rate was 31.3%. Only 38% of programs targeted rural RNs for recruitment. Supports for rural student recruitment and retention, including partnerships with community colleges, rural clinical placements, and online offerings, were limited in number and/or scope. RN-to-BSN programs with the capacity to recruit and retain rural learners may help increase the number of BSN-prepared rural nurses. Increased collaboration among stakeholders will support rural nurses in continuing their education. [J Nurs Educ. 2020;59(10):557-565.].

Rural-urban differences in educational attainment among registered nurses: Implications for achieving an 80% BSN workforce.

Multiple professional organizations and institutes recommend the Bachelor of Science in Nursing (BSN) degree as a minimum standard for registered nurse practice. Achieving this standard may be particularly challenging in rural areas, which tend to be more economically disadvantaged and have fewer opportunities for higher educational attainment compared to urban areas. Our primary objective was to provide updated information on rural-urban differences in educational attainment. We also examined rural-urban differences in employment type, salary, and demographics among registered nurses in different practice settings. Data were obtained from the 2011-2015 American Community Survey (ACS) Public Use Microdata Sample (PUMS). The sample included registered nurses (RN) between the ages of 18-64years (n=34,104) from all 50 states. Chi-square tests, t-tests, and multivariable logistic regression were used to examine the relationship between rurality and BSN preparedness and salary across practice settings. Urban nurses were more likely to have a BSN degree than rural nurses (57.9% versus 46.1%, respectively; p<0.0001), and BSN preparedness varied by state. In adjusted analysis, factors in addition to residence associated with BSN preparation included age, race, and region of the country. Differences in wages were experienced by nurses across practice settings with urban nurses generally earning significantly higher salaries across practice settings (p<0.0001). Strategies to advance nursing workforce education are needed in rural areas and may contribute to improved care quality and health outcomes.

Lower Postsurgical Mortality for Individuals with Dementia with Better-Educated Hospital Workforce.

To investigate whether care in a hospital with more nurses holding at least a Bachelor of Science in Nursing (BSN) degree is associated with lower mortality for individuals with Alzheimer's disease and related dementias (ADRD) undergoing surgery ADRD. Cross-sectional data from 2006-07 Medicare claims were linked with the Multi-State Nursing Care and Patient Safety Survey of nurses in 4 states. Adult, nonfederal, acute care hospitals in California, Florida, New Jersey, and Pennsylvania (N=531). Medicare beneficiaries aged 65 and older with and without ADRD undergoing general, orthopedic, or vascular surgery (N=353,333; ADRD, n=46,163; no ADRD, n=307,170). Thirty-day mortality and failure to rescue (death after a complication). Controlling for hospital, procedure, and individual characteristics, each 10% increase in the proportion of BSN nurses was associated with 4% lower odds of death (odds ratio (OR)=0.96, 95% confidence interval (CI)=0.93-0.98) for individuals without ADRD, but 10% lower odds of death (OR=0.90, 95% CI=0.87-0.94) for those with ADRD. Each 10% increase in the proportion of nurses holding a BSN degree or higher was associated with 5% lower odds of failure to rescue (OR=0.95, 95% CI=0.92-0.98) for individuals without ADRD but 10% lower odds of failure to rescue (OR=0.90, 95% CI=0.87-0.94) for those with ADRD. Individuals undergoing surgery who have coexisting ADRD are more likely to die within 30 days of admission and die after a complication than those without ADRD. Having more BSN nurses in the hospital improves the odds of good outcomes for all individuals and has a much greater effect in individuals with ADRD.

The University of Wisconsin-Milwaukee Flexible Option for Bachelor of Science in Nursing Degree Completion.

The 2010 "Future of Nursing: Leading Change, Advancing Health" report from the Institute of Medicine recommended that 80% of registered nurses (RNs) obtain a bachelor of science in nursing (BSN) degree by 2020. Hospitals with BSN nurses have reduced morbidity and mortality. In 2014, the University of Wisconsin-Milwaukee and the University of Wisconsin-Extension launched the University of Wisconsin Flexible Option BSN (UW Flex BSN) as an additional model for BSN degree completion, adding to the in-person and online delivery models already being offered.In this article, the authors examine the decision to launch the UW Flex BSN program as a competency-based, time-variable approach to RN-to-BSN degree completion. They discuss the factors contributing to its success (including proactive, wraparound support for students through the use of academic success coaches and regular and substantive interaction with faculty), design and program elements and decisions, and continuing challenges that have yet to be resolved.UW Flex BSN is one version of direct-assessment, competency-based education, and it represents the first of its kind in a public institution for postlicensure BSN degree completion. The program meets all Higher Learning Commission standards and requirements and is grounded in the American Association of Colleges of Nursing Baccalaureate Essentials and program quality standards. The UW Flex BSN for degree completion is a successful example of a competency-based, time-variable education model that has been applied in a practice discipline.

The 2017 Environmental Scan

The past year was momentous for science and technology. In May, the White House Office of Science and Technology Policy announced meetings and an interagency workgroup to probe opportunities for the use of artificial intelligence (Felten, 2016, May 3Felten E. Preparing for the future of artificial intelligence. 2016, May 3https://www.whitehouse.gov/blog/2016/05/03/preparing-future-artificial-intelligenceGoogle Scholar). In October, the President hosted a landmark meeting, The White House Frontiers Conference (Holdren and Smith, 2016Holdren J. Smith M. President Obama to host White House Frontiers Conference in Pittsburgh, PA. 2016, Augusthttps://www.whitehouse.gov/blog/2016/08/30/president-obama-host-white-house-frontiers-conference-pittsburgh-paGoogle Scholar). Scientists, economists, and workforce planners were among the participants asked to envision the country in 50 years and to project how robotics, artificial intelligence, and other technological breakthroughs will influence health care, space travel, communities and cities, climate change, and poverty. Also part of the White House initiative were two landmark reports: Preparing for the Future of Artificial Intelligence, from the Executive Office of the President, National Science and Technology Council Committee on Technology, 2016Executive Office of the President, National Science and Technology Council Committee on Technology Preparing for the future of artificial intelligence. 2016, Octoberhttps://www.whitehouse.gov/sites/default/files/whitehouse_files/microsites/ostp/NSTC/preparing_for_the_future_of_ai.pdfGoogle Scholar and a companion document, The National Artificial Intelligence Research and Development Strategic Plan (National Science and Technology Council, Networking and Information Technology Research and Development Subcommittee, 2016National Science and Technology Council, Networking and Information Technology Research and Development Subcommittee The national artificial intelligence research and development strategic plan. 2016, Octoberhttps://www.nitrd.gov/PUBS/national_ai_rd_strategic_plan.pdfGoogle Scholar). This White House agenda is a critical indicator of the rapidly developing innovations that will impact the nursing profession. Not only does nursing need to prepare for these changes, but nurses must be “the architects of change,” which was the theme of the National Council of State Boards of Nursing’s (NCSBN’s) 2016 Annual Meeting. In 2015, the United Nations published Transforming Our World: The 2030 Agenda for Sustainable Development, its 2030 agenda for sustainable development. To help regulators prepare for the future, NCSBN held a conference in October 2016, Regulation 2030, during which regulators and nursing leaders from around the world imagined the world in 2030 by addressing 25 emerging trends. The discussions resulted in concept maps that can be operationalized to accelerate progress and positive outcomes in nursing policy and regulation or can be used to manage risks and deter negative consequences. Immediately after Regulation 2030, NCSBN held the International Nurse Regulators Consortium, during which regulatory leaders from seven countries explored the evolution of concepts that inform public protection models. The keynote speaker, Dr. Daniel Susskind, highlighted essential themes from the book he recently coauthored, The Future of the Professions: How Technology will Transform the Work of Human Experts (2015), and led a discussion on how the work of professionals will change as machines become increasingly capable of doing that work, as medical monitoring devices are increasingly worn or imbedded in people and used in homes, and as people rely more on information from collective and Web-accessible platforms (Susskind and Susskind, 2015Susskind R. Susskind D. The future of the professions: How technology will transform the work of human experts. Oxford University Press, USA, Cary, NC2015Google Scholar). Benjamin Franklin said, “By failing to prepare for the future, we prepare to fail.” The first step in preparing for the future is to be fully aware of the present and to comprehend its implications for the future. The 2017 NCSBN Environmental Scan discusses the current state of nursing, explores the milieu in which regulators are immersed, and investigates the rapidly evolving innovations in health care, technology, politics, and society. It also describes where regulators need to focus their attention to stay ahead of change and to ensure a future that is safer than today. A health care workforce does not consist of a well-defined set of roles, but changes over time in response to many factors. It is influenced by the form of government of the society, definitions of health, social values, costs, the society’s expectations for the health care system, and the political power of various players. Ada Jacob Cox, PhD, RN, FAAN (1997) Making accurate nursing workforce predictions beyond a few years requires knowing as much about emerging technology as knowing about data and trends. The process of making such predictions is complex and nuanced: one must look as far ahead as possible and determine if the economy and a multitude of other unpredictable factors will influence the data. In 2017, an additional question arises: will the profession be flexible enough to accommodate changes in personnel and staffing as well as the technology and innovation that are destined to influence the health care workforce of the future? NCSBN’s National Nursing Database tracks the number of U.S. licensed nurses from 55 boards of nursing (BONs) daily. The database does not include numbers from the Oklahoma, Hawaii, and Louisiana-PN BONs. As of September 2016, the database revealed 3,880,565 registered nurses (RNs) and 913,453 licensed practical nurses and licensed vocational nurses (LPN/VNs) in the United States (National Council of State Boards of Nursing, 2016aNational Council of State Boards of Nursing National Nursing Database: A profile of nursing licensure in the US. 2016https://www.ncsbn.org/national-nursing-database.htmGoogle Scholar). The most recent Occupational Employment Statistics data indicate that 2,687,310 RNs and 695,610 LPN/VNs were employed in the United States as of May 2015 (U.S. Bureau of Labor Statistics, 2016U.S. Bureau of Labor Statistics Occupational employment statistics. 2016http://www.bls.gov/oes/oes_emp.htmGoogle Scholar). These statistics show that 2015 had the largest number of employed nurses in more than a decade. However, as Figure 1 illustrates, the RN workforce has increased, and the LPN/VN workforce has decreased since 2012. The distribution of employed RNs varies substantially by state, as shown in Figure 2. California, Nevada, Utah, Oklahoma, and Georgia have the fewest RNs employed per capita: 600 to 700 nurses per every 100,000 people (U.S. Bureau of Labor Statistics, 2016U.S. Bureau of Labor Statistics Occupational employment statistics. 2016http://www.bls.gov/oes/oes_emp.htmGoogle Scholar; U.S. Census Bureau, 2016U.S. Census Bureau Annual estimates of the resident population for the United States, regions, states, and Puerto Rico: July 1, 2015. 2016http://www.census.gov/popest/data/index.htmlGoogle Scholar). Alaska, Hawaii, Colorado, Maine, Nevada, Oregon, Rhode Island, and Utah have the fewest LPN/VNs employed per capita: 0 to 100 LPN/VNs per every 100,000 people. Over the past year, the supply and demand of nurses has been a topic of much discussion. The maps in Figure 2 demonstrate a state-level snapshot of the supply of employed nurses. However, for those studying and monitoring the nursing workforce, regional differences within states are often the main concern. For instance, California has one of the lowest employed nurse-to-population ratios; however, within the state, city centers such as San Francisco may have high nurse-to-population ratios, whereas rural areas may have low nurse-to-population ratios. In-state regional nurse employment numbers are available for download from the U.S. Bureau of Labor Statistics, 2016U.S. Bureau of Labor Statistics Occupational employment statistics. 2016http://www.bls.gov/oes/oes_emp.htmGoogle Scholar. Nurse employment settings have slowly shifted over the past few years, possibly driven by health care costs. The most expensive places to deliver care are inpatient facilities and emergency departments (National Center for Health Statistics, 2016, October 7National Center for Health Statistics CDC health expenditures. 2016, October 7http://www.cdc.gov/nchs/fastats/health-expenditures.htmGoogle Scholar). Care traditionally delivered in those settings will increasingly be provided at home or in the community. Moving care to the community or the home is likely to produce large savings and a shift in workforce distribution. Urgent care clinics employing advanced practice registered nurses (APRNs) are projected to grow to 12,000 by 2019 and deliver simple services at a 72% savings over emergency departments (Rechtoris, 2016, March 9Rechtoris M. 7 statistics on urgent care centers, EDs & retail clinics. 2016, March 9http://www.beckersasc.com/asc-quality-infection-control/5-statistics-on-urgent-care-centers-emergency-departments.htmlGoogle Scholar). The home care market is projected to expand to $157 billion by 2022 (Elsevier, 2016Elsevier Revenue cycle management in home health care. 2016, Julyhttp://icd-10online.com/wp-content/uploads/2016/08/EL-Home-Health-White-Paper-web.pdfGoogle Scholar). The growth of these nonhospital settings will affect the nursing workforce, especially APRNs. In the United States, more than 250,000 APRNs practice in four roles: certified nurse practitioner , certified registered nurse anesthetist (CRNA), certified nurse midwife (CNM), and clinical nurse specialist (CNS). In 2014, the number of certified nurse practitioners was 222,000 (American Association of Nurse Practitioners, 2016American Association of Nurse Practitioners American Association of Nurse Practitioners fact sheet.2016https://www.aanp.org/all-about-nps/np-fact-sheetGoogle Scholar). CRNAs currently number more than 45,000 (Phillips, 2017Phillips S. The 29th annual APRN legislative update.The Nurse Practitioner. 2017; 42: 18-46Crossref PubMed Scopus (15) Google Scholar). In 2015, the American Midwifery Certification Board reported 11,210 CNMs. The number of CNSs is more difficult to estimate because they were not recognized in some states until recently and still are not recognized in a few states (Newman, 2016, April 21Newman R. Obamacare is in better shape than you think. 2016, April 21http://finance.yahoo.com/news/obamacare-united-health-repeal-not-happening-150042506.htmlGoogle Scholar). The overwhelming majority of APRNs prescribe (95.2%) and, on average, have been in practice more than 12 years. Ninety-six percent of APRNs have graduate degrees, and 83% hold advanced certification in primary care (American Association of Nurse Practitioners, 2016American Association of Nurse Practitioners American Association of Nurse Practitioners fact sheet.2016https://www.aanp.org/all-about-nps/np-fact-sheetGoogle Scholar). APRNs, who are growing in number, are well positioned to step further into the primary care arena (Academy of Medical-Surgical Nurses et al., 2016Academy of Medical-Surgical Nurses American Association of Colleges of Nursing American Association of Critical-Care Nurses Critical Care American Association of Neuroscience Nurses American Association of Nurse Anesthetists American Association of Nurse Practitioners Public Health Nursing Section American Public Health Association RE: CMS-5517-P – Medicare program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) incentive under the physician fee schedule, and criteria for physician-focused payment models (81 Fed.Reg. 28162 May 9, 2016).2016, June 27http://www.aacn.nche.edu/government-affairs/aprn-advocacy/CMS-QPP-Proposed-Rule-APRN-Comment.pdfGoogle Scholar). When allowed to practice to the full extent of their education and training, they care for the vulnerable in designated health professional shortage areas, both urban and rural (Xue et al., 2016Xue Y. Ye Z. Brewer C. Spetz J. Impact of state nurse practitioner scope-of-practice regulation on health care delivery: Systematic review.Nursing outlook. 2016; 64: 71-85Abstract Full Text Full Text PDF PubMed Scopus (97) Google Scholar). In a large national sample of ambulatory patients, Barnes and others found that APRNs have a 13% greater likelihood of working in primary care in states that allow full-practice authority and that they are 23% more likely to be caring for Medicaid patients if the state allows full reimbursement for their care (2016). As shown in Table 1, the trend for new graduates finding employment has improved since 2012. In 2012, only 51% of new graduates had a job less than 1 month after graduation. In 2016, 75% did. After 6 months, 97% had jobs, compared with 86% in 2012.Table 1New Graduate RNs Employed After Graduation2012 (n = 4,110)2013 (n = 6,121)2014 (n = 8,902)2015 (n = 3,861)2016 (n = 3,901)Employed (%)Employed (%)Employed (%)Employed (%)Employed (%)> 1 month (graduated in summer)5156627175>4 months (graduated in spring)7176788588>6 months (graduated in previous year)8687889397Data for 2012–2015 from previous scans. Data for 2016 from National Student Nurses’ Association, 2016National Student Nurses’ Association 2016 NSNA survey of new graduate nurse employment. Manuscript in preparation.2016Google Scholar. RN = registered nurse. Open table in a new tab Data for 2012–2015 from previous scans. Data for 2016 from National Student Nurses’ Association, 2016National Student Nurses’ Association 2016 NSNA survey of new graduate nurse employment. Manuscript in preparation.2016Google Scholar. RN = registered nurse. In 2016, the American Association of Colleges of Nursing (American Association of Colleges of Nursing, 2016American Association of Colleges of Nursing Employment of new nurse graduates and employer preferences for baccalaureate-prepared nurses.2016, Novemberhttp://www.aacn.nche.edu/leading_initiatives_news/news/2016/employment16Google Scholar) conducted a brief online survey of 743 deans of nursing, asking about employment rates for new nurses immediately after graduation and 4 to 6 months after graduation. The survey, which had a response rate of 77.5%, found that the average job-offer rate at graduation for entry-level nurses with a Bachelor of Science in nursing (BSN) degree was 70%; for entry-level nurses with a Master of Science in nursing, or MSN, degree, the rate was 74%. The survey also revealed that 92% of entry-level BSN nurses had job offers 4 to 6 months after graduation. These results mirrored those of the National Student Nurses’ Association, 2016National Student Nurses’ Association 2016 NSNA survey of new graduate nurse employment. Manuscript in preparation.2016Google Scholar. The employment rates varied across regions: the South had the highest rate (77%), and the West had the lowest (66%). A comparison of these findings with those of a survey conducted by the National Association of Colleges and Employers, 2015National Association of Colleges and Employers The class of 2015 executive survey report. 2015, Septemberwww.naceweb.org/uploadedfiles/.../2015-student-survey-executive-summary.pdfGoogle Scholar (n = 39,950) of new college graduates across disciplines indicates that nursing is doing well. The National Association of Colleges and Employers found that only 50.6% of their respondents had job offers at graduation, a percentage that was the highest since the recession. As shown in Table 2, BSN graduates continue to be employed as RNs at a greater percentage (92.73%) than graduates of associate degree (i.e., ADN) programs (89.59%) or accelerated BSN programs (86.08%) (National Student Nurses’ Association, 2016National Student Nurses’ Association 2016 NSNA survey of new graduate nurse employment. Manuscript in preparation.2016Google Scholar). Similarly, in the 2016 annual survey of new graduate employment (American Association of Colleges of Nursing, 2016American Association of Colleges of Nursing Employment of new nurse graduates and employer preferences for baccalaureate-prepared nurses.2016, Novemberhttp://www.aacn.nche.edu/leading_initiatives_news/news/2016/employment16Google Scholar), deans of baccalaureate programs (n = 576) reported that 54% of hospitals and other health care settings require new hires to have a BSN degree—a 6.6% increase from 2015. Further, the deans reported that 97.9% of employers express a strong preference for hiring BSN program graduates. Likely, the recommendation in the Institute of Medicine’s (IOM’s) report, Future of Nursing (2011), to increase the percentage of BSN-educated nurses, as well as research findings indicating that increased ratios of BSN-educated nurses positively affect patient safety, has influenced employers to prefer BSN-educated nurses to ADN-educated nurses. The reason accelerated BSN graduates are being hired at lower percentages is not as clear. Brandt et al., 2015Brandt C.L. Boellaard M.R. Zorn C.R. The faculty voice: Teaching in accelerated second baccalaureate degree nursing programs.Journal of Nursing Education. 2015; 54: 241-247Crossref PubMed Scopus (7) Google Scholar suggest that employers may have an inaccurate perception that accelerated BSN programs are abbreviated and that the content is trimmed. As the nursing shortage plays out, these hiring differences may dissolve.Table 2New Graduate RN Employment by Program20122013201420152016Type of ProgramEmployed RNs (%)Number of employed RNsEmployed RNs (%)Number of employed RNsEmployed RNs (%)Number of employed RNsEmployed RNs (%)Number of employed RNsEmployed RNs (%)Number of employed RNsAssociate Degree61966721,316721,013821,07089.591,208BSN prelicensure721,686811,686821,698871,57192.731,953Accelerated BSN5821869386812048342286. 08553Note. BSN = Bachelor of Science in nursing; RN = registered nurse. Open table in a new tab Note. BSN = Bachelor of Science in nursing; RN = registered nurse. National Student Nurses’ Association, 2016National Student Nurses’ Association 2016 NSNA survey of new graduate nurse employment. Manuscript in preparation.2016Google Scholar) also looked at a 2-year trend of employment percentages by type of institution (Table 3). These data illustrate that graduates of private not-for-profit institutions have the highest employment percentages, followed by public institutions and then private for-profit institutions. All three types of institutions increased their employment percentages from 2015 to 2016.Table 3Employment Rates of Graduates of For-Profit Versus Not-for-Profit and Pubic InstitutionsEmployed as RNPublicPrivate (Non-for-Profit)Private (For-Profit)2015 n = 3,548Yes84.6% (1,930)86.1% (709)82.24% (366)No15.4% (351)13.9% (114)17.0% (78)2016 n = 3,901Yes89.56% (2,265)90.77% (757)87.92% (473)No10.44% (264)9.23% (77)12.08% (65) Open table in a new tab Discussion continues regarding the supply and demand of nurses. Does a surplus exist? Or a shortage? The answers depend on whether the interpretation is based on a macro or micro view of the nursing workforce. A national view, a state-level view, or an in-state regional view may result in different conclusions. Nuances of the nursing workforce can only be understood by interpreting both the macro and micro views. For instance, if a surplus exists at the state level but a shortage exists at an in-state regional level, the data suggest recruiting more practicing nurses and simultaneously adding more nurses to the educational pipeline in the affected region. Another common nursing workforce question is: Will enough nurses will be available to make up for the looming baby boom retirements? Auerbach et al., 2015Auerbach D.I. Buerhaus P.I. Staiger D.O. Will the RN workforce weather the retirement of the baby boomers?.Medical Care. 2015; 53: 850-856Crossref PubMed Google Scholar conducted a study that forecasted the size and age distribution of the nursing workforce through 2030. The researchers projected that annual retirements from nursing will accelerate from 20,000 per year a decade ago to 80,000 per year in the next decade. However, projections also revealed that the entry of new RNs into the workforce could counteract this acceleration. Of course, the projections are contingent on the entry into nursing remaining at its current high rate. In addition, the researchers compared their results with demand estimates by the U.S. Department of Health and Human Services (HHS) Health Resources and Services Agency and noted that their estimate of the future RN supply fell slightly below the agency’s estimates. The retirement rate of older nurses and the entry rate of newer nurses are just two variables that fluctuate. Additional factors that may impact future workforce demands include global economic downturns or upturns, changes in health care laws, and new methods and modes of health care delivery, including better preventive health care that keeps patients out of the hospital. Advances in technology may have the greatest impact on the nursing workforce, making the current use of workforce data and modeling obsolete. In Japan, where the elderly outnumbers the labor force, robotic nurses are projected to save the country $21 billion per year in health care costs. Engineers have already created robotic nurses that look and speak like human beings. These machines are performing nursing skills, including helping patients transfer, taking vital signs, and administering medications. They also perform telehealth, serving as an intermediate between physician and patient (Masui, 2016, January 27Masui A. Development of care robots growing in aging Japan.The Japan Times. 2016, January 27http://www.japan-times.co.jp/news/2016/01/27/national/social-issues/development-care-robots-growing-aging-japan/#.V-A1ePkrJaQGoogle Scholar; Leiber, 2016Leiber N. Europe bets on robots to help care for seniors.http://www.bloomberg.com/news/articles/2016-03-17/europe-bets-on-robots-to-help-care-for-seniorsDate: 2016Google Scholar). In the United States, Duke Pratt School of Engineering and the School of Nursing has invented a telerobotic intelligent nursing assistant, or TRINA, a mechanical robot nurse that takes vital signs and delivers medications to patients. The scientists at Duke have greater plans for TRINA and others like it. They envision robotics playing a role in the care of patients with highly infectious diseases such as Ebola (Bridges, 2016, November 16Bridges V. Duke officials test, refine robot-nurse.2016, November 16http://www.newsobserver.com/ news/local/community/durham-news/article114543668.htmlGoogle Scholar). What do changes in technology mean for the nursing workforce? Presently, the impact on nursing is uncertain; however, the types of nursing skills required in the future may be drastically different than those of today. Perhaps, the future will require fewer nurses but have increased demands for highly technically skilled nurses and direct-care nurses for aging patients (Macy, 2016Josiah Macy, Jr. Foundation Registered nurses: Partners in transforming primary care. Presented at the Macy Foundation conference on preparing nurses for enhanced roles in primary care, Atlanta, GA2016, JuneGoogle Scholar). As machines become more sophisticated and take over some responsibilities of humans, questions emerge about the role of regulators in keeping patients safe. Today, robots cannot reason through ethical dilemmas, make decisions weighing options, or consider a person’s feelings or a family situation. However, delegation may be cast in a new light, with nurses delegating tasks once performed by them or assistive personnel to robots. Questions also emerge about who will oversee the robotic workforce and be accountable when things go wrong. These are a few challenging issues of the near future. As new workforce modeling techniques are developed and new ways of estimating workforce needs emerge, NCSBN works with BONs to build a national workforce database of the future. The long-term vision is to have workforce data and statistics on the entire U.S. nursing workforce. The database already provides aggregate data that reflects local, regional, state, and national workforce characteristics. However, only 17 BONs currently provide data to NCSBN’s nursing workforce database: Arizona, Arkansas, Connecticut, Georgia, Iowa, Kentucky, Maine, Minnesota, Mississippi, Nevada, New Hampshire, North Carolina, Ohio, South Dakota, Texas, Washington, and Wyoming. Data are collected at the time of licensure renewal. Questions are based on the National Forum for Nursing Workforce Centers Minimal Dataset, and data are stored in Nursys®, NCSBN’s nurse licensure and disciplinary database. BONs currently participating in the project transmit the data to Nursys and can later access their aggregate data and run real-time workforce reports for their state. To keep pace with the changing environment of health care, educators must continually monitor the pulse of nursing in the United States. Students must be prepared to enter a challenging workforce that holds high expectations for performance and advanced delivery of care. How should nurses be prepared for the future? The IOM’s 2010 Future of Nursing recommended an 80% BSN workforce by the year 2020 (Institute of Medicine (IOM) Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, 2011Institute of Medicine (IOM) Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing The future of nursing: Leading change, advancing health. National Academies Press, Washington, DC2011Google Scholar). This goal inspired the formation of nursing coalitions around the country that developed strategies to meet it, and in subsequent years, the number of BSN graduates has risen in the United States. In 2016, Altman, Butler, and Shern assessed the progress of the Future of Nursing recommendations and concluded that, between 2010 and 2014, the number of employed nurses with a BSN degree increased from 49% to 51%. Further, they found that the number of baccalaureate programs has increased faster than associate-degree or diploma programs. Buerhaus et al., 2016Buerhaus P. Auerbach D. Staiger D. Recent changes in the number of nurses graduating from undergraduate and graduate programs.Nursing Economic$. 2016; 34: 46-48PubMed Google Scholar published comparable data. They analyzed the most recent findings from the Integrated Postsecondary Education Data System and observed that in 2002, 893 ADN programs and 667 BSN programs existed. In 2014, the number of ADN programs increased to 1,245 (28%), and the number of BSN programs increased to 1,078 (38%). Current data, however, suggest that the overall number of RN programs may be beginning to taper. The number of RN programs increased from 1,571 in 2003 to 2,410 in 2015, but, in 2016, the number decreased to 2,402 (See Figure 3). These data do not include the RN-to-BSN programs (National Council of State Boards of Nursing, 2016aNational Council of State Boards of Nursing National Nursing Database: A profile of nursing licensure in the US. 2016https://www.ncsbn.org/national-nursing-database.htmGoogle Scholar). Funded by the Robert Wood Johnson Foundation to develop a more highly educated nursing workforce, the Academic Progression in Nursing (APIN) program was created by the Tri-Council for Nursing—an alliance of the AACN, the American Nurses Association, the American Organization of Nurse Executives, and the National League for Nursing. Grants provided by the program have been instrumental in advancing strategies and models that promote the advancement of nursing education and employment. More than $9 million has been invested in the APIN program, and nine states—California, Hawaii, Massachusetts, Montana, New Mexico, New York, North Carolina, Texas, and Washington—have received grants. Some APIN states have reported an increased BSN workforce compared with the national average, although outcomes vary widely from state to state. APIN identified the following five models to allow a more seamless advancement of education (Altman et al., 2016Altman S.H. Butler A.S. Shern L. Assessing progress on the Institute of Medicine report on the future of nursing. The National Academies Press, Washington, DC2016Crossref Scopus (126) Google Scholar): •Baccalaureate completion programs in community colleges: Currently, 22 states allow community colleges to confer baccalaureate degrees, although only seven states allow community colleges to administer nursing degrees; of those seven, only Florida and Washington have a structured path.•State or regionally shared competency models or outcomes-based curriculum: The prelicensure nursing curriculum is not standardized, but the model is intended to achieve standardized outcomes.•Accelerated RN-to-MSN programs: These programs offer ADN-educated nurses a streamlined way to obtain an advanced degree. Some programs allow students to “step out” with a BSN degree.•Shared statewide or regional curriculum: Universities and community colleges form partnerships and collaborate on a shared curriculum or curricular components, allowing students to seamlessly transition from an associate degree to a baccalaureate program, without repeating coursework.•Shared baccalaureate curriculum: Community colleges and universities work together to establish a baccalaureate curriculum; students can take courses at community colleges and universities, but they can take the National Council Licensure Examination only after completing the baccalaur

Non-Bachelor of Science in Nursing Registered Nurse to Bachelor of Science in Nursing Registered Nurse: A Change in Critical Thinking.

With recommendations from national nursing associations and accrediting bodies to transition to an all baccalaureate prepared nurse workforce by 2020, it is important to understand the expertise that a baccalaureate degreed nurse brings to patient care. The purpose of this article is to establish the differences of a non-bachelor of science in nursing (BSN) registered nurse and a 4-year prepared nurse, as well as to identify the education and clinical trends in critical care that require a BSN-prepared nurse. The history of associate degree and diploma degree nurses is admirable and served a purpose serving up to and post World War II. In more recent years, particularly in critical care, as health care is becoming more complex, extension of technology, and pay-for-performance issues are tied to patient outcomes, it is essential the non-BSN registered nurses return to continue their education earning a BSN degree.

Scaling Up to Meet the IOM Recommendations (80% BSN by 2020): Sustaining Quality With Growth

Grand Canyon University (GCU) educates over 6,500 registered nurse (RN)-bachelor of science in nursing (BSN) and almost 1,000 pre-licensure nursing students every year. To create a system with excellent student learning outcomes and high faculty satisfaction takes vision and organizational structures that allow growth without compromising quality. Nurse leaders are very familiar with the 2010 Institute Of Medicine's (IOM) recommendation that 80% of all RNs should have a BSN degree, or higher, by 2020. 1 Institute of Medicine of the National Academy The Future of Nursing: Leading Change, Advancing Health. Institute of Medicine of the National Academy, Washington, DC2010 Google Scholar This recommendation was based on findings from numerous studies that demonstrated increased education of RNs led to improved quality patient outcomes. As a consequence of these findings, healthcare organizations began to determine the educational mix of their own RN staff and to create systematic plans to meet the IOM recommendation. Grand Canyon University (GCU) educates over 6,500 registered nurse (RN)-bachelor of science in nursing (BSN) and almost 1,000 pre-licensure nursing students every year. To create a system with excellent student learning outcomes and high faculty satisfaction takes vision and organizational structures that allow growth without compromising quality. Nurse leaders are very familiar with the 2010 Institute Of Medicine's (IOM) recommendation that 80% of all RNs should have a BSN degree, or higher, by 2020. 1 Institute of Medicine of the National Academy The Future of Nursing: Leading Change, Advancing Health. Institute of Medicine of the National Academy, Washington, DC2010 Google Scholar This recommendation was based on findings from numerous studies that demonstrated increased education of RNs led to improved quality patient outcomes. As a consequence of these findings, healthcare organizations began to determine the educational mix of their own RN staff and to create systematic plans to meet the IOM recommendation.

A Community College's Perspective on the RIBN Initiative

The Regionally Increasing Baccalaureate Nurses (RIBN) initiative pairs community colleges and private colleges with universities to help nursing students complete a bachelor of science in nursing (BSN) degree early in their career. In the Eastern North Carolina Collaborative of the RIBN initiative, East Carolina University is partnered with 5 community colleges: Beaufort County Community College, Pitt Community College, Lenoir Community College, Roanoke-Chowan Community College, and Craven Community College. All of the partners in this collaborative have rigorous nursing programs and know how valuable the RIBN program can be to our region. In this sidebar, I will specifically describe Beaufort County Community College’s perspective on the RIBN initiative. Beaufort County Community College serves not just the county of Beaufort but also Hyde, Tyrrell, and Washington counties—essentially, the landmass between the Pamlico and Albemarle sounds. In total, our service area is slightly more than 2,000 square miles [1]. In addition, students from neighboring Martin County who wish to pursue nursing may also attend Beaufort County Community College, because Martin Community College does not offer a nursing program. The North Carolina Department of Commerce currently designates all of these counties as tier 1 counties (a designation given to counties that are most economically distressed); residents of these rural counties face barriers such as limited infrastructure, a higher unemployment rate, limited access to health care, and limited access to higher education [2]. When the leaders of the nursing program at Beaufort County Community College were approached about the RIBN concept, we immediately realized that participation in this initiative would allow our program to become part of an affordable solution for students who wanted to earn a BSN degree. Our program’s nursing graduates overwhelmingly choose to stay in the rural communities in which they live. They are employed by long-term care facilities, small community hospitals, physician offices, and agencies that provide home health care or hospice care. These employers have not had access to an applicant pool of nurses with baccalaureate degrees, but we believed that the RIBN initiative could change that. Thus the RIBN program will have a significant positive impact on rural students who wish to pursue a BSN degree and on health care establishments in the region. The RIBN initiative has also prompted a frank discussion of how we can better prepare students in the traditional associate degree in nursing (ADN) program so that they are better positioned to pursue further education once they graduate from Beaufort County Community College. This conversation led to a paradigm shift in the way we advise students. Historically, we gave our prenursing students a curriculum plan that could be completed in 2 years. If they wanted to continue their education and earn a BSN degree after completing the ADN program, they faced the challenge of having to take college algebra, statistics, microbiology, additional courses in the humanities, and other transfer courses; this meant having to study for an additional year and a half—while working a full-time job—before they could apply to a RN-BSN program. However, we now encourage prenursing students to take the more advanced courses needed to satisfy transfer credit requirements, instead of taking lower-level courses that fulfill only the minimum requirements for the ADN. Currently, approximately 20% of our students take courses that would fulfill BSN requirements, but we hope to increase this percentage. Our lofty goal is that 75% of ADN graduates will need only the university-level nursing courses to obtain their BSN degree. As part of this shift, we are currently in the process of reviewing articulation agreements for the RN-BSN programs; these agreements provide a simplified, guaranteed transfer process. We are also increasing enrollment in transfer courses, providing information to students regarding the RN-BSN admission requirements of nearby universities, and realigning our ranking procedure to give “points” to students who take more advanced courses that provide transfer credits. Over the next few years, we hope to significantly increase the percentage of nursing students at Beaufort County Community College who enroll in the RIBN program. The RIBN program and other initiatives are better preparing our students to function in and lead the health care establishments in our communities. With the changes that are now taking place in national health care policy, we are going to need many new leaders to help our rural communities navigate through the storm.

New Roles and Shifting Priorities for Nurses

In my CO M M E NT ARY, I cite few studies from the literature. Linda Burnes Bolton, DrPH, RN, FAAN, and Donna E. Shalala, PhD, provide thorough citations and supportive material in the content of their feature articles. Instead, my commentary elaborates on expanding nursing roles in the hospital beyond the bedside. I also delve into the role of the advanced practice nurse across the continuum of care in the United States.I am continually amazed that even though healthcare professionals are trying to speak the new language of population health and coordination of care that reflects the changes occurring through healthcare reform, we always seem to return to hospital-centric ideas. The feature authors are helping us expand our horizons across the continuum while grounding us in the Institute of Medicine (IOM 2011) report on which this issue of Frontiers centers, and why and how to operationalize the report's recommendations.New Roles and Shifting PrioritiesThere is no going back to the expensive illness care system we have had in place for decades. The nation's entitlementdriven system promotes a lack of individual accountability for one's health, enabling some users of the system to lead an unhealthy lifestyle. Significant dollars are paid to the providers who care for the ill, and very few dollars are spent for primary care providers to coach and partner with their patients toward wellness. The incentives for both provider and patient are misaligned in our old system. In this new system of wellness, providers will be financially motivated to serve as care partners with their consumers to help them attain the right level of care for the most appropriate amount of time.The transformation to a health system from an illness system will take a long time, in part because the new system is shifting accountability to individuals for maintaining health and managing their chronic illnesses as effectively as possible-a shift that will no doubt encounter resistance.Nursing Changes in the HospitalThe major tenets and principles of the Affordable Care Act (ACA) mandate reimbursement to hospitals for moving from volume to value, decreasing or eliminating all hospital-acquired conditions, and decreasing or eliminating hospital readmissions. New incentives-pay for performance, not for volume-have been developed as part of the new payment plan.In her interview for this issue of Frontiers, Burnes Bolton articulates the value of bachelor of science in nursing (BSN)prepared nurses in her organization's operations. The studies that she and Shalala cite in their features support the fact that BSN-prepared nurses experience better hospital outcomes than do those nurses without a BSN degree. I agree, and I support the authors in their comments and conclusions on this front.One area that was not discussed by either Burnes Bolton or Shalala is the role of the patient in value-based care. The participation of the patient and his family or significant other is essential to exceptional outcomes. Nursing does have significant control over the number of falls, infections, or skin breakdown occurrences that take place, and nurses are responsible for including the patient and family as part of the care and wellness continuum. However, if the nurse does not engage the patient and significant other, neither the patients' satisfaction nor their clinical outcomes may reflect substantial improvement. Furthermore, under the value-based purchasing model, the hospital's reimbursement is negatively affected by poor outcomes, such that 70 percent of the weighted formula in pay for performance is attributed to the clinical metrics and 30 percent to patient satisfaction outcomes (CMS 2013).To develop a culture in hospitals of nurses as partners with patients and families, the curriculum for, and the faculty teaching, our BSN students should emphasize the following:* Helping the patient become fully informed about her disease* Effectively coordinating care with the patient's entire care and wellness team* Selecting the most cost-effective care path, equipment, and supplies for the patient* Respecting the patient's right to decide her treatment* Honoring, respecting, and incorporating the patient's cultural beliefs about illness, health, and death into her careAdditional Hospital Nursing RolesOther nursing roles are emerging in the hospital as the new models of care are designed or evolve, which were not discussed in the feature articles. …

Healthcare Employersʼ Policies on Nurse Education

The 2010 recommendation that the proportion of registered nurses with BSN (bachelor of science in nursing) degrees in the nursing workforce should increase from the current 40% to 80% by the year 2020 has shifted the focus on nurses educational progression from state legislatures-where changes in entry-level requirements were debated for decades-to the executive suites of large healthcare providers. The recommendation, contained in the report titled The Future of Nursing: Leading Change, Advancing Health, by the Robert Wood Johnson Foundation Initiative on the Future of Nursing at the Institute of Medicine, suggests that human resources policies for nurses have the potential to double the rates of college degree completions (IOM, 2010). We surveyed 447 nurse executives in hospitals, nurse-led clinics, and home and hospice companies to explore the current practices of healthcare employers with regard to this recommendation. Almost 80% of respondents reported that their institution either preferred or required newly hired nurses to have a bachelor's degree, and 94% of the facilities offered some level of tuition reimbursement. Only 25%, however, required their nurses to earn a BSN or offered salary differentials on the basis of educational attainment (9%). We conclude that if employers are serious about wanting a more highly educated nurse workforce, they need to adopt requirements for degree completion and wage differentials in the coming years. The likelihood that such policies will be widely adopted, however, is dramatically affected by the dynamics of nursing supply and demand.