New Future of Nursing Research Highlights Challenges Ahead for Employers

Hospitals and other employers have made progress on Institute of Medicine workforce proposals, but more is needed to meet goals.

    • January 13, 2014

Two new studies on implementation of the employer-focused recommendations from the Institute of Medicine's (IOM) Future of Nursing: Leading Change, Advancing Health report find both progress and room for growth.

The studies, both led by Patricia Pittman, PhD, of the George Washington University School of Public Health and Health Services, examine progress hospitals and other health care facilities have made advancing educational recommendations in the Future of Nursing report. The first study focused on the recommendation that 80 percent of nurses have bachelor of science (BSN) degrees by 2020. The IOM urged employers to further that goal by “encourage[ing] nurses with associate’s and diploma degrees to enter baccalaureate nursing programs within five years of graduation by offering tuition reimbursement, creating a culture that fosters continuing education, and providing a salary differential and promotion.”

Pittman and colleagues administered a web-based survey in August and September of 2011, just under a year after the IOM issued its report, gathering data from 447 nurse executives in hospitals, nurse-led clinics, and home and hospice care companies. Nearly 80 percent of respondents said that their institutions preferred or required newly hired nurses to have bachelor’s degrees. In addition, 94 percent of facilities offered some level of tuition reimbursement to encourage nurses already on staff to complete their BSNs.

Going beyond such incentives, some employers had developed what Pittman refers to as “hard policies”: BSN requirements or bigger paychecks for BSN-prepared nurses. Such approaches were not nearly as widely implemented. Twenty-five percent of employers in the survey made completing a BSN degree within five years a firm requirement, while 9 percent offered a pay differential to nurses who complete a BSN—a specific recommendation of the IOM.

“It certainly looks like there's consensus among health care employers that they’d like to have a higher proportion of BSNs in the nursing workforce,” Pittman says. Since the Future of Nursing report, “Many have implemented or maintained programs that will help make that happen, in particular, tuition reimbursement.... The big question is whether the enthusiasm for increasing the percentage of BSNs dissipates” as the nation’s nursing shortage worsens.

The study, “Healthcare Employers’ Policies on Nurse Education,” was published in the November/December, 2013, issue of the Journal of Healthcare Management.

Pittman’s second study examines progress on a different IOM recommendation aimed at employers: that they develop nurse residency programs. Such programs help give newly minted nurses the real-world job skills they need and also help reduce turnover.

Pittman’s research team relied on the same survey’s responses from hospital nurse executives, and found that, despite the many financial challenges confronting hospitals, 37 percent already offered nurse residency programs in 2011. Just one-fifth of those received external funding to launch or maintain the program. Residencies were more common in mid-sized hospitals with 100 to 399 beds, not-for-profit hospitals, and the South.

The executives who had not implemented residency programs identified three key obstacles: financial constraints, concerns about taking senior staff away from other work, and a shortage of faculty to supervise new nurses as they learn best practices.

“Residency programs were initially created as a retention strategy,” Pittman explains, “not a quality-improvement strategy or cost-saving strategy. We know the cost of turnover is very high, so if a hospital can retain a higher proportion of its nurses, it can count the money it saves. That said, the investment is also higher.”

But she says hospitals are beginning to take a broader view of residency programs. “Particularly as the nursing role evolves, employers now recognize that residencies are essential to training nurses ... to do the job they think needs to be done in order to respond to their incentives—avoiding hospital readmission penalties, for example.”

The study, “Residency Programs for New Nurse Graduates: How Widespread Are They and What Are the Primary Obstacles to Further Adoption,” was published in the November, 2013, issue of the Journal of Nursing Administration. Read the study.

Pittman's studies were funded by the Robert Wood Johnson Foundation (RWJF) Initiative on the Future of Nursing, which is rooted in the recommendations of the Future of Nursing report. Through the Initiative, RWJF continues to support the research agenda set forth by the report and implement the recommendations in the areas of nurse training, education, professional leadership and workforce policy.

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