Oct 6 2011
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Creating Incentives for Nurses to Acquire Baccalaureate Degrees

By Peter Lazes, PhD
Director, Healthcare Transformation Project and Director, Program for Economic Transitions
Cornell University

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As was clearly stated in the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health1, there is an urgency to transform our current health care system and education system for nurses in order to improve the coordination of care, provide better chronic care management, and control the cost of care for individuals and communities. Increasing the number of BSN-prepared nurses to 80% of RNs is an important component of the current recommendations which will help achieve the aforementioned goals. Yet, there are a number of factors tied to the shifting focus of the health care industry that may impede the full implementation of this recommendation.

As the IOM report argues, the ways in which nurses were educated and practiced during the 20th century are no longer adequate for dealing with the realities of health care in the 21st century. In order to equip 80% of RNs with baccalaureate degrees, health care professionals and nursing school administrators need to acknowledge that non-acute care work is an increasingly critical component of current health care reform legislation and of changes in our reimbursement system. Unless there is a clear emphasis in nursing school curricula on the shift from hospital-based care to community care and from a fee-for-service reimbursement system to a capitation or global payment model, there may be little incentive for nurses to pursue an additional nursing degree. “Why bother? I already have the skills that I need” might be a logical response from a nurse who is currently employed by a hospital. While acute care nurses will still be needed, a growing number of nurses will be required to staff the new jobs that are being created in primary care practices, in hospital clinics, and in medical homes. Nurses must be prepared for a spectrum of job opportunities that will require a novel set of skills but will also present creative and impactful ways to influence patient care.

Second, in order to encourage RNs to obtain BSN degrees, it must be made clear that new educational opportunities will provide nurses with important problem-solving, communication, teamwork, patient engagement and care management skills. These skills will facilitate partnerships with physicians, other health care professionals and patients, enhancing the ability of nurses to be active contributors to restructuring the provision of health care. Such education will give nurses the tools to deepen their engagement and to develop new roles and responsibilities rather than perceiving themselves as passive bystanders in a changing system, a common complaint of many nurses. BSN educational opportunities, therefore, will need to become a venue to prepare nurses for the significant changes ahead.

Third, it will be important for future BSN programs to be developed in ways that reflect the lifestyles and needs of the current generation of nurses who are comfortable with social media and a range of technologies and who must focus on multiple commitments to family and to being a care provider. Nursing programs need to redesign their educational curricula and residency programs to reflect and to respond to this new generation of nurses, encouraging them to learn and grow based on their values and needs. This will call for a profound transformation of our schools of nursing in terms of how they approach and engage nurses to pursue new and additional educational opportunities.

As was noted in the report, there are several issues related to hiring a sufficient number of competent nursing faculty members. In order to ensure the provision of appropriate and attractive educational opportunities for more nurses to obtain BSN degrees, both increased salaries for nursing faculty and appropriate residency programs for both acute and primary care work need to be a focus of nursing school administrators. Schools of nursing will need to change their organizational incentives and approach to faculty development in addition to a transformation of curricula and engagement with nursing students.

In order for the IOM report’s recommendation to increase the number of BSN-prepared nurses to 80% of RNs to be fully effective, it is imperative that the education nurses receive in baccalaureate programs equip them with the shifting skill sets needed in the changing world of health care. Nurses will benefit from additional education only if it is timely, appropriate and corresponds to their personal and professional needs.

1Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing at the Institute of Medicine. 2011. The future of nursing: leading change, advancing health. Washington, CD: National Academies Press.

Additional references:

Marshall H. Chin, Anne C. Kirchhoff et al, Sustaining Quality Improvement in Community Health Centers: Perspectives of Leaders and Staff, 2008, J. of Ambulatory Care Manage, Vol. 31, No. 4, pp. 319-329.

Karen Davis, Stephen C. Schoebaum, and Anne Marie J. Audel, A 2020 Vision of Patient-Centered Primary Care, Oct. 2005, Journal of General Internal Medicine, 20(10): 953-57.

Douglas McCarthy, Kimberly Mueller, and Jennifer Mreen, Kaiser Permanente: Bridging the Quality Improvement in Community Health Centers: Perspectives of Leaders and Staff; 2008, J. of Ambulatory Care Manage, Vol. 31, No. 4, pp. 319-329.

Tags: Future of Nursing, Health & Health Care Policy, Health Care Education and Training, Nurses and Nursing, Nursing, Research & Analysis, Social Determinants of Health, Voices from the Field