Creating a Better Educated Workforce: Transforming Patient Care

May 7, 2012, 6:00 PM, Posted by Polly Bednash

Happy National Nurses Week! The Robert Wood Johnson Foundation (RWJF) has a proud history of supporting nurses and nurse leadership, so this week, the RWJF Human Capital Blog will feature posts by nurses, including leaders from some of our nursing programs. Check back each day to see what they have to say. This post is by Geraldine "Polly" Bednash, PhD, RN, FAAN, Chief Executive Officer/Executive Director of the American Association of Colleges of Nursing (AACN) and National Program Director, New Careers in Nursing (NCIN).

The environment and systems in which health care is delivered have grown increasingly complex over the last decade. For some time now, many individuals have contrasted the intensive care unit of the past with the medical surgical units of today, noting there is not much difference. Patient care is more complex, the technology is more sophisticated, new knowledge is emerging and nurses and other health professionals are being asked to consider the need to have a dramatically increased level of sophistication about how to intervene in all of this. Moreover, health care knowledge and science is expanding rapidly with new evidence emerging daily about patient care, while the locus of care delivery changes at the same rapid pace. Just contrast the cataract surgery of today with that done 20 years ago. Or the increasing focus on care delivered in communities, not acute care systems.

How do we provide the highest quality care, that is safe, timely, effective, efficient, and patient centered care – the STEEEP scenario – if we do not embrace the importance and value of expanding our capacity to intervene through lifelong learning and through formal education? And how do we assure that we are prepared to seek that emerging knowledge and apply it in the complex array of systems or circumstances in which care is delivered if we are not continually striving to grow our capacity to intervene?

The recent Institute of Medicine (IOM) Report on the Future of Nursing recommendation that at least 80 percent of the nursing workforce hold a baccalaureate or higher degree by 2020 was driven by the above reality about the complexity of health care. The IOM report was very clear that evidence has emerged that having a more educated workforce in nursing is better for patient care.

Yet, an intense debate has emerged about that recommendation focused on whether or not the recommendation is fair, necessary, or even realistic. Some individuals question whether having policies that encourage, or require, additional education, will serve as a barrier to delivering nursing care. I think instead the questions should be whether nursing can meet its social mandate to deliver good without having a more educated workforce?

The IOM report on the Future of Nursing was preceded by another IOM report titled Crossing the Quality Chasm which challenged all health professions to dramatically change their education to meet the STEEEP expectations. Nursing is not the only profession that is facing a dramatically reshaped level of practice expectations and all those other health professions are rapidly changing their educational expectations to respond to this challenge.

If nursing does not embrace the importance of having a better educated workforce, it is patients who will suffer and we will be an outlier profession in the midst of dramatic transformation in the education of every other health profession. More important, nursing will fail in our mandate to be socially relevant, responsive, and qualified to practice if we fail to embrace expanded education as a fundamentally important component of being a competent professional.

The TriCouncil for Nursing has agreed that academic progression in nursing is extremely important as a means for assuring that nurses have the state of the art information for addressing patient care needs in this highly complex system of health care today. And, very important to this conversation is the awareness that the options for acquiring a baccalaureate or a master’s degree in nursing are enormous. Online education programs for both baccalaureate and master’s degree programs are available for nurses in any location and make acquiring the additional education very affordable and available.

Also, we know that the demand for advanced practice nursing’s professionals in this country is enormous. No matter what happens in the Supreme Court deliberations about the Affordable Care Act, the nation will see a dramatic increase in demand for primary, secondary and tertiary care services that Advanced Practice Registered Nurses can deliver. If we do not assist individuals to move to graduate studies early and in volume, we will never be able to fill our role as providers of these important services and the nation’s health care needs will not be met.

Moreover, if we believe nurses must be more fully engaged in policy development – whether this is as an active participant in the policy generating process or simply an informed monitor of the policy process, nursing professionals must have a sophisticated education about the policy process.

Finally, there is clear and abundant evidence that the shortage of nursing faculty – that is the availability of nurses with doctoral degrees – is a major factor in turning qualified students away from school. And, the aging of the nursing faculty far exceeds the aging of the general nursing professional population. We must move new graduates to graduate studies as soon as possible and also must do away with barriers to early entry to graduate studies like requiring nurses to have experience before entering a graduate nursing program.

We will clearly fail in our capacity to deliver high quality care without a focus on advancing the education of all nursing professionals. The challenge to all of us will be to avoid conceptualizing this mandate as a burden but to instead see this as a mechanism for enhancing our professional capacity to meet the needs of patients and our society.

NCIN is a national program of the Robert Wood Johnson Foundation and AACN that is working to: help alleviate the national nursing shortage; increase the diversity of nursing professionals; expand capacity in baccalaureate and graduate nursing programs; and enhance the pipeline of potential nurse faculty.


This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.