Hardwiring 80 by 20 in a North Texas Hospital

Oct 9, 2013, 9:00 AM, Posted by

Three years ago this week, the Institute of Medicine issued a landmark report, Future of Nursing: Leading Change, Advancing Health. Its recommendations include increasing the proportion of nurses with baccalaureate degrees to 80 percent by 2020. Cole Edmonson, DNP, RN, FACHE, NEA-BC, is chief nursing officer at Texas Health Presbyterian Hospital Dallas, and a Robert Wood Johnson Foundation Executive Nurse Fellow (2012 – 2015). He also serves as practice team co-lead for the Texas Team, the state’s Action Coalition.


Improving the lives of people in the communities we serve is our guiding mission and it is supported by our Magnet Redesignation program and our professional practice model. In 2010, when the Institute of Medicine’s (IOM) Future of Nursing report was released, we were one of the few IOM meeting sites in Texas to bring together people from both practice and academia to hear about the report and begin to discuss how we might fulfill the 2020 vision with the creation of new partnerships.


The IOM report was a call to action, to which we responded. Texas Health Presbyterian Hospital Dallas, a part of Texas Health Resources, began the journey by exposing leadership and direct care staff to the report, the research (compelling reasons) behind it, its recommendations, and the gap analysis of the organization in the eight areas of recommendations.

The nursing leadership, with the direct care nurses and the system leadership, integrated the Future of Nursing report into our nursing strategic plan in 2011. The strategies and tactic with metrics of success set in motion a series of actions to meet the 80 percent bachelor of science in nursing (BSN) goal by 2020, doubling the nurses with doctorates, Advanced Practice Registered Nurse (APRN) practice scope, and positioning nurses in strategic positions including the Board of Trustees.

The base of 51 percent BSN-prepared nurses at the bedside represented a significant challenge; we had a gap of 29 percent, or roughly 261 non-BSN prepared nurses. Valuing every nurse in the organization was a central tenet in our plan. We needed to respect both life circumstance and readiness to return to school.

We secured a partnership with an RN to BSN program, prioritized tuition reimbursement for this group, launched an image campaign with compelling reasons to obtain a BSN, shifted recruitment to focus more on BSN schools, and initiated a preferential hiring practice to hire more BSN-prepared nurses, with the ability to hire Associate-Degree-prepared nurses who committed to obtain BSNs within three years.

We created flexible schedules to support nurses who were attending classes, and created study groups for nurses returning to school. We promoted the career advancement program and paid specific attention to the need to obtain a BSN to advance. In shared governance meetings and forums, we frequently discussed the career options for BSN-prepared nurses in leadership, education, etc.

Our outcome at the end of 2012 was that we increased BSN-prepared nurses at the bedside by 16 percent to a total of 67 percent. And today, there are more than 150 nurses in the RN to BSN program with expected graduation dates within the next two years.

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