Final why bsn, bl4, rev2.26.13

Why BSN?The evidence of why patients & families need BSN

nurses

Paulette C Compton, RN, MSN, MCProgram Director

MaricopaNursing-Banner Boswell MCC

PCCompton Why BSN? 2Imagine…….

SCENERIO: The principal at the new school for your children or your nieces & nephews tells you they have teachers with different education preparation and degrees but there is NO difference in their ability to teach your children/nieces/nephews.

What do you think about this?

What questions would you have for the principal?

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PCCompton Why BSN? 3

What do you know about ADN vs. BSN?

What does the concept ‘entry into practice’ mean?

Is it common to have different entry into practice points in a specific profession?

Do you know of any other profession who has more than one way to enter into practice?

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PCCompton Why BSN? 4What is a ‘profession’?

Defining Characteristics of a Profession:1) Established ethical standards (AZBN &

ANA Code of Ethics)2) Widely recognized body of knowledge (ANA

Nursing Scope & Standards of Practice)3) Use body of knowledge in the interest of

others. (‘helping profession’)4) Body of body of knowledge is derived from

research (EBP), education and training at a university institution of higher learning. (4 year college degree)

Adapted from SOURCE: Australian Council of Professions (2004)http://www.qualityresearchinternational.com/glossary/profession.htm

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PCCompton Why BSN? 5ANA 1965 Position Paper

The 1965 ANA Position Paper recommended:① Requirement making the baccalaureate

degree the minimum educational standard for professional nursing practice: Registered Nurse (RN)

② Create new license for associate degree nurses: Registered Associate Nurses (RAN)

③ Eliminate two types of technical nursing education programs:

Diploma Practical

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ANA’s Rationale for Position Paper on Nursing Education

ANA’s Rationale for 1965 Position Paper on Nursing Education

1) Increasing complexity of healthcare and nursing practice

2) Majority of nurses trained in diploma programs, which focused on staffing hospital with students, rather than higher education in colleges or universities

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ANA’s Rationale for Position Paper on Nursing Education (cont.)

4) Professionals are educated in institutions of higher learning

5) Nursing lagging behind other healthcare professions who are increasing educational requirements which result in nurses the ‘least educated’ healthcare professional

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PCCompton Why BSN? 8Nurses are the ‘least educated’ healthcare profession!

Healthcare Occupations: Minimum Education Degree for Entry to PracticeAssociate

Registered NurseRespiratory Therapist TechPharmacy TechOccupational Therapy AssistantsPhysical Therapy Assistants

BaccalaureateRespiratory Therapist

MastersPhysical TherapistOccupational TherapistSocial WorkerSpeech TherapistCounselor

DoctoralPhysicianPharmacist

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Source: HRSA 2008 National Sample Survey of Registered Nurses

http://bhpr.hrsa.gov/healthworkforce/rnsurvey/

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Source: HRSA 2008 National Sample Survey of Registered Nurses


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What is the Tri-Council for Nursing?

“The Tri-Council for Nursing is an alliance of four autonomous nursing organizations each focused on leadership for education, practice and research. …... These organizations represent nurses in practice, nurse executives and nursing educators….”

Tri-Council Member Organizations:1) American Nurses Association

2) National League for Nursing

3) American Association of Colleges of Nursing

4) American Organization of Nurse Executives

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2010 Policy Statement from Tri-Council for Nursing

Educational Advancement of Registered Nurses:

A Consensus Position

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2010 Policy Statement from Tri-Council for Nursing

Educational Advancement of Registered Nurses:

A Consensus Position (cont)

Quote from 2010 Policy Statement:

“A more highly educated nursing profession is no longer a preferred future; it is a necessary future in order to meet the nursing needs of the nation and to deliver effective and safe care.”

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Did you know……….?

Did you know…….?① US Army, Navy, and Air Force require BSN

for RNs.② US Public Health Service require BSN for

RNs.③ 76% of respondents to 1999 Harris Poll

believe nurses should have 4 year college degree to practice nursing

④ AONE: American Organization of Nurse Executives released statement in 2005 calling for all RN be educated in BSN programs.

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PCCompton Why BSN? 15ANCC Magnet Hospital Recognition

Average Magnet Direct Care RN Education

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PCCompton Why BSN? 16Why BSN?

Why BSN??? The answer is simple. The evidence indicates:

Patient outcomes are better when a higher proportion of nurses are educated with BSN.

Patient mortality rates decrease when a higher proportion of nurses are educated with BSN.

Failure to rescue rates by nurses decrease as a higher proportion of nurses are educated with BSN.

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PCCompton Why BSN? 17Opinion vs. Evidence2.26.13


EFFECT of RN Educational Level on Patient Outcomes Evidence

Aiken, L.H., et al. (2003).Educational levels of hospital nurses & surgical patient mortality, Journal of American Medical Association, 290, 16-17-1623.

STUDY RESULTS: N=#232,342. A 10% increase in the proportion of nurses holding a bachelor’s

degree was associated with a 5% decrease in both the likelihood of patients dying within 30 days of admission and the odds of failure to rescue (odds ratio, 0.95; 95%CI, 0.91-0.99 in both case).

STUDY CONCLUSION: In hospitals with higher proportions of nurses educated at baccalaureate level or higher, surgical patients experienced lower mortality and failure to rescue rates.

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Aiken, L.H., et al. (2008). Effects of Hospital Care Environment on Patient Mortality and Nurse Outcomes. Journal of Nursing Administration, 38(5), 223-229

STUDY RESULTS: N =#232,342. Each 10% increase in the proportion of nurses with a BSN was associated with a 4% decrease in risk of death.

STUDY CONCLUSION: This study reaffirmed 2003 Aiken study in JAMA which found in hospitals with higher proportions of nurses educated with BSN, patient mortality decreased.

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Friese, C.R., et al. (2008) Hospital nurse practice environments and outcomes for surgical oncology patients. Health Services Research, 43(4), 1145-1163

STUDY RESULTS: Hospitals whose nurses had more advanced educational preparation had lower mortality rates (p<.05). Higher education was associated with lower failure to rescue rates (p<.01).

(By convention, a p value of 0.05 is considered a statistically significant result)

STUDY CONCLUSION: Improvements in the quality of nurse practice environments could reduce adverse outcomes for hospitalized surgical oncology patients.

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Tourangeau, A.E., et al. ( 2007) Impact of hospital care on 30-day mortality for acute medical patients. Journal of Advanced Nursing, 57(1), 32-41.

STUDY RESULTS: N=46,993. A 10% increase in the proportion of baccalaureate-prepared nurses was associated with 9 fewer deaths for every 1000 discharged patients. This is a similar finding of Aiken (2003) study.

STUDY CONCLUSIONS: Evidence supports current movement to

legislate BSN as minimum requirement for RN entry to practice. Because of impact of BSN lowering mortality rates, authors recommend hospitals aggressively seek to hire and retain BSN nurses to care for acute medical patients, who require the scope and depth of knowledge attained in BSN education to provide safe quality care to complex acute medical patients.

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Estabrooks, C.A., et al. (2005). The impact of hospital nursing characteristics on 30-day mortality. Nursing Research, 54(2), 72-84.

STUDY RESULTS: N= #18,142. The hospitals with a higher proportion of baccalaureate-prepared nurse were associated with lower rate of 30-day patient mortality (95% CI, 0.81-0.96).

STUDY CONCLUSIONS: Hospital nursing

characteristics are an important consideration in efforts to reduce the risk of 30-day mortality of patients.

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What is rationale for opinion opposing BSN minimal entry into practice?

Why do you think anyone would have the ‘opinion’ BSN minimal entry into practice is not a good idea?

1) WIIFM….good or bad?2) Unaware of clinical issues3) Unaware of health policy issues4) Fear of change5) Fear of loss of job6) Inability to obtain BSN7) Increased tuition to obtain BSN8) Increased cost to health care organizations9) Fear of increased nursing shortage10) Fear of evidenced-based practice11) ??

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Educating Nurses: A Call for Radical Transformation Carnegie Report

The Carnegie study on nursing education, led by Patricia Benner, studied the current nursing education system in the US.

The study found ALL nurses are undereducated for the very complex nursing practice in the health care system.

One of the many Carnegie recommendations:Require BSN minimum entry into practice.

Source: Benner, Patricia, et al (2009) Educating Nurses: A Call for Radical Transformation

http://www.carnegiefoundation.org/elibrary/educating-nurses-highlights

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http://www.carnegiefoundation.org/elibrary/educating-nurses-highlights


Educating Nurses: A Call for Radical Transformation Carnegie Report http://www.carnegiefoundation.org/elibrary/educating-nurses-highlights

Carnegie Report (2009) Recommendations on Entry and Pathways in Nursing Education.

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Advisory Board Research r/t New Grad Practice Readiness

Advisory Board (2008) Bridging the Preparation-Practice Gap: Volume I: Quantifying New Graduate Nurse Improvement Needs

Initial research identified 36 new grad competencies: 18 clinical & 18 non-clinical

Evidence indicates only 10% of nurse practice leaders are satisfied with new grad proficiency r/t 36 new grad competencies.

Evidence indicates 90% of nursing faculty are satisfied with the new grad proficiency r/t 36 new grad competencies.

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Advisory Board Research r/t New Grad Practice Readiness

Evidence indicates only 10% of nurse practice leaders are satisfied with new grad practice readiness r/t 36 new grad competencies.

Evidence indicates 90% of nursing faculty are satisfied with the new grad practice readiness r/t 36 new grad competencies.

Boswell Spr 10 data indicates

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What is the IOM?

Institute of Medicine

Private, non-governmental, nonprofit organization providing unbiased and authoritative advice to decision makers and the public.

Established in 1970, the IOM is the health arm of

the National Academy of Sciences, chartered under President Abraham Lincoln in 1863.

www.iom.edu

SOURCE: www.iom.edu/About-IOM.aspx2.26.13

http://www.iom.edu/

http://www.iom.edu/About-IOM.aspx


What is the purpose of the IOM?

“The Institute of Medicine asks and answers the nation’s mostpressing questions about health and health care.”

“The mission of the IOM is to advise the nation on matters of health and medicine.”




What does the IOM do?

“The IOM applies a distinct research process to provide objective and straightforward answers to difficult questions of national importance.”

“These leading national and international scientists [who conduct the studies], all of whom serve as volunteers, are asked to set aside preconceptions and to rely on evidence in their pursuit of knowledge and truth.”




Why are IOM Reports Essential to Nursing Education?

The IOM Reports:1) provide evidence how to improve our

healthcare system2) provide evidence how to improve the health

of Americans & improve patient outcomes in our nursing practice

3) IOM focus is also on healthcare professions education with goal of a consistent framework with all healthcare professions education emphasizing interdisciplinary care

SOURCE: Finkelman A & Kenner, C (2009) Teaching IOM: Implications of the IOM Reports for Nursing Education. ANA: Silver Spring, MD2.26.13


IOM Report: To Err is Human 1999

The report identified remarkably high incidence of errors in health care. At least 44,000 to 98,000 people die in hospitals each year in the US as a result of medical errors that could have been prevented, based on estimates from two major studies.

Definition of ‘medical error’-the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim.

The highest incidence of medical errors with serious consequences occurs more frequently in ICUs, ORs, and EDs.

Recommendation of need to change to blame-free environment which does not focus on punishing individuals for errors but changes to a root cause analysis to determine individual practice and system problems which result in errors.

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PCCompton Why BSN? 33IOM Report: Crossing the Quality Chasm 2001

The report found our health care system is fragmented, inefficient, and poorly organized.

IOM 1990 definition of ‘quality’-“the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”

The report identified ‘quality’ as a system property with six important improvement aims.◦Health care ‘quality’ should be:◦Safe◦Effective◦Patient-centered◦Timely ◦Efficient ◦Equitable

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IOM Report: Patient Safety: Achieving a New Standard of Care (2003)

The report identified the need for a much broader approach to patient safety than was first stated in To Err is Human.

Definition of ‘patient safety’-The prevention of harm to patients, where harm can occur through errors of commission and omission.

The report describes the need for commitment from all stakeholders to a culture of safety and improved information system, which us clinical data at point of care to prevent, recognize, and recover from adverse events.

Recommended need HHS assume lead role for establishing a standards-based nation health information infrastructure to support comprehensive patient safety programs to detect and analyze adverse events and near misses.

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The Commonwealth FundMirror, Mirror on the Wall: How the

Performance of the U.S. Health Care System Compares Internationally, 2010 Update Report

http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2010/Jun/Mirror-Mirror-Update.aspx

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Click onInteractiveFeature toCompareSpecificHealthIndicators:http://www.commonwealthfund.org/usr_doc/site_docs/slideshows/MirrorMirror/MirrorMirror.html

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http://www.commonwealthfund.org/usr_doc/site_docs/slideshows/MirrorMirror/MirrorMirror.html






THE COMMONWEALTH

FUND

Note: * Estimate. Expenditures shown in $US PPP (purchasing power parity).Source: Calculated by The Commonwealth Fund based on 2007 International Health Policy Survey; 2008 International Health Policy Survey of Sicker Adults; 2009 International Health Policy Survey of Primary Care Physicians; Commonwealth Fund Commission on a High Performance Health System National Scorecard; and Organization for Economic Cooperation and Development, OECD Health Data, 2009 (Paris: OECD, Nov. 2009).

AUS CAN GER NETH NZ UK US

OVERALL RANKING (2010) 3 6 4 1 5 2 7

Quality Care 4 7 5 2 1 3 6

Effective Care 2 7 6 3 5 1 4

Safe Care 6 5 3 1 4 2 7

Coordinated Care 4 5 7 2 1 3 6

Patient-Centered Care 2 5 3 6 1 7 4

Access 6.5 5 3 1 4 2 6.5

Cost-Related Problem 6 3.5 3.5 2 5 1 7

Timeliness of Care 6 7 2 1 3 4 5

Efficiency 2 6 5 3 4 1 7

Equity 4 5 3 1 6 2 7

Long, Healthy, Productive Lives 1 2 3 4 5 6 7

Health Expenditures/Capita, 2007 $3,357 $3,895 $3,588 $3,837* $2,454 $2,992 $7,290

Country Rankings

1.00–2.33

2.34–4.66

4.67–7.00

Overall Ranking

PCCompton Why BSN? 38IOM Report (2003) Health Professions Education (2003)

The education of health professionals is viewed as a bridge to quality care.

The recommendation of the report is all organizations involved in the education of healthcare professionals implement the five core competencies.1) Provide PATIENT CENTERED CARE2) Work in INTERDISCIPLINARY TEAMS3) Employ EVIDENCED-BASED PRACTICE4) Apply QUALITY IMPROVEMENT5) Utilize INFORMATICS

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IOM Model 2003 Overlap Core Competencies for Health Professionals 2.26.13

PCCompton Why BSN? 40What is QSEN?

Quality and Safety Education in Nursing

QSEN is a comprehensive website for quality and safety education for nurses, funded by Robert Wood Johnson Foundation

QSEN is a faculty resource to learn and share ideas about teaching-learning strategies, which promote quality and safety competency development in nursing

QSEN includes video presentations and annotated bibliographies for faculty and nursing students to learn about quality and safety in nursing

www.QSEN.org

SOURCE: www.QSEN.org2.26.13

http://www.QSEN.org/

http://www.QSEN.org/

PCCompton Why BSN? 41QSEN: Quality & Safety Education in Nursing

QSEN initial goal to describe competencies which would apply to ALL nurses & define a competent and qualified nurse.

QSEN utilized IOM recommended 5 competencies for all health professions AND created 2 competencies for IOM Quality Improvement competency: Quality Improvement & Safety

QSEN identified KSAs (Knowledge, Skills, & Attitudes) for each competency

QSEN competencies to serve as guide for ◦Curricular development for academic programs◦Transition to practice◦Continuing education programs.

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PCCompton Why BSN? 42Patient-Centered Care

IOM Provide Patient-Centered Care: Identify, respect, and care about patients’ differences, values, preferences, and expressed needs; relieve pain and suffering; coordinate continuous care; listen to, clearly inform, communicate with, and educate patients; share decision-making and management and continuously advocate disease prevention, wellness, and promotion of healthy lifestyles, including a focus on population health.

QSEN Patient-Centered Care: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.

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PCCompton Why BSN? 43Interdisciplinary Teams

IOM Work in Interdisciplinary Teams: Cooperate, collaborate, communicate, and integrate care in teams to ensure that care is continuous and reliable.

QSEN Teamwork & Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.

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Apply Quality Improvement (QI)

IOM Apply Quality Improvement (QI): Identify errors and hazards in care; understand and implement basic safety design principles, such as standardization and simplification; continually understand and measure quality of care in terms of structure, process, and outcomes in relation to patient and community needs; design and test interventions to change processes and systems of care, with the objective of improving quality.

QSEN Two Competencies = IOM One competency

1) Quality Improvement (QI): Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems.

2) Safety: Minimize risk of harm to patients and providers through both system effectiveness and individual performance.

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PCCompton Why BSN? 45EBP Evidenced-Based Practice

IOM Employ evidenced-based practice: Integrate: 1) Best research results2) Clinical expertise3) Patient values to make patient care decisions.-Participate in learning and research activities to the

extent feasible.

QSEN Evidenced-based practice: Integrate: 1) Best current evidence2) Clinical expertise3) Patient/family preferences and values for delivery of optimal health care

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PCCompton Why BSN? 46Utilize Informatics

IOM Utilize Informatics: Communicate, manage knowledge, mitigate error, and support decision-making using information technology.

QSEN Informatics: Use information and technology to communicate, manage knowledge, mitigate error, and support decision-making.

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Evidence New Grad Knowledge Gaps in Quality Improvement Education

Kovner, C.T., et al. (2010) New Nurses’ Views of Quality Improvement Education. The Joint Commission Journal on Quality and Patient Safety. 36(1), 29-35.

STUDY RESULTS: N=436 (38.6%) newly licensed RNs thought they were “poorly” or “very poorly” prepared about or had “never heard of QI.” BSN grads reported significantly higher levels of preparation in EBP, evidenced-based practice; assessing gaps in practice, teamwork, collaboration; and many research skills.

STUDY CONCLUSIONS: RN educational programs need to improve education about and application of QI concepts and to consider focusing QI content into a separate course to assure it is taught.

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Evidence New Grad Knowledge Gaps in Quality Improvement Education

Sullivan, D. T., et al. (2009). Assessing quality and safety competencies of graduating prelicensure nursing students. Nursing Outlook. 57, 323-331.

STUDY RESULTS: N= 565. Only 49% newly licensed RNs reported curriculum included reliable resources for locating evidence-based reports and clinical guidelines. Students believed they were most prepared to perform skills in core competencies patient-centered care & informatics. Students felt least prepared for skills in evidenced-based practice & quality improvement tools and evaluating the effects of practice changes.

STUDY CONCLUSIONS:Due to gaps between theoretical presentation of quality and safety information and demonstrated application in practice, need to focus on redesign of curriculum content to include quality and safety education/practices. Special attention is needed to develop student competency in quality improvement.

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EBP Resources for Clinical Practice

What have you learned in our program about EBP & Quality Improvement?

What are the EBP resources you use in the clinical to obtain current evidence for your nursing practice?

What are your thoughts about your EBP preparation in our program?

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IOM-RWF 2010 Forum on the Future of Nursing: Acute Care

“Many unknowns about health care remain as the country pushes forward with health care reform. But one thing is certain. The US cannot adequately address the challenges facing its health care system without addressing the challenges facing the nursing profession. Nurses are the largest segment of the heath care workforce and are essential to providing quality care…….The goal of this initiative is to help transform nursing as part of far-reaching reforms in the health care system.”

SOURCE: Preface to Summary of October 2009 Forum on the Future of Nursing: Acute Care

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PCCompton Why BSN? 51Conclusions & Plan

① Nursing practice continues to be extremely complex and increasing in complexity.

② Carnegie Report states we are under-educating all nurses….. both ADN & BSN….and recommend requirement BSN minimum entry into practice.

③ Advisory Board research indicates major gap between academia and practice…..only 10% of nurse practice leaders are satisfied with the new grad proficiencies on 36 competencies.

④ Nurses are the least educated health professional.

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PCCompton Why BSN? 52Conclusions & Plan (cont)

⑤ Nurses need to be educated in ALL of the IOM-QSEN core competencies.

⑥ BSN education provides the comprehensive nursing education required to teach quality improvement, safety, evidenced-based nursing practice, team collaboration, informatics, and patient centered care.

⑦ Research indicates patient mortality and failure to rescue rates decrease with higher percentage of BSN nurses.

⑧ Our US Healthcare System has poor patient outcomes & ranks 7th compared to six other industrialized countries.

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PCCompton Why BSN? 53Conclusions & Plan (cont)

⑨ Nurses are patient advocates and therefore must support expectation of requirement for BSN in nurses in order to improve patient outcomes.

⑩ Short-term approach: Regulation/legislation requiring BSN in 3 years post Associate Degree graduation.

⑪ Long-term approach: Regulation/legislation requiring BSN minimal entry into practice.

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Health & Medicine

Final why bsn, bl4, rev2.26.13