Editor’s note: This issue of American Nurse Today…Online introduces a new regular department called “Viewpoint,” which highlights the thoughts, opinions, and expertise of well-known nurse leaders. We welcome your comments about these thought-provoking articles.
The combination of the rich supply of new nurse graduates and the Magnet Recognition® Program for excellence, which brings quality and economic value to healthcare organizations, is driving the expectation that new nurses should have bachelor-of-science (BSN) degrees to enter practice. For years, we’ve heard much talk of a nursing shortage. Yet, hard as it is to imagine, today we have a bubble of too many nurses. Many regional markets suddenly are swimming in a sea of new nurses, with unexpectedly large pools of bright, enthusiastic, newly minted graduates desperate for a job. Why did this happen? How long will it last?
Is health care recession proof?
By December 2010, the current economic recession in the United States will have lasted a full 3 years—coinciding with the largest enrollment of nursing students within the past 5 years, major job losses across all business sectors, and a decreasing census in hospitals (the largest employers of nurses). Job losses among the general population have led to service contraction in the healthcare field. The result: less business for hospitals and outpatient departments.
What’s more, uncertainty brought on by the 2010 healthcare reform law has caused many large healthcare organizations to defer program expansion until reimbursement changes become clearer. With many more people slated to receive healthcare services with lower reimbursement for providers, health care will be one of the last sectors to declare that it’s not recession-proof. Although it may grow due to an increased demand for services, far less dollars will be spent per patient as a result of the country’s economic status and healthcare reform. Pressure to reduce costs per case will rise dramatically.
How long will we see a glut of nurses?
For the next 5 years or perhaps longer, we may see fewer nurses retiring, opting instead to “age in place” out of fear that even if economic recovery is inevitable, keeping one’s job provides an economic safety net. About 25% of nurses are older than age 50; unless a large-scale turnover occurs in this group within the next 10 years, fewer positions may be available for new graduates seeking jobs in inpatient hospital settings.
How does Magnet designation fit into the picture?
Health care is a competitive business, and the nursing workforce is a key differentiator in how hospitals brand their services. The 372 hospitals that have earned the prestigious Magnet designation have seen increases in their bond ratings and a greater ability to “sell” quality and safety to the community.
The Magnet program elevates the reputation and standards of the nursing profession and, by association, raises educational expectations for the workforce. The Magnet program doesn’t specify educational levels for nurses. When applying for Magnet status, a healthcare organization must submit a plan describing how expectations are set and support is provided to nurses at all levels who seek formal education. Under the component of “structural empowerment,” the source of evidence for formal education specifies that organizations seeking Magnet status provide data that reflect the educational direction of the workforce. Organizations are expected to track nurse workforce data to substantiate that goals for improvement have been met.
The best nurse graduates seek employment in Magnet facilities because of their reputation as employers of choice for nurses. Thus, Magnet facilities and organizations seeking Magnet designation clearly have an incentive to hire BSN graduates.
The link between BSNs and better outcomes
The literature shows that nurses with additional education generally outperform those with less education. This is a compelling justification for hiring BSN graduates. A growing body of research clearly links baccalaureate-prepared nurses to lower mortality and failure-to-rescue rates. Studies published in Health Services Research in August 2008 and the Journal of Nursing Administration in May 2008 confirm the findings of previous research that linked educational level with patient outcomes.
The nursing workforce must consist of individuals with the capacity to take on the growing complexities of health care. Nurses must come to the table with technical, communication, and “customer service” skills combined with the ability and inclination to use research and seek compliance with standards. Patient-care results in such areas as falls, skin care, hospital-acquired infections, and patient satisfaction (all considered “nurse-sensitive measures”) must demonstrate improvements, thus guaranteeing reimbursement for the high-quality outcomes achieved.
Uniting in the call for advanced education
The Tri-Council organizations (American Association of Colleges of Nursing, American Nurses Association, American Organization of Nurse Executives, and National League for Nursing) are united in the view that a more highly educated nursing workforce is critical to meeting the nation’s nursing needs and delivering safe, effective patient care. The Tri-Council’s consensus position on educational advancement of registered nurses states: “Current healthcare reform initiatives call for a nursing workforce that integrates evidence-based clinical knowledge and research with effective communication and leadership skills. These competencies require increased education at all levels. At this tipping point for the nursing profession, action is needed now to put in place strategies to build a stronger nursing workforce. Without a more educated nursing workforce, the nation’s health will be further at risk.” (See www.aone.org/aone/advocacy/Letters/2010/May2010/TricouncilEdStatement.pdf.)
According to the Tri-Council, large number of nurses with advanced education are needed to serve as healthcare teachers, scientists, primary-care providers, specialists, and leaders. The Tri-Council urges “all nurses, regardless of entry-point into the profession, to continue their education in programs that grant baccalaureate, master’s, and doctoral degrees. A wide variety of education options exist to further the preparation of today’s nursing workforce, including degree-completion, online, accelerated, and part-time degree programs.”
What actions can employers take?
How can employers and nurses take advantage of today’s glut of new nurses to push for institutionalizing the expectation of entry-level BSNs for tomorrow’s workforce? How can the nursing profession as a whole as well as individual employers and individual nurses benefit from the large pool of new nurse graduates? Can we turn this into a win-win-win situation, for both the short term and long term?
The possibilities for resolving the entry-into-practice issue—once and for all—include:
- setting hiring standards
- partnering with human resource experts to communicate hiring expectations
- aligning with nurse employees to help them attain educational levels that enable them to be more effective in their current and future roles.
Success story #1: VA
The Department of Veterans Affairs (VA) was the first system to achieve organization-wide adoption of advanced education as the key to individual nurse advancement. Thousands of VA nurses returned to school to enhance their education and skills. This surge in education, which took place a decade ago, contributed to the VA’s reinvention as a leader in healthcare worldwide.
The goal of advancing education for nurses with the upgrade of the Nurse Qualification Standards was set in the late 1990s. For 5 years before these standards were enacted, VA nurses met with union representatives, clinical partners, and leaders throughout the country to discuss the advantages of baccalaureate education for nurses. Getting to that goal was a long road, but it was worth the time and effort.
Success story #2: Main Line Health
An integrated healthcare system in the Philadelphia suburbs, Main Line Health received more than 600 applications this year from BSN-prepared nurse graduates for the 70 positions available in the nurse residency program. The few associate-degree nurses who applied and were accepted were Main Line Health employees who’d been supported by tuition reimbursement and met the hiring standards of a specified grade-point average and outstanding recommendations from faculty and nurse managers. To deal with the surge in applicants, Main Line Health developed a rigorous set of applicant screening tools and hiring steps that yielded an outstanding final pool of hires for the 1-year residency program.
Let’s act now
With time and further education, many graduates of nursing diploma schools and associate-degree programs have the potential to become excellent nurses and contribute to high-quality health care. However, the current market has yielded a bonanza of novice nurses with BSNs, and employers are sure to take advantage of this. As long as this bumper crop exists, the nursing profession has an excellent opportunity to develop collaborative models in which colleges and universities partner with nursing-diploma and associate-degree programs to develop bridge programs that enroll graduates immediately into BSN completion programs. Employers can support current staff in completing the BSN through local and online educational programs.
Health care is changing rapidly. Converging market forces have altered forecasts made more than 40 years ago about nurses’ educational requirements. We must heed the trends—and respond with actions to ensure that both the new nurses entering the workforce and veteran nurses have the education they need to meet the challenges ahead. This is the time for innovations that work for patients, students, and nursing schools.
Nancy M. Valentine is Senior Vice President and Chief Nursing Officer at Main Line Health in Bryn Mawr, Pennsylvania. She served as national Chief Nursing Officer for the U.S. Department of Veterans Affairs in Washington, D.C. when the VA adopted new nurse qualification standards.