Documenting chief nursing officers' preference for BSN-prepared nurses

Developing the Graduate Nurse Residency: An Oral History With Dr. Colleen Goode and Dr. Mary Krugman

Health care organizations face the challenge of needing newly licensed nurses to fill positions and facilitate competent care for patients. Wide variation in graduate nurse orientation programs, a growing complexity of care, and high graduate nurse turnover rates led to the development of nurse residency programs. The historical perspectives of two nursing pioneers involved in the development of a national model for nurse residency programs provide context to the importance of creating a vision, providing leadership, and applying an evidence-based rationale to structure a series of learning and work experiences designed to support graduate nurses as they transition into their first professional nursing position. [J Contin Educ Nurs. 2022;53(4):171-177.].

Integrating service learning into the RN to BSN curriculum with the application of QSEN competencies

To accomplish the goal of a more highly educated nursing workforce, academic nursing has supported a significant increase in the number of RN to BSN programs. The focus of educating practicing registered nurses is moving toward revising and designing curriculum that promote positive patient outcomes and supports contemporary healthcare practices. Facilitating a service-learning model for RN to BSN curricula and applying the Quality and Safety Education in Nursing (QSEN) competencies are two effective methods for enhancing professional practice. The purpose of this article is to promote the concept of integrating service learning into the RN to BSN curriculum and applying the QSEN competencies to learning activities to achieve improved quality and patient safety.

Baccalaureate prepared nurses as the new entry-level nursing cadre in Uganda: A qualitative study of BSN student and faculty perspectives in two universities

BACKGROUND

Low-income countries suffer chronic problems in producing, employing and distributing their health workers. The World Health Organization advocates for upgrading the number and quality of nursing professionals. As nurses and midwives comprise more than 60% of the health workforce in Uganda, the country's goal to improve nursing education is consistent with international recommendations.

OBJECTIVES

To understand the dimensions of Uganda's relatively new baccalaureate-prepared nurse cadre (BSN), we explored the views of students and faculty in relation to training, job prospects, scope of practice, and satisfaction of BSNs in Uganda.

DESIGN

We used a descriptive qualitative design.

SETTING AND PARTICIPANTS

We interviewed BSN students and faculty at two large public nursing schools in Uganda in 2017.

METHODS

We conducted focus group discussions and key informant interviews and used a thematic analysis approach to analyze data.

RESULTS

The four overarching themes were: 1) BSN training is viewed as distinct from "bedside" training, 2) A rift between nursing cadres undermines workplace harmony, 3) BSNs are dissatisfied with their salary scale, and 4) BSNs are motivated to move abroad.

DISCUSSION

At this moment in the transition, the professional nursing culture within Uganda is not conducive to encouraging BSN entry. To gain traction and momentum for BSNs as an entry-level cadre in Uganda, policy makers might align incentives to encourage BSN trainees, as there are few BSNs within training programs and clinical settings. Increasing lower cadre nurses' understanding of the role of BSNs may help improve relations between nursing cadres. Aligning job descriptions with pay differentials in clinical settings and expanding meaningful job opportunities could help retain BSNs within Uganda.

Attitudes towards Bachelor-level education amongst Bavarian midwives: Results of a descriptive cross-sectional survey in Bavaria, Germany

INTRODUCTION

In Germany, the traditional vocational midwifery training lasts three years. This training is marked as Qualification Level 4 of the European Qualification Framework (EQF). There are very few midwives with a Bachelor degree, and an even smaller number of universities that offer a qualification program at EQF Level 6 (Bachelor). The aim of this paper is to analyze the attitude and interests of traditionally educated German midwives in undertaking a university degree.

METHODS

Midwives were surveyed within the framework of a descriptive cross-sectional study. The survey has 13 items and was available as a web-based survey between 1 November 2016 and 31 January 2017. Alternatively, the midwives were able to send a hardcopy version of the questionnaire back by mail, anonymously. Data was obtained from 534 midwives. The quantitative data were analyzed using SPSS (Version 23). The qualitative data were structurally analyzed using a qualitative content analysis.

RESULTS

It was found that 57.7% of the surveyed midwives are interested in completing a university degree, and 40.1% could imagine themselves pursuing a degree. The respondents were overwhelmingly positive in their opinion of university qualifications and qualification upgrades. Nevertheless, the open-question responses indicated that there are strong concerns surrounding the level of proficiency and experience-based knowledge taught for a university degree, which are essential elements in the traditional training system.

CONCLUSIONS

Although midwives understand the importance of a Bachelor degree, they need to be informed about the expertise and practical skills taught in the degree curriculum.

Associations between nurse education and experience and the risk of mortality and adverse events in acute care hospitals: A systematic review of observational studies

OBJECTIVES

To provide knowledge from the summarization of the evidence on the: a) associations between nurse education and experience and the occurrence of mortality and adverse events in acute care hospitals, and; b) benefits to patients and organizations of the recent Institute of Medicine's recommendation that 80% of registered nurses should be educated at the baccalaureate degree by 2020.

DATA SOURCES

A systematic search of English and French literature was conducted in six electronic databases: 1) Medline, 2) PubMed, 3) CINAHL, 4) Scopus, 5) Campbell, and 6) Cochrane databases. Additional studies were identified by searching bibliographies, prior reviews, and by contacting authors.

REVIEW METHOD

Studies were included if they: a) were published between January 1996 and August 2017; b) were based on a quantitative research design; c) examined the associations between registered nurse education or experience and at least one independently measured adverse event, and; d) were conducted in an adult acute care setting. Data were independently extracted, analysed, and synthesized by two authors and discrepancies were resolved by consensus. The methodological heterogeneity of the reviewed studies precluded the use of meta-analysis techniques. However, the methodological quality of each study was assessed using the STROBE criteria.

FINDINGS

Among 2109 retrieved articles, 27 studies (24 cross-sectional and three longitudinal studies) met our inclusion criteria. These studies examined 18 distinct adverse events, with mortality and failure to rescue being the most frequently investigated events. Overall, higher levels of education were associated with lower risks of failure to rescue and mortality in 75% and 61.1% of the reviewed studies pertaining to these adverse events, respectively. Nurse education was inconsistently related to the occurrence of the other events, which were the focus of only a small number of studies. Only one study examined the 80% threshold proposed by the Institute of Medicine and found evidence that it is associated with lower odds of hospital readmission and shorter lengths of stay, but unrelated to mortality. Nurse experience was inconsistently related to adverse event occurrence.

CONCLUSION

While evidence suggests that higher nurse education is associated with lower risks of mortality and failure to rescue, longitudinal studies are needed to better ascertain these associations and determine the specific thresholds that minimize risks. Further studies are needed to better document the association of nurse education and experience with other nursing-sensitive adverse events, as well as the benefits to patients and organizations of the Institute of Medicine's recommendation.

Is a baccalaureate in nursing worth it? The return to education, 2000-2008

OBJECTIVE

A registered nurse (RN) license can be obtained by completing a baccalaureate degree (BSN), an associate degree (AD), or a diploma program. The aim of this article is to examine the return to baccalaureate education from the perspective of the nurse.

DATA SOURCES

National Sample Survey of Registered Nurses, 2000, 2004, and 2008.

STUDY DESIGN

The effect of education on RN wages is estimated using multivariate regression, both for initial education and for completing a second degree. The coefficients are used to calculate lifetime expected earnings. Multinomial logistic regression is used to examine the relationship between education and job title.

PRINCIPAL FINDINGS

Lifetime earnings for nurses whose initial education is the BSN are higher than those of AD nurses only if the AD program requires 3 years and the discount rate is 2 percent. For individuals who enter nursing with an AD, lifetime earnings are higher if they complete a BSN. The BSN is associated with higher likelihood of being an advanced practice registered nurse, having an academic title, and having a management title.

CONCLUSIONS

Because baccalaureate education confers benefits both for RNs and their patients, policies to encourage the pursuit of BSN degrees need to be supported.

Mixed messages: hospital practices that serve as disincentives for associate degree-prepared nurses to return to school

Nearly 80% of associate's degree-prepared nurses do not return to school for a more advanced degree in nursing, which is an issue of concern to many nursing leaders. This interpretive phenomenological study investigates what influences associate's degree-prepared nurses to refrain from continuing their professional education and obtain a baccalaureate or higher-level degree. Although these nurses generally wished they had a higher degree, they did not feel pursuing one was necessary. They did not perceive that their standard of patient care would change with further professional training involved in obtaining a higher educational degree. Furthermore, they did not perceive any distinctions in professional ability between themselves and colleagues with more advanced nursing degrees. The culture of service health care organizations in which associate's degree-prepared nurses are employed, as well as other factors, are likely directly responsible for the practicing nurses' lack of appreciation for the relevancy and rewards of returning to school.

The future of baccalaureate degrees for nurses

PROBLEM.  Unlike other professional healthcare disciplines, the profession of nursing has multiple levels of entry. Recently, several states have proposed legislation to mandate completion of baccalaureate education after 10 years of nursing licensure. METHODS.  This article examines the proposals, statistics, strategies, and other relevant literature on baccalaureate education for nurses and the positive outcomes associated with a more highly educated nursing workforce. FINDINGS.  The proposal recognizes the entry level preparation provided by associate degree nurses and is an innovative solution that offers a balance between multiple entry levels into practice and continued educational preparation. CONCLUSIONS.  Through a combination of the entry level preparation of associate degree nurses and baccalaureate education, a stronger nursing workforce can be created and patient outcomes and quality of care improved.

Investing in human capital: an academic-service partnership to address the nursing shortage

The well-documented shortage of nurses and the impact of educational preparation of nurses on patient care outcomes provide a compelling argument for the need to increase the number of registered nurses and to advance their educational preparation. This article describes the application of human capital theory in a creative venture between a health system and a school of nursing that has demonstrated success in addressing these issues. A tuition advancement program was developed to support interested personnel in attaining the associate degree in nursing and to support current RNs in attaining the baccalaureate degree. The venture included support for graduate preparation of nurses interested in becoming faculty.

Preparing the nursing workforce of the future

Nurse shortages coupled with the need for national healthcare reform present a challenge. We are not preparing enough nurses nor are we preparing nurses with the right skills to fully participate in a reformed healthcare system. Historical forces in nursing education have resulted in multiple levels of entry into nursing practice and an inadequate nursing workforce. Today's environment of expanding knowledge, the call for interdisciplinary healthcare delivery teams, and evidence of the relationship between nurse education and improved patient outcomes strongly indicate the need for nurses prepared at the baccalaureate level. Requiring a baccalaureate degree for entry into nursing practice, and as the initial degree of nursing education would prepare nurses earlier for graduate education and the much needed roles of educator, researcher and advanced practice nurse. The nursing profession should take the lead in advocating for educational policies that would adequately prepare the nurse workforce of the future.

Essentials of a productive nurse work environment

BACKGROUND

Staff nurse work environments must be improved. To do so, their quality must be measured. The Essential of Magnetism (EOM) tool measures eight characteristics of a productive and satisfying work environment identified by staff nurses in magnet hospitals as essential to quality patient care. The EOM items are based on grounded theory and are used to measure attributes of the work environment as functional processes. The EOMII is a revision of two of the subscales of the EOM.

OBJECTIVES

To test the hypotheses that staff nurses in hospitals designated as having excellent work environments (Magnet) will score significantly higher on the EOMII and on two outcome indicators than will their counterparts in Comparison hospitals. Additional aims include establishing the psychometric properties of the EOMII; updating the National Magnet Hospital Profile; ascertaining relationships between nurse attribute, work, and contextual variables and the characteristics of a productive work environment; and investigating the relationship between the magnet structure, care processes and relationships and two single-item indicators, overall job satisfaction, and nurse-assessed quality of patient care.

METHODS

This was a secondary analysis of aggregated data from 10,514 staff nurses in 34 hospitals who completed the EOMII and the two outcome indicators.

RESULTS

The EOMII is a valid and reliable measure of the quality of work environment from a staff nurse perspective. The hypotheses were confirmed. There are differences in essentials and outcome variables by (a) context-nurses in magnet hospitals report the most productive work environment; (b) education-master's prepared nurses report the most favorable environments; (c) experience-the most inexperienced and the most experienced report the most satisfying, productive environments; and (d) clinical unit-medical and surgical specialty and outpatient units report the healthiest work environments.

DISCUSSION

The primacy of magnet designation as a contextual variable indicating a quality work environment was affirmed. A larger percentage of magnet hospitals meet the magnet profile now than in 2003. Item analysis of the EOMII subscales provides guidance on how to improve the unit work environment. Suggestions are made for additional study and research.

Types of Intensive Care Units With the Healthiest, Most Productive Work Environments

Background The quality of nurses’ work environments in hospitals is of great concern. The American Association of Critical-Care Nurses has specified 6 standards essential to a healthy (ie, satisfying and productive) work environment. These standards are sufficiently aligned to the Essentials of Magnetism processes to make this tool suitable for measuring healthy work environments.

Objectives To identify differences in staff nurses’ perceptions of the work environment by type of intensive care unit.

Methods A cross-sectional descriptive design with strategic sampling was used in this secondary analysis of data from 698 staff nurses working in 34 intensive care units in 8 magnet hospitals. Intensive care units were grouped into 4 types: medical, including coronary care; surgical, including trauma and cardiovascular; neonatal and pediatric; and medical-surgical. All nurses completed the Essentials of Magnetism instrument. Analysis of variance was used to identify initial differences; multivariate analysis of variance was used to control for covariates.

Results The intensive care nurses and units scored above the National Magnet Hospital Profile mean on process variables and on the Essentials of Magnetism outcome variables. Neonatal and pediatric units scored significantly higher than did the other types of intensive care units sampled.

Conclusions Intensive care unit structures supported care processes and relationships that resulted in job satisfaction among nurses and high-quality care for patients in this strategic sample. Systematic study of the structures and processes present in units reporting a healthy work environment can be used to assist other clinical units in improving work environments.

Advancing the science in the measurement of health care quality influenced by nurses

A robust set of quality measures is essential to provide consumers with a vehicleto evaluate nurses' contributions to the care of hospitalized patients, providers, and systems with a set of nursing processes and outcomes to guide quality improvement, and insurers with indicators to reward hospitals for high quality nursing services. The processes employed by the Nursing Care Performance Measures Steering Committee convened by the National Quality Forum (NQF) in 2004 resulted in the endorsement of 15 indicators of health care quality influenced by nurses and contributed to the identification of significant gaps in measurement and priority areas for future research. This critical review of the state of the science related to health care processes and outcomes that reflect nurses' contributions to the quality of care for hospitalized patients is intended to push the boundaries in the measurement of nursing performance. Specific recommendations for future research and measure development are presented.

Hospital Initiatives to Support a Better-educated Workforce

A 2003 article in the Journal of the American Medical Association documented that mortality rates from common surgical procedures were significantly lower in hospitals employing more staff nurses prepared at the baccalaureate level. In this report, that study's authors review case studies of 6 hospitals that demonstrate the kinds of initiatives employers are sponsoring to support a better-educated nurse workforce.

The National Post-Baccalaureate Gradua te Nurse Residency Program

The Chief Nursing Officers (CNOs) of the University HealthSystems Consortium (UHC) of Academic Hospitals desired to increase the numbers of baccalaureate graduate nurses hired by their facilities and provide a more consistent, uniform transition into practice for these graduate nurses. A partnership between the UHC CNOs and the American Association of Colleges of Nursing (AACN) led to establishing a National Post-Baccalaureate Graduate Nurse Residency Program. The structure, curriculum, and outcomes measures were developed and the program was implemented, with growth from six original pilot sites to 34 academic hospitals. Outcomes from the first year of program operation at these six sites show a high rate of retention, decreased stress by graduate nurses over time, improved organization and prioritization of care, and increased satisfaction in the first year of practice.

Education as a Determinant of Career Retention and Job Satisfaction Among Registered Nurses

PURPOSE

To compare job satisfaction and career retention in two cohorts of RNs, those whose highest degrees were the associate degree (AD) or the bachelor's degree (BS) in nursing.

DESIGN

Survey.

METHODS

Instruments included a career satisfaction scale and questions based on the ongoing U.S. Health and Retirement Survey. Three-thousand nurses in the U.S. state of Vermont were surveyed with a resulting response rate of 56.7%. Of these respondents, 878 RNs fit the study criteria.

FINDINGS

BS RNs started their nursing careers earlier, were employed longer, had held more positions, and in the largest age cohort (age 40-54), were more likely to have been in their current positions at least 10 years. BS RNs scored significantly higher in job satisfaction related to: (a) opportunity for autonomy and growth, (b) job stress and physical demands, and (c) job and organizational security. AD and BS nurses were not significantly different in their satisfaction with supervision; career, continuing education, and promotion opportunities; or pay and benefits.

CONCLUSIONS

These findings indicate support of bachelor's level education for individual and social return on investment, and they show that AD education might have unintended consequences. Implications for the nursing shortage and educational policy are discussed.

Answering the call for quality nursing care and patient safety: a new model for nursing education

Current discussion on the need to dramatically change nursing education and practice is based on clear concerns about the changing nature of healthcare. The increasingly complex healthcare system of our nation provides sophisticated interventions yet concerns about quality persist. A new model of education and practice is proposed and this model is being implemented through a groundbreaking partnership to prepare a master's educated, entry-level, generalist nursing clinician to lead and guide care at the point of care. The competencies associated with this new clinician are discussed and future implications for evaluation and monitoring are shared.

Educational levels of hospital nurses and surgical patient mortality

CONTEXT

Growing evidence suggests that nurse staffing affects the quality of care in hospitals, but little is known about whether the educational composition of registered nurses (RNs) in hospitals is related to patient outcomes.

OBJECTIVE

To examine whether the proportion of hospital RNs educated at the baccalaureate level or higher is associated with risk-adjusted mortality and failure to rescue (deaths in surgical patients with serious complications).

DESIGN, SETTING, AND POPULATION

Cross-sectional analyses of outcomes data for 232 342 general, orthopedic, and vascular surgery patients discharged from 168 nonfederal adult general Pennsylvania hospitals between April 1, 1998, and November 30, 1999, linked to administrative and survey data providing information on educational composition, staffing, and other characteristics.

MAIN OUTCOME MEASURES

Risk-adjusted patient mortality and failure to rescue within 30 days of admission associated with nurse educational level.

RESULTS

The proportion of hospital RNs holding a bachelor's degree or higher ranged from 0% to 77% across the hospitals. After adjusting for patient characteristics and hospital structural characteristics (size, teaching status, level of technology), as well as for nurse staffing, nurse experience, and whether the patient's surgeon was board certified, 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% confidence interval, 0.91-0.99 in both cases).

CONCLUSION

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

Irish diploma in nursing students' first clinical allocation: the views of nurse managers

AIM OF THE STUDY

To ascertain the views held by some Irish general nurse managers of the Diploma in Nursing students' first clinical allocation.

RATIONALE

Until 1994, nurses in Ireland were trained under a 3-year apprenticeship system and were employed throughout their clinical experience. In March 1997, the first intake of Diploma in Nursing students into one Dublin university were scheduled to commence their clinical placements. As this was the first time that supernumerary students were to be placed in the clinical areas, it was important to discover how effective the whole process was in terms of nurse managers' experiences.

RESEARCH METHODS

A grounded-theory approach, using unstructured interviews, explored Irish nurse managers' views of the impact of supernumerary students in the workplace. Ethical approval was granted. All available nurse managers in three general teaching hospitals linked with the university agreed to take part (n = 10).

RESULTS

Three themes emerged from the data, entitled 'Structure', 'Students' and 'Support'. In general, the managers believed that staff had had sufficient preparation for this change and that the whole process had been well handled. The respondents were pleasantly surprised by the students' abilities and interest in nursing. Minor problems were dealt with successfully at the local level and the support received by the students was found to be excellent.

DISCUSSION

Preconceptions of the students as more intellectual and less able for practical nursing were found to be untenable. The students' presence was welcomed and their questioning attitude, enthusiasm and application of knowledge was praised. Strong clinical support was required and students benefited from giving care, rather than just observing care given.

CONCLUSION

It is recommended that supernumerary students should be encouraged to give full care under supervision, in order to learn and to become proficient in all clinical skills. The next phase of change, transition to degree status for students from 2002, will benefit from lessons learned in the past 7 years since transition from certificate to diploma education.

Hallmarks of the professional nursing practice environment

THE AMERICAN Association of Colleges of Nursing (AACN) is the national voice for university and 4-year college education programs in nursing. Representing more than 560 member schools of nursing at public and private institutions nationwide, AACN's educational, research, governmental advocacy, data collection, publications, and other programs work to establish quality standards for bachelor's-degree and graduate-degree nursing education, assist deans and directors to implement those standards, influence the nursing profession to improve health care, and promote public support of baccalaureate and graduate nursing education, research, and practice. Task forces are appointed by the AACN Board of Directors as issues arise that require study and action. This white paper was prepared by the AACN Task Force on Hallmarks of the Professional Practice Setting.