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Journal of Nursing Administration:
doi: 10.1097/NNA.0b013e31829d60b1

An Essential Next Step for Nursing

Zimmermann, Deb DNP, RN, NEA-BC

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Author Affiliation: Chief Nursing Officer and Vice President of Patient Care Services, Virginia Commonwealth University Health System, Richmond, VA; Chair, Commission on the Magnet Recognition Program, Silver Springs, MD.

The author declares no conflicts of interest.

Correspondence: Deb Zimmermann, Virginia Commonwealth University Health System, 1250 East Marshall Street, PO Box 980510, Richmond, VA 23298-0510 (;

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

Nursing is valued for specialized knowledge, skill, and caring in improving the health of the public and ensuring safe, quality care.1,2 These concepts define professional nursing practice and serve as a guiding compass for all clinicians. Professional nursing is based on a social contract from which the nurse is granted privileges and, in turn, is accountable to the public. Changes in the population and the community directly impact the profession. Advances in technology, public demand for improved clinical outcomes, and the need for new models of care have accelerated the need for nurses with the skills and knowledge to manage a challenging healthcare environment.

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If nurses are to possess the capabilities to manage in complex systems, they must be educated in systems theory and the frameworks for translation of new knowledge to practice. Competencies in leadership, healthcare policy, population health, and evidence-based practice will be expectations for all nurses. Experts have demonstrated a correlation between higher levels of nurse education and improved patient outcomes3-8 and recommended the redesign of nursing curriculum and education standards.9-12 In 2010, the Institute of Medicine’s (IOM) Future of Nursing report set a bold goal and challenged the profession to achieve an 80% baccalaureate degree (BSN) in the nursing workforce by 2020.12 The authors of the IOM report established this target after an assessment of progress on education progression among academic institutions and availability in registered nurse (RN) to BSN programs across the country.12 After a comprehensive review of the literature and consultation with experts, the Commission on Magnet Recognition® (the Commission) established a standard that effective June 2013, all applicant and redesignating organizations are required to develop an action plan and set a target, demonstrating progress toward having 80% of RNs obtain a BSN or graduate degree in nursing by 2020.13 Magnet® organizations have a history of leading change and facilitating innovation.14 The Commission holds the opinion that to be full partners in leading healthcare reform and designers of new systems impacting population health, nurses need the foundation of BSN preparation.

New education models and partnerships are flourishing throughout the country. In North Carolina, transformational nursing leaders from community colleges, universities, and healthcare organizations have blended the associate degree (AD) and BSN into an innovative regionally based program.15 Dually enrolled in a community college and university, students attend 3 years at the community college, completing general education classes and obtaining their AD. Students then sit for the NCLEX and work part-time as RNs at participating healthcare organizations. Graduates acquire their BSN degree after a 4th and final year at a university. It is expected that by 2020, 55 community colleges and 15 universities across North Carolina will offer this innovative option. Collaboration beyond traditional articulation agreements became a reality because dedicated nurse leaders removed old institutional barriers.15

In Florida, 9 community colleges award BSNs, and at least 3 other states are working on similar strategies.16 In Virginia, 16 Magnet organizations piloted a predictive modeling tool developed by J. Cain and D. Zimmermann (unpublished data, 2012) that allows frontline managers and organizational leaders to accurately forecast the impact of policy changes on education progression of the workforce (see Document, Supplemental Digital Content 1, More than 2000 nurses have learned to use the model, and Virginia chief nursing officers (CNOs) agreed to institute workforce policies on education progression.17 Policies vary depending on individual organizational needs and demographics, but in a recent survey of CNOs, a growing number of employers have established timelines requiring new nurses to complete a BSN within 3 to 5 years of hire.18 Employers are offering onsite collegiate education, advancement opportunities through clinical ladders, and flexible scheduling for students. In every state, nurses are collaborating and implementing strategies tailored to their unique environments.16 The work of state coalitions from the Future of Nursing Campaign for Action ( highlights strategies that are under way across the country.

As the nation’s largest group of licensed healthcare professionals, nurses play a pivotal role in the design, delivery, and transformation of healthcare. An investment in education serves the nation’s health and advances the greater good. Supporting BSN education is an essential next step in the progression toward a more educated nursing workforce. Nursing is positioned to assume a leadership role in healthcare reform, and it is up to nursing to raise the standards so that the vision becomes a reality.

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1. American Nurses Association. Nursing’s Social Policy Statement. 2nd ed. Washington, DC: American Nurses Association; 2003.

2. American Nurses Association. Nursing’s Social Policy Statement: The Essence of the Profession. 3rd ed. Silver Spring, MD: American Nurses Association; 2010.

3. Aiken LH, Clarke SP, Cheung RB, Sloane DM, Silber JH. Educational levels of hospital nurses and surgical patient mortality. JAMA. 2003; 290 (12): 1617–1623.

4. Blegen MA, Goode CJ, Park SH. Baccalaureate education in nursing and patient outcomes. J Nurs Adm. 2013; 43 (2): 89–94.

5. Estabrooks CA, Midodzi WK, Cummings GG, Ricker KL, Giovannetti P. The impact of hospital nursing characteristics on 30-day mortality. Nurs Res. 2005; (2): 74–84.

6. Friese CR, Lake ET, Aiken LH, Silber JH, Sochalski J. Hospital nurse practice environments and outcomes of surgical oncology patients. Health Serv Res. 2008; 43 (4): 1145–1163.

7. Tourangeau AE, Doran DM, Hall LM, et al. Impact of hospital nursing care on 30-day mortality in acute medical patients. J Adv Nurs. 2007; 57 (1): 32–44.

8. Lee A, Sloane DM, Aiken LH. An increase in the number of nurses with baccalaureate degrees is linked to lower rates of postsurgery mortality. Health Aff. 2013; 32 (3): 579–586.

9. American Association of Colleges of Nursing. Essentials of baccalaureate education for professional nursing practice. 2008. Accessed May 1, 2013.

10. The National Advisory Council on Nurse Education and Practice. Meeting the Challenges of the New Millennium: Sixth Annual Report to the Secretary of the U.S. Department of Health and Human Services, Washington, DC; 2008. Available at Accessed July 1, 2013.

11. Benner P, Sutphen M, Leonard Y, Day L. Educating Nurses: A Call for Radical Transformation. Stanford, CA: The Carnegie Foundation for the Advancement of Teaching; 2010.

12. Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press; 2010.

13. American Nurses Credentialing Center. Magnet Recognition Program® FAQ: data and expected outcomes. 2013. Accessed May 1, 2013.

14. McHugh MD, Kelly LA, Smith HL, Wu ES, Vanak JM, Aiken LH. Lower mortality in Magnet hospitals. Med Care. 2012; 32 (8): 771–787.

15. Didow N, Bridges D. Foundation for nursing excellence: Regionally Increasing Baccalaureate Nurses in North Carolina (RIBN). Business case analysis and economic impact. 2013. Accessed May 1, 2013.

16. AARP and the Robert Wood Johnson Foundation. Initiative on the Future of Nursing. Campaign for Action. 2013. Available at Accessed May 1, 2013.

17. Zimmermann D. A more highly educated workforce. A model for the future. Presented at: Meeting of the Virginia Magnet Consortium. March 2011; Roanoke, VA.

18. Goodloe L, Bodin S. A survey of Virginia chief nursing officers on education progression. Presented at: Meeting of the Virginia Action Coalition. December 2012; Richmond, VA.

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