The Future of Nursing: Leading Change, Advancing Health, the seminal 2010 report from the Institute of Medicine (IOM), called for 80% of nurses to have at least a bachelor of science in nursing (BSN) by 2020. Even though research has shown that increasing the number of nurses with baccalaureates improves in-hospital mortality rates, whether there is a business case to be made for that 80% figure is unclear. A new single-hospital, patient-level study suggests that the answer is yes.
The seven-month study followed 8,500 medical or surgical patients at an academic medical center with 1,500 nurses. Yakusheva and colleagues used electronic medical records to compare outcomes of care according to increasing proportions of nurses with BSNs, examining both a 10% increase and the 80% mark. As has been seen before, a 10% increase in the proportion of care provided by nurses with BSNs improved mortality rates, in this case by 11%, and when the BSN proportion was 80%, hospital stays were 2% shorter and readmission rates dropped 19%.
Moreover, raising BSN staffing to 80% would return an estimated $5.6 million in yearly savings to the hospital.
“The study makes the case for potentially large and sustainable financial gains from hiring more BSN-educated nurses,” says lead author Olga Yakusheva, PhD, an economist at the University of Michigan School of Nursing.
Even though the study shows that hiring more nurses with BSNs improves a hospital's financial bottom line, a nurse with a baccalaureate earns only about $5,000 more per year than one with an associate's degree. In most other occupations, Yakusheva told AJN, “baccalaureate-prepared individuals make $15,000 or more than associate-level graduates.” This lack of financial reward, she says, discourages nurses from furthering their education.
Boosting the proportion of nurses with baccalaureates to 80% makes strong business sense and “should serve as a catalyst to hasten a transition that has been a long time in the making and remains in the public's interest,” writes Linda Aiken, Claire M. Fagin Leadership Professor in Nursing, professor of sociology, and director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania in Philadelphia, in a commentary on Yakusheva's innovative study. The $5.6 million gain at the study hospital would more than offset the $1.8 million estimated cost of hiring and training an 80% BSN workforce.
Only about half of U.S. nurses have BSNs, and 10% of hospitals have nursing staffs in which 20% of nurses or fewer have BSNs. Few hospitals are on target to reach the IOM's 80% goal, and “getting close to 70% BSNs on staff is now considered exemplary stewardship,” says Yakusheva.
All patients deserve high-quality care, and investing in nurses’ education improves patient outcomes and increases hospitals’ income. “Passing some of these financial gains [on] to nurses with BSNs, via greater pay increases,” says Yakusheva, “could be a win–win proposition.”—Carol Potera
Yakusheva O, et al. Med Care. 2014;52(10):864–9Aiken LH Med Care. 2014;52(10):861–3