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Examining the Beliefs of Skilled Nursing Facility Directors of Nursing Regarding BSN Completion and the Impact of Nurse Leader Education on Patient Outcomes

Holle, Cynthia L., DNP, MBA, RN; Sundean, Lisa J., PhD, MHA, RN; Dellefield, Mary Ellen, PhD, RN; Wong, John, PhD; Lopez, Ruth Palan, PhD, GNP-BC, FAAN

JONA: The Journal of Nursing Administration: February 2019 - Volume 49 - Issue 2 - p 57–60
doi: 10.1097/NNA.0000000000000710
Departments: Spotlight on Leadership

Research suggests that acute care patients cared for by baccalaureate-educated nurses have better outcomes. Directors of nursing (DONs) in skilled nursing facilities (SNFs) have lower rates of baccalaureate attainment than acute care nurses for unclear reasons. To understand the interest in advancing education, researchers surveyed SNF DONs in Connecticut to examine their beliefs about academic advancement and the impact of DON education on resident outcomes. Nearly 70% of participants with diplomas and associate degrees lacked interest in degree advancement and did not believe a baccalaureate degree is necessary for DONs or that DON level of education impacts resident outcomes. Alternatives to degree completion may include interventions to provide SNF DONs with skills for improving resident outcomes.

Author Affiliations: Advanced Health Services Research Fellow (Dr Holle), Center of Innovation in Long-Term Services and Supports, Providence VA Medical Center, Rhode Island; Assistant Professor (Dr Sundean), College of Nursing and Health Sciences, University of Massachusetts Boston; Research Nurse Scientist (Dr Dellefield), VA San Diego Healthcare System; and Clinical Professor (Dr Dellefield), Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, California; Assistant Professor (Dr Wong), School of Nursing, MGH Institute of Health Professions, Boston, Massachusetts; and Professor (Dr Lopez), University of Tennessee, Knoxville.

The authors declare no conflicts of interest.

Correspondence: Dr Holle, Center of Innovation in Long-Term Services and Supports, Providence VA Medical Center, 830 Chalkstone Ave, Bldg 32, Providence, RI 02908-4799 (

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