Qualifications, training, and level of education remain highly debated topics among nurses. Even though acuity in hospitals continues to climb and nursing care remains more challenging and complex, many hospitals struggle with the thought of exclusively hiring BSN-prepared nurses. Evidence has repeatedly demonstrated that organizations with a higher percentage of BSN-prepared nurses achieve better patient outcomes, including lower mortality, a decrease in failure-to-rescue rates, and fewer hospital-acquired infections.1 The literature also shows that an increase in education is directly correlated with decreased length of stay and better outcomes in surgical patients.2 In addition, a meta-analysis exploration of BSN degrees and patient outcomes determined that higher BSN degree rates led to decreased failure-to-rescue and mortality and improved patient outcomes.3
The National Academy of Medicine (formerly the Institute of Medicine) Future of Nursing report included the key message of “nurses achieving higher levels of education and training through an improved education system that promotes academic achievement.”4 Specifically, the recommendation was to increase the proportion of nurses with a baccalaureate degree to 80% by 2020. However, given the impending nursing shortage and identified barriers, such as financial implications and time, to obtaining a BSN degree, there's often hesitancy to recruit solely BSN-prepared nurses.5 Our pediatric academic medical center, located in Pittsburgh, Pa., began to strategize ways to meet this goal and help nurses aspiring to the BSN degree overcome these barriers.
This article describes a program that sets the vision for achieving 80% BSN-prepared nursing staff. Key objectives for the program included developing strategic goals, holding nurse leaders accountable, executing recruiting strategies, and providing financial support. (See Figure 1.)
Setting the vision
First, we worked to develop a plan for the program. Our CNO, in collaboration with the senior nursing leadership team, developed several strategic planning sessions in which leaders and frontline staff worked together to ensure consensus. These collaborative sessions were necessary for the group to understand and establish the “why.” Goals were established to help decrease infection rates, morbidity, and mortality, and staff understood the vision and plan to reach 80% BSN-prepared nurses with the understanding that evidence has demonstrated improved patient outcomes.
Strategic goals and targets
The overarching strategic goal of this project seemed simple: to increase the percentage of BSN-prepared nurses in the organization. However, the complexities of turnover, vacancy, nursing shortage, faculty shortage, and baseline number of BSN-prepared nurses had to be factored into the equation when projecting targets for each department. It was important for our organization to specify, by department, the baseline and target goal of BSN-prepared nurses to ensure that the organization could meet the overall goal. Once each unit's target was identified, we then projected the number of years it would take to reach the recommendation of 80% BSN-prepared nurses in the organization.
Nurse leader accountability and the call to action
An essential component of success in reaching 80% BSN-prepared nurses was holding nurse leaders accountable to meet their department's specific goals. Each department was given annual targets and a strategy to meet their goals. Nurse leaders were held accountable for recruiting, hiring, and retaining BSN-prepared nurses through tactics such as a hiring “bench” in collaboration with our talent acquisition department, an annual nursing open house, messaging during interviews regarding BSN degree attainment within a defined time frame, the use of tuition reimbursement to support educational advancement, and the use of career ladders for professional development. Accountability metrics were then integrated into each nurse leader's individual yearly goals.
To ensure that employees at all levels of the organization were educated on the call to action to increase BSN degree rates, it was imperative that nurse leaders could articulate the evidence on why organizations choose to hire and retain more BSN-prepared nurses. This information was then communicated to all levels, including our organization's board of directors, executives, and frontline staff, via meetings, town hall sessions, and informal rounding.
Specific recruiting strategies
A variety of recruiting and hiring practices exist related to BSN-prepared nurse hiring. Some organizations require a BSN degree for new hires, whereas some require a signed agreement that the newly hired nurse will return to school and complete a BSN degree within a certain time frame. Requiring nurses to have a BSN degree upon hiring is challenging for many organizations given regional nursing shortages. Our organization worked with human resources and talent acquisition to develop a recruiting strategy that utilized new hiring tactics to increase BSN degree rates. For example:
- Primarily recruit BSN-prepared nurses with the understanding that there will be some candidates without a BSN degree hired.
- If a nurse leader wants to hire a nurse without a BSN degree, the leader must discuss the rationale with the chief nurse who may challenge the leader on the candidate pool and the candidate's commitment to return to school before approving the hire.
- Require nurse leaders to tell candidates without BSN degrees during the interview that they're expected to return to school for their BSN. This may or may not include a signed agreement.
The importance of role modeling
Leaders were expected to serve as role models and pursue their own academic advancement as part of this initiative. At minimum, all nurse leaders were required to obtain a master's degree in nursing or another health-related field, as well as a national nursing certification. Elevating nursing excellence in an organization begins with leadership's desire to better their own individual performance through advanced knowledge and education.
Overcoming financial barriers
It's apparent that some nurses who desire to advance their education feel trapped by the financial burden. At our organization, tuition reimbursement provided one avenue of funding to help support the expense, as well as developing scholarships as an additional source of funding. Another tactic to decrease financial burden was to involve local universities and offer tuition discounts. In addition, we offered a salary differential for BSN-prepared nurses to help offset the expense.
In 2009, our pediatric academic medical center moved toward initial Magnet® recognition and began making changes to thoughtfully increase BSN- and graduate-prepared nurses based on the key strategies we identified. From 2009 to 2018, nurses possessing a BSN degree or higher increased 38%. Specifically, 61% of our nurses had a BSN degree in 2009. By 2018, we reached 84%. In addition, all nurse leaders hold a BSN degree and all leaders overseeing a patient care unit hold a master's degree and national certification.
Given this steady increase, nursing leadership is confident that the organization will reach its stretch goal of 90% BSN-prepared nurses by 2020. (See Figure 2.)
Although achieving our goal is monumental, it's imperative to sustain the culture through innovation and organizational support. Nurse leaders must collaborate with frontline staff, human resources, and executive leadership to develop tactics to achieve this goal. In addition, developing strong, strategic partnerships with schools of nursing to support staff members advancing their education is paramount to the success of creating a nursing workforce equipped to face the challenge of a more complex healthcare environment. These partnerships can include reduced tuition, tuition advancement, and onsite class cohorts at the organization instead of at the university.
As organizations strive to meet the recommendation of 80% BSN-prepared nurses by 2020, our pediatric academic medical center has developed a strategic plan with tactics to support and attain this goal. Working collaboratively with internal and external partners, organizations can successfully recruit and retain BSN-prepared nurses to improve patient outcomes. By setting a vision and executing thoughtful strategies, leaders and staff work collaboratively to achieve and demonstrate success.