Hospitals and nursing schools: A symbiotic relationship

"It is a symbiotic relationship. The hospital is continually helping the educational organization to define what competencies nurses need to demonstrate...Hopefully, what the educational entity can give back to the hospital is assistance with such things as continuing education, research development, and assistance with evaluation of programs."

This content is sponsored by Capella University

The Institute of Medicine set a goal in its 2010 report The Future of Nursing: To have 80 percent of registered nurses hold a bachelor's degree or higher by 2020. This is an ambitious goal to achieve, especially considering that, at that point, less than half of practicing RNs in the United States held BSNs or higher, according to F. Patrick Robinson, PhD, RN, FAAN.

Dr. Robinson is the dean of the School of Nursing and Health Sciences at Capella University, a role he took on earlier this year. Capella's healthcare offerings include undergraduate and graduate degrees in nursing, healthcare administration, and public health.

Here, Dr. Robinson discusses why having a highly educated nurse workforce is of upmost importance and how organizations that employ nurses can work with academic institutions to help them meet their 80/20 goals over the next five years.

Q: What was the impetus behind the IOM's recommendation that 80 percent of nurses have a BSN by 2020?

Dr. Patrick Robinson: The idea was not new, but despite great effort, the ability to make it happen legislatively had always failed. Prior to the release of IOM's The Future of Nursing report, there were seminal research findings that there is an incremental decrease in mortality as the percentage of nurses with BSNs goes up.

Additional research at the time suggested there is decrease in "failure to rescue" with a more educated nurse workforce. The "failure to rescue" outcome rate goes down as the percentage of baccalaureate-educated nurses increases.

But it's been a long time since the report was released. Further research has been done since then, and the call for more education is even stronger now. The research is international: There have been well-controlled studies in Australia, Asia and Europe showing the same sort of outcomes but even more findings, such as that the occurrence of certain post-operative complications goes down when higher percentages of nurses have baccalaureate degrees. There has been a host of research since the report which points to the need for baccalaureate-prepared nurses to increase the safety and the quality of care.

I think an interesting aside is I've been a nurse for 25 years and the thought had always been that it would be through legislative action that this push would occur, but it has been through market pressure. The fascinating part is that employers have turned the tide without the hand of the regulators. Employers are now demanding it, and that's pretty extraordinary. Nurses have been fighting for this decade after decade, but now it's the hospitals and employers that understand what we've been saying for half a century.

Q: How much progress do you think has been made toward this goal?

PR: Quite a bit actually. In 2010, the percentage of practicing nurses with a baccalaureate degree was 49 percent. Today that percentage is closer to 60. That's quite a dramatic jump since the publication of the IOM report. We had never been able to cross that 50 percent mark.

Whether or not we can get to the 80 percent, I'm not sure. Things are starting to slow down now, so whether or not the goal remains aspirational or achievable by 2020 remains to be seen. We've long had the evidence, but now there is widespread acknowledgement that it's in the best interest of society to move down this road.

Q: What are some barriers to reaching the 80/20 goal?

PR: The obvious one is cost. Baccalaureate education is more expensive than education at a community college. The community college system plays an incredibly important role in educating our populous and nursing has been a part of that since after World War II. It's an entre into the profession for many individuals. It can bring you to full licensure as an RN in a more economical way with a little less time. Associate degree nursing programs are probably closer to three full years than they are to two, but cost is certainly one, and time would be somewhat associated with that.

Accessibility is another problem. Even though a lot of individuals may desire to have a bachelor's after they complete their associate degree, the number of programs that make that accessible are still fewer than we would hope.

The third would be that there's still a need and desire for a nurse's first degree to be baccalaureate as opposed to a step progression. We hit a bottleneck. It's extremely challenging to provide pre-RN licensure education today. We need to expand capacity of the number of clinical training spots and the availability of clinical faculty. Innovation and new ways of thinking about clinical nursing education are also sorely needed.

Q: Beyond the IOM's recommendation, why would a hospital be interested having a more highly educated nurse workforce?

PR: Safety and quality. There's another market driving factor called the Magnet designation. It's a prestigious designation and it signifies that nursing matters at Magnet-designated hospitals and healthcare agencies. It's not easy to obtain the designation, but when hospitals do obtain the designation of Magnet — which does include demonstrating active efforts to increase the number of baccalaureate-prepared nurses — it becomes a source of pride and a status symbol, and means by which they can attract nurses. We're always teaching graduates that they should look for Magnet status or for a hospital to be on the Magnet journey when they are looking for jobs. There's no better external validation for nursing than Magnet. That's something I would always tell my students to look for and urge them to discuss during the interview process why a hospital may not be on that journey if they encounter one that's not.

Q: What is an example of a great partnership between a school and a nurse employer? What made it successful?

PR: If you think about it, there is an education/practice gap. And that should make sense — it's hard to teach students exactly everything they need to be competent on their first day of work. One of the things I think is incredibly important to nursing in general is to create those robust academic-practice partnerships. A leading initiative of the American Association of Colleges of Nursing and the American Organization of Nurse Executives is to promote those relationships.

It is a symbiotic relationship. The hospital is continually helping the educational organization to define what competencies nurses need to demonstrate. Those change pretty rapidly, and certainly academic course materials can't keep up on that, so engagement of practice partners to continually define what we should be assessing in the students is important. Hopefully, what the educational entity can give back to the hospital is assistance with such things as continuing education, research development, and assistance with evaluation of programs. Additionally, educational institutions need clinical training space for all levels of nursing education.

There should be academic-practice partnerships; we're a practice-based discipline. Without the connection of one to the other, it doesn't make sense — this is often the case but it doesn't make sense.

Q: Why wouldn't a hospital want to have such a partnership?

PR: There should be no reason they wouldn't want to, but there are a lot of choices out there. It's incumbent upon the educational institution to make sure they're bringing real value to the hospital partner, and I guess vice versa. Hospital leaders have a vested interest in narrowing the education-practice gap and academic leaders want their graduates to be the employee of choice. From the hospital perspective, when the gap is wide it can be very expensive to develop nurses to the desired level of competency.

Q: Is there anything you'd like to add about advancing the education of nurses?

PR: We focus a lot on the BSN goal within the IOM's report, and they do call out that 80/20 percentage, but if you read the whole report, it's calling for a highly educated workforce. In addition to needing the number of baccalaureate grads, we need nurses with graduate degrees as leaders and advanced practice nurses like nurse practitioners. That's going to be enormous as we move forward. The Affordable Care Act has ensured health insurance coverage for an additional 16 million people in the U.S. Optimally, all those people will access primary care services. Research has consistently demonstrated that most of that primary care can be delivered by nurse practitioners at a reduced cost at an equivalent or better level of quality. Plus, we desperately need nurses committed to educating our future nursing workforce through faculty roles.

We need to be encouraging nurses to take the next step in their educational journey regardless of their current degree status. Furthermore, we need to make that educational mobility affordable, accessible and desirable.

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