Legislative initiatives related to nursing education include efforts to recruit and retain nurses as well as support competence and quality care.
The growing nursing shortage is impacting every aspect of the U.S. healthcare delivery system.
Absent aggressive intervention, the Health Resources and Services Administration (HRSA) projects that by 2020 the shortage will grow to more than 1 million RNs—representing a shortage of 36 percent.
The Bureau of Labor reports that nursing will have the second greatest job growth of all U.S. professions in the time period spanning 2004–2014, which has led to a renewed interest. However, in FY 2007, HRSA turned away 96% of qualified applicants for the nursing scholarship program due to inadequate funding. http://bhpr.hrsa.gov/nursing/scholarship/
Several states have introduced legislation to address nursing education, much of which has included appropriations to either create a new nursing education program or to expand capacity of an existing program, or to provide funds for nursing scholarships and/or loan forgiveness to qualified candidates.
Nursing Education Advancement—What Is It?
There are four nursing education programs leading to eligibility to sit for the licensing exam for authority to practice as a registered nurse: (1) hospital-based diploma, (2) hospital-based or community college associate degree, (3) bachelor's degree, and (4) master's degree; the latter (#4) is a less common entry point.
State legislative initiatives and action taken during the 2008 American Nurses Association's (ANA) House of Delegates has resulted in a renewed discussion related to nursing education and a different approach to advancement.
The 2008 ANA House of Delegates RESOLVED, that the American Nurses Association support initiatives to require registered nurses (RNs) to obtain a baccalaureate degree in nursing within ten years after initial licensure, exempting (grand-parenting) those individuals who are licensed or enrolled as a student in a nursing program at the time legislation is enacted; and be it further RESOLVED, that the American Nurses Association advocates for and promotes legislative and educational activities that support advanced education in nursing. ANA's efforts to influence nursing education date back to 1965.
Brief History of ANA's Position on Nursing Education
Passage of the Comprehensive Nurse Training Act in 1964 prompted the American Nurses Association (ANA) Committee on Education to study nursing education, practice and scope of responsibilities. At the time, the study recognized the increasing complexity of health care and changes in practice, raising concerns about hospital - based diploma education programs. Subsequently, in 1965, the ANA Board of Directors adopted the Committee on Education's statement, which became ANA's “position paper” and contained the recommendation that the “minimum preparation for beginning professional nursing practice should be baccalaureate degree education in nursing. The position paper noted that the educational programs of the time prepared workers for current practice and structures, not for the future. Also contained within the position paper was the description of three levels of nursing education: baccalaureate education for beginning nursing practice, associate degree education for beginning technical nursing practice, and vocational education for assistants in the health service occupations.
The 1965 ANA position paper was later reaffirmed by a 1978 ANA House of Delegates resolution which resulted in the recommendation that by 1985 the minimum preparation for entry into professional practice would be the baccalaureate degree. The designation of two levels of nursing practice, professional and technical, was reaffirmed. What was envisioned to be an orderly transition to an educational system of two levels and subsequent differentiated practice never occurred.
Practice has continued to evolve with increased specialization, greater demands related to technology, paperwork, and responsibility for coordinating and supervising care provided by other workers. Declining reimbursement rates have had a great influence on staffing patterns. Nurse positions have been eroded with nurse extenders (assistive personnel) filling positions previously designated for nurses; leading to fewer nurses supervising more assistive personnel in provision of care for increasingly complex patients.
Why Seek Legislation Or Regulations That Would Require A Nurse To Attain A Baccalaureate Degree In Nursing Within Ten Years Of Initial Licensure?
This approach continues to recognize all educational entries into the profession while acknowledging the changing healthcare environment and associated competencies necessary to adapt to those changes.
An incremental approach permits those choosing to enter the profession with a diploma or associate degree to pursue additional skill sets while strengthening entry level competencies: moving from novice to expert.
Nursing education advancement with work experience can result in greater relevance for the learner.
Baccalaureate nursing education is intended to result in a deeper understanding of the cultural, political, economic, and social issues that affect patients and influence health care delivery. Coursework offered at the baccalaureate level include such areas as healthcare economics, health informatics, health policy, leadership, and research.
It is also known that:
Research has revealed the relationship between advanced education and patient outcomes, such as lower patient mortality.
Baccalaureate prepared nurses are more likely to report higher job satisfaction scores in relation to opportunities for growth, and to remain in practice longer than others.
Increasingly more complex healthcare needs of a multi cultural and aging population underscores the need for advanced education.
A stronger theoretical base and foundation in nursing research is needed as a result of the shift to evidenced based practice and expansion of more sophisticated technologies, pharmacologic and other treatment modalities.
Sound leadership skills are essential for case management, as well as to support the ability to delegate and supervise care provided by dependent practitioners (LPNs) and nurse extenders within the framework of varying care delivery models.
There is a shortage of nursing faculty and subsequent limited cadre of nurses from which to draw.
Advanced education will better enable nurses to practice as full partners on a multidisciplinary team, given the education advancement of a number of other health professions: Social workers - master's degree; Physical therapists – master's degree in 2002, doctoral required by 2020; Pharmacists – PharmD has replaced the bachelor of pharmacy degree.
The military (US Army, Navy and Air Force) require a baccalaureate degree for nurses on active duty. The Veteran's Health Administration requires a baccalaureate degree for nurses wishing to advance beyond entry level appointment. Internationally, the baccalaureate degree in nursing is required upon entry into the profession in the Philippines, Australia, Ireland, and half of Canada's provinces. The Royal College of Nurses voted to support a transition to require a university degree for professional nursing practice.
A recommendation that at least 2/3 of the nursing workforce hold a baccalaureate degree or higher by 2010 was presented to Congress by the National Advisory Council on Nursing Education and Practice (a group appointed by the Secretary of Health and Human Services)
Since 2005, legislation requiring nursing education advancement resulting in a BSN within ten years of inital licensure has been introduced in three states (NY, NJ, RI).
2013 Session, so far......
- New Jersey AB 553 / SB 1258
- New York AB 3103 / SB 628
An Increase In The Number Of Nurses With Baccalaureate Degrees Is Linked To Lower Rates Of Post-surgery Mortality Ann Kutney-Lee, Douglas M. Sloane and Linda H. Aiken Health Affairs, Vol. 32, No. 3: 579-586 (March 2013)
An Institute of Medicine report has called for registered nurses to achieve higher levels of education, but health care policy makers and others have limited evidence to support a substantial increase in the number of nurses with baccalaureate degrees. Using Pennsylvania nurse survey and patient discharge data from 1999 and 2006, we found that a ten-point increase in the percentage of nurses holding a baccalaureate degree in nursing within a hospital was associated with an average reduction of 2.12 deaths for every 1,000 patients—and for a subset of patients with complications, an average reduction of 7.47 deaths per 1,000 patients. We estimate that if all 134 hospitals in our study had increased the percentage of their nurses with baccalaureates by ten points during our study’s time period, some 500 deaths among general, orthopedic, and vascular surgery patients might have been prevented. The findings provide support for efforts to increase the production and employment of baccalaureate nurses.
Baccalaureate Education in Nursing and Patient Outcomes Mary A. Blegen, Colleen Goode, Shin Hye Park, Thomas Vaughn, Joanne Spetz JONA, Vol. 43, No. 2 (February 2013)
A study examined the relationship between registered nurse (RN) education and nurse-sensitive patient outcomes. It was revealed that hospitals with a higher percentage of RNs with baccalaureate of higher degrees had lower congestive heart failure mortality, decubitus ulcers, failure to rescue, and post operative deep vein thrombosis of pulmonary embolism and a shorter length of stay.
Advanced nursing education tool kit
: briefing paper, strategic action plan; model bill and talking points is available to members.
Mandatory Continuing Education
Another approach used to support nursing competence and quality care is mandatory education for RNs for license renewal/re-registration.
Disclaimer: Every effort has been made to include all legislation enacted, but omissions are possible.