WASHINGTON, D.C., May 14, 2010 – In light of the recent passage of healthcare reform legislation, the Tri-Council for Nursing has issued a timely consensus statement calling for all registered nurses to advance their education in the interest of enhancing quality and safety across healthcare settings. The Tri-Council organizations, including the American Association of Colleges of Nursing, American Nurses Association, American Organization of Nurse Executives, and National League for Nursing, are united in their view that a more highly educated nursing workforce is critical to meeting the nation’s nursing needs and delivering safe, effective patient care.
In the policy statement, the Tri-Council organizations state:
“Current healthcare reform initiatives call for a nursing workforce that integrates evidence-based clinical knowledge and research with effective communication and leadership skills. These competencies require increased education at all levels. At this tipping point for the nursing profession, action is needed now to put in place strategies to build a stronger nursing workforce. Without a more educated nursing workforce, the nation's health will be further at risk.”
Nurses with advanced education are needed in large numbers to serve as teachers, scientists, primary care providers, specialists, and leaders throughout the healthcare delivery system. The Tri-Council encourages all nurses, regardless of entry-point into the profession, to continue their education in programs that grant baccalaureate, master’s, and doctoral degrees. A wide variety of education options exist to further the preparation of today’s nursing workforce, including degree- completion, online, accelerated, and part-time degree programs.
The Tri-Council was compelled to issue this statement following an assessment of how best to prepare nurses for contemporary practice. Participating organizations, which represent nurses in practice, research, and academic settings, deliberated on many issues, including the need to meet workforce demands and prepare nurses for new models of practice; the complexity of the healthcare environment and patient care needs, and the imperative to address the nurse faculty shortage, which is limiting enrollment capacity in schools of nursing.
The policy statement ends with a call to action which advocates for system changes in nursing practice and education; for nurses to understand the importance of academic progression and embrace lifelong learning; and for policymakers at the state and federal levels to fund programs and launch collaborative initiatives that facilitate nurses seeking to advance their education.
EDUCATIONAL ADVANCEMENT OF REGISTERED NURSES: A CONSENSUS POSITION
A policy statement from the Tri-Council for Nursing:
American Association of Colleges of Nursing (AACN) American Nurses Association (ANA) American Organization of Nurse Executives (AONE) National League for Nursing (NLN)
The Tri-Council for Nursing has developed this document to inform key stakeholders of the urgent need for a more educated nursing workforce. The focus of this policy statement is on the educational advancement of the current and future nursing workforce to address the need for improved patient quality and safety. This message of common view is from the four diverse nursing organizations that collaborate together through Tri-Council. More nurses with baccalaureate and higher degrees are needed in all settings. The leaders of the profession acknowledge this reality and are now providing direction for academic progression through formal, degree-granting programs.
There are currently too few nurses choosing to advance their education. First is a need for education advancement to the baccalaureate level then to the graduate level to meet the urgent need for Advanced Practice Registered Nurses (APRNs) and nurse educators. Current healthcare reform initiatives call for a nursing workforce that integrates evidence-based clinical knowledge and research with effective communication and leadership skills. These competencies require increased education at all levels. At this tipping point for the nursing profession, action is needed now to put in place strategies to build a stronger nursing workforce. Without a more educated nursing workforce, the nation's health will be further at risk.
The Tri-Council supports advancing the educational preparation of nurses. Its leaders acknowledge that there are multiple access points into the nursing profession, and this consensus position directs advancement from the point of entry. Tri-Council members recognize that nurses enter the profession today from a wide variety of access points: Licensed Practical Nurse (LPN) progression programs; generic pre-licensure programs in diploma, associate degree, and baccalaureate programs; accelerated baccalaureate programs for graduates of non-nursing disciplines; and entry-level master’s programs. All of these options contribute to the diversity and expanding numbers of Registered Nurses (RNs) available to meet the nation’s need for nursing care. However, more nurses with advanced preparation are needed to meet the healthcare demands of an increasingly diverse and aging population. To make this happen, innovative and expanded educational opportunities are needed for nurses seeking preparation as APRNs, leaders, and educators. A more highly educated nursing profession is no longer a preferred future; it is a necessary future in order to meet the nursing needs of the nation and to deliver effective and safe care.
Developments Leading to Consensus Position
A. Future Workforce Demands
The complexity of care and the predicted shortage of RNs to provide that care drive the need for those nurses in the workforce to be better prepared. This is necessary in order to accommodate new models of care delivery, to coordinate the care of individuals with complex health problems across healthcare settings, and to teach future nurses in all types of nursing education programs.
B. Complexity of Health Care Environment and Patient Care Needs
The increasing complexity of technology, medical therapies and treatments, and chronic health conditions (in all age groups) underscores the need for nurses to be more highly educated. Increased education and advanced degrees will better prepare RNs to develop process improvements that address medical errors, reimbursement issues, navigating multiple systems of care, and other challenges in the healthcare delivery system. There is a growing body of research clearly demonstrating the relationship between higher educated nurses and patient outcomes. For example, one study showed that fewer patients die in hospitals with a larger percentage of more highly educated nurses.
The new healthcare reform agenda calls for new approaches to delivering care to chronically ill individuals and a greater focus on health promotion and disease prevention, which will require nurses to know research, care coordination, outcomes management, risk assessment, and quality improvement. These methods are core to professional nursing practice. In addition, quality, safety, and diversity of needs are critical to appropriate care, and new methods of care require competence in these areas. Nurses prepared in baccalaureate and higher degree programs are prepared to use a systems approach in addressing outcomes related to disparities that preclude quality care. These approaches require that nurses have advanced study and are prepared for system change implementation.
C. The Need to Address the Nurse Faculty Shortage
AACN and NLN data demonstrate current nursing faculty shortages. Advanced education opportunities will expand the pool of nurses able to pursue academic preparation to fill nurse educator roles and to continue adding to nursing research. The most recent data (National Sample Survey, 2004) reveal that too few nurses are pursuing graduate degrees needed to assume advanced roles. These data show that about 6.4% of those initially educated in associate degree programs and 11.7% of those prepared in diploma programs had obtained graduate degrees in nursing or related fields. Additionally, only 22.1% of nurses prepared initially in a baccalaureate programs had obtained post-RN master’s or doctoral degrees. To solve the need for faculty and more APRNs to manage new models of care, a greater majority of diploma, Associate Degree in Nursing (ADN) and Bachelor of Science in Nursing (BSN) graduates must pursue advanced study.
Call to Action:
A. System Changes in Nursing Practice and Nursing Education
Education: An increased emphasis on role development and professional accountability through continued academic education needs to be instilled in nursing graduates from all program types. Schools of nursing must collaborate to actively promote more streamlined models of progression to baccalaureate and graduate degrees including LPN to BSN, RN to MSN, and/or BSN to doctorate programs, among other routes. Clear and reasonable articulation agreements are needed so that educational progression is not repetitive of nurses’ previous education and experience and achieve the goals of accessibility and flexibility, regardless of educational delivery location and method.
Employers: Practice sites must implement programs of support for nurses who pursue baccalaureate and graduate degrees. These programs should include both financial and professional incentives.
Professional Associations: National nursing organizations must make a commitment to the academic progression of their membership as a cornerstone of their strategic plan.
B. Individual Responsibilities of Nurses to Access Advanced Education
Personal responsibility is critical to academic progression of the nursing profession. While regulation and licensure requirements can mandate educational advancement, a hallmark of professional accountability is action on the part of each member of the profession to be informed of the evidence, appreciate the urgency of the academic progression issue, and pursue academic progression in the manner best suited to the individual’s situation.
C. State and Federal Policy Initiatives to Promote Academic Progression
- State governments should work closely with their boards of nursing to ensure that educational standards remain high when considering legislative options to address the nursing shortage and meet workforce demands.
- State grant opportunities should be available for diploma, associate, and baccalaureate nursing programs to collaborate and develop comprehensive statewide articulation agreements to facilitate a seamless pathway for nurses to obtain BSN and graduate nursing degrees.
- The ability to reverse state nursing shortages is further inhibited by the demand for nurse faculty. Scholarships, stipends, and loan repayment opportunities should be created or continued to help support nurses pursuing graduate education with a preference given to full-time and doctoral nursing students who agree to teach full-time at an accredited school of nursing.
- State governments should partner with their nursing board, nursing programs, state nursing associations, hospitals, state hospital associations, and other stakeholders to enact legislation that supports the progression of nurses to advance their education. Advancing the education of nurses will strengthen the nursing workforce and better serve the community.
- Regulators and state law makers should support implementation of quality, innovative nursing program designs that facilitate academic progression.
The primary source of federal dollars for the profession is the Nursing Workforce Development programs (Title VIII, Public Health Service Act), which addresses all aspects of the nursing shortage— education, recruitment, retention, and practice. Over the years, rising educational costs, inflation, and stagnant funding levels have prevented the Title VIII programs from supporting sufficient numbers of nurses and nursing students. A larger investment must be made in these programs and, moreover, the dollars invested in Title VIII should give preference to nursing students enrolled full-time in RN-BSN, BSN, accelerated BSN, and graduate nursing programs.
From 1971 to 1978, Congress provided capitation grants (formula grants based on the number of students enrolled) to schools of nursing in support of nursing education. These grants allowed schools of nursing the flexibility to direct dollars to areas of greatest need, including hiring new faculty, upgrading equipment and clinical laboratories, and recruiting students. As a result, this type of program has had a stabilizing effect on past nursing shortages. Today’s schools of nursing need additional resources, particularly faculty, to educate the next generation of nurses.
Federal support is needed to recruit new nurses and retain them in healthcare settings. Nurse residency programs, in which a new nurse is provided a sustained training and mentorship program, have proven to be effective in improving nurse retention rates. A federal program should be created so that Medicare dollars are accessible for hospitals to create nurse residency programs. These programs allow new nurses to develop their skills and present a structured opportunity for diploma or associate degree nurses to continue their education through RN-BSN programs.
Advanced Practice Registered Nurses are in high demand given the need for primary care providers as well as the need for providers in rural and underserved areas. However, little funding is available for their clinical education. Therefore, the federal government should invest Medicare dollars in the training of APRNs.
The Tri-Council is an alliance of four autonomous nursing organizations each focused on leadership for education, practice and research. While each organization has its own constituent membership and unique mission, they are united by common values and convene regularly for the purpose of dialogue and consensus building, to provide stewardship within the profession of nursing. These organizations represent nurses in practice, nurse executives and nursing educators. The Tri-Council’s diverse interests encompass the nursing work environment, health care legislation and policy, quality of health care, nursing education, practice, research and leadership across all segments of the health delivery system.