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67 Executive Briefing: Future of the Nurse Workforce Sponsored by: T he 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 am- bitious 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 Sci- ences at Capella University, a role he took on earlier this year. Ca- pella'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. Question: What was the impetus behind the IOM's recom- mendation 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 re- search 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 show- ing 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 de- grees. 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 legisla- tive 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 re- mains aspirational or achievable by 2020 remains to be seen. We've long had the evidence, but now there is widespread ac- knowledgement 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 commu- nity college system plays an incredibly important role in edu- cating our populous and nursing has been a part of that since after World War II. It's an entre into the profession for many in- dividuals. 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 as- sociated with that. Accessibility is another problem. Even though a lot of individuals may desire to have a bachelor's after they complete their associ- ate 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 progres- sion. 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 hospi- tal be interested having a more highly educated nurse work- force? 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 num- ber of baccalaureate-prepared nurses — it becomes a source of Hospitals and Nursing Schools: A Symbiotic Relationship