Spokane Journal of Business

Working toward a more educated RN workforce

Goal is for more nurses to earn four-year degrees

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Washington state’s nursing leaders are continuing to make momentous progress toward reaching the national goal of creating a highly educated, diverse nursing workforce that will be better prepared to take care of all people now and in the future. 

With the rise of chronic conditions such as diabetes, asthma, and heart disease, which now affect almost half of all Americans, care is more complex in every setting—hospitals, home, skilled-nursing facilities, ambulatory care, and clinics. And because of that complexity, there is an increased demand for nurses with a Bachelor of Science in nursing (BSN) and graduate degrees.

The Washington Center for Nursing received the two-year, $300,000 Academic Progression in Nursing grant from the Robert Wood Johnson Foundation in 2012. Since then, we have focused on efforts to meet the Institute of Medicine’s recommendation of increasing the percentage of registered nurses with a baccalaureate degree or higher to at least 80 percent by 2020—our state average is currently 53 percent.

More evidence points to BSN-prepared nurses as the key to achieving high-quality care, improved health outcomes, and lower costs—the triple aim of health care reform. Research has shown that lower mortality rates, fewer medication errors, and positive outcomes are all linked to nurses prepared at the baccalaureate and graduate-degree levels. 

In a recently released study, “Economic Evaluation of the 80% Baccalaureate Nurse Workforce Recommendation: A Patient-Level Analysis,” researchers found that a 10 percent increase in the proportion of BSNs on hospital units was associated with lowering the odds of mortality by 11 percent. 

Dozens of similar national and international studies echo these findings. Associate degree in nursing (ADN) programs equip students with essential nursing skills, and the baccalaureate education enhances both clinical competency and care delivery. BSN students are immersed in community health, care coordination, research, informatics, and leadership, all of which prepare them to be strategic, critical thinkers who practice preventive care in interprofessional environments. 

Seamless pathways

Moving to a BSN has been riddled with credit redundancies and delays for many nurses in Washington, due to differences among academic institutions over how credit hours are determined, what courses are required for acceptance, limits on the number of transferrable credits, and other variations. 

But nurses and nursing students in our state will soon have an easier time getting their BSN, thanks to the collaboration between nurse leaders and the state community and technical colleges and four-year universities, which the Academic Progression in Nursing project bolstered. 

Last March, the academic institutions reached a landmark deal called the associate in nursing direct transfer agreement. The degree streamlines the number of credits required for an associate degree in nursing and decreases the time and cost to earn a BSN degree. Several “early adopter” colleges and universities are now working on implementing the degree, and future students who will be admitted to a community or technical colleges that offer the degree could enjoy the new pathway as early as September 2015 on some campuses.

Having acquired a second $300,000 grant this summer, we’re focusing on collaborating with nursing employers across the state to develop strategies and policies that promote academic progression in the incumbent workforce. 

We have begun working with major hospital/system employers from different regions of our state. Deaconess Hospital/Rockwood Health System and Pullman Regional Hospital are representing Eastern Washington. They will help us gather and share information about the policies or practices that are working in their hospitals, as well as the challenges or barriers they’ve encountered in this work. Together, we will collaborate in developing effective tools to help institutional leaders statewide promote and support academic progression for their nurses.

Another crucial aspect to quality nursing care is increasing diversity and inclusion in the nursing profession. For instance, while comprising 17 percent of the U.S. population, in 2013, Latinos made up just 3 percent of the nursing workforce, according to a survey by the National Council of State Boards of Nursing and the National Forum of State Workforce Centers. 

With the changing demographics of our state, nurses need to understand, reflect, and value the diversity of the communities they serve, and have the ability to provide culturally appropriate care. To support this effort, WCN launched a yearlong diversity mentoring pilot program, which paired nursing students and new nurses from underrepresented minority groups with experienced nurses to support them as they start their careers. 

While responding to these emerging demands in health care, we’re also keeping a close watch on the fluctuating statewide workforce data. Many new graduates pursue hospital jobs, assuming that only an acute-hospital environment will help anchor their core knowledge and competencies. However, many care settings offer similar opportunities. 

For example, new nurses in long-term care hone their skills in assessing and managing changes in cognition, providing person-centered care, dealing with end-of-life care support, and supervising other staff. Recent national research reflects a dramatic increase in the numbers of younger RNs seeking employment outside of the hospital, as care moves to other settings. 

Although new RN graduates are having difficulty finding jobs in some areas in Washington, and hospital nurse vacancies are down, this isn’t an indication that the nursing shortage doesn’t exist. The nursing shortage has been distorted by the economic crisis: Experienced nurses have been working extra shifts, switching from part-time to full-time employment, delaying retirement, and some that weren’t working in nursing had to return to work. 

The average RN in our state is 48, and a significant portion of our nurses is 50 and older. However, as the economy improves, and our aging baby boomer nursing workforce approaches retirement, the number of new RNs being educated to replace RNs who will retire is insufficient. Projections show that the demand for RNs will outpace supply in the next decade, and as many as 12,000 more RNs will be needed in Washington in 2031. We need to educate and retain more nurses. 

There are many challenges facing nursing, and many unknowns about health care in general, but collaboration, agility and innovation are some of nursing’s strong points. We will continue to work to ensure that the nursing workforce supports a healthy Washington.


Linda Tieman is the executive director for the Tukwila, Wash.-based Washington Center for Nursing.

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