OO7 an action plan that includes a target and demonstrates evidence of progress toward 80% of registered nurses obtaining a baccalaureate or graduate degree in nursing by 2020. Include an assessment of the current status; an evaluation of methods and strategies to increase the educational level of the workforce; and an appraisal of established, realistic targets to meet the organization’s strategy to increase the number of registered nurses with a degree in nursing (baccalaureate or graduate degree).
Target
Homestead Hospital subscribes to the Institute of Medicine (IOM) recommendation of increasing the proportion of nurses with a baccalaureate or graduate degree to 80% by 2020 (IOM Recommendation: Future of Nursing, 2010).
Evidence of Progress towards Bachelor of Science in Nursing (BSN) or Graduate Degree Attainment
Homestead Hospital nurses utilize StepOne to enter their professional demographic information such as certification, educational attainment, professional activities and community outreach. It is a web-based program that enables them to access and update their information securely and conveniently 24 hours a day. As part of their annual performance evaluation requirement, nurses update their profile yearly and as needed, when there are changes in their professional activities. StepOne generates reports such as percentage of RNs with BSN and higher degree, which assists nurse leaders in monitoring and evaluating initiatives that support the 80% BSN and higher goal.
Based on reports generated from StepOne, the table below demonstrates a steady increase in the percentage of nurses with BSN and higher hospital-wide.
Year |
% Clinical RNs with BSN or Higher |
% Non-Clinical RNs with BSN or Higher |
Overall % of RNs with BSN or Higher |
Change from |
2011 |
41% (149/360) |
54% (68/125) |
45% (217/485) |
Baseline |
2012 |
45% (161/360) |
57% (75/131) |
48% (236/491) |
3% |
2013 |
46% (157/342) |
68% (88/129) |
52% (245/471) |
4% |
2014 |
54% (206/379) |
70% (82/116) |
58% (288/495) |
6% |
Assessment of Current Status
At the end of September 2014 (FY 2014), 51% of nurses had BSN, 6.5% with Masters of Science in Nursing (MSN), and 0.4% with Doctor of Nursing Practice (DNP) degrees with an overall BSN and higher degree percentage of 58%. There were 102 (21%) nurses pursuing their BSN and 11 (2%) pursuing their BSN without MSN. According to the StepOne report, by the time this group of nurses are finished matriculating, an estimated 81% of Homestead Hospital’s RN workforce would have BSN degree or higher. However, this number did not indicate when this target is going to be achieved. To obtain a more realistic projection, the Magnet Designation department collected information on the “expected graduation year” from their individual StepOne profile, their immediate supervisors, the on-site Scholars Program office and Human Resource (HR) department. The breakdown of the “expected graduation year” is as follows:
Expected Graduation Year |
2014 |
2015 |
2016 |
2017 |
2018 |
Total % of Nurses Matriculating |
Number of RNs |
22 (5%) |
48 + 2 *new hires in 2012(10%) |
20 + 27*new hires in 2013 (9%) |
8 + 18 *new hires in 2014 (5%) |
1 (0.2%) |
29% |
*Note: Nurses who are on boarded without BSN are expected to obtain it within 3 years of hire.
In order to delve further into the nurses’ motivation for going back to school, the Evidence-based Practice and Research Council (EBPRC) conducted a research titled, “Examining the Perceived Value of Certification and Education among Registered Nurses (RN)”. The council completed the study in June 2014. The results revealed that Homestead Hospital nurses who had a BSN tend to value both education and certification to a higher degree than did nurses who did not posses a BSN. Neither group (those who had a BSN and those who did not) thought that certification or education would help their career development or compensation levels. The researchers concluded that the motivation was largely driven by internal rewards (personal satisfaction...sense of professionalism, etc.) They finished the study by proposing another question: Given the costs associated with BSN and certification attainment, and given the perception that there are no external rewards for obtaining BSN/certification -- what type of and how much internal motivation does it take for individual nurses to work towards an advanced degree and certification? And...what can we do as an organization to help motivate nurses? The investigators shared the results of the studies and their recommendations in the Professional Development Council (PDC) and Unit Practice Council (UPC) Chair Collaborative meetings.
Evaluation of Methods and Strategies
Homestead Hospital has always had a strong focus on professional development as part of its culture. This strong thrust in education is clearly depicted in the Professional Practice Model with professional development as one of its components. Nurse leaders have encouraged and supported nurses to pursue further education through role modeling, flexible scheduling and ongoing conversations with their nurses. During the past 3 years, the organization has employed new strategies in order to meet the IOM goal.
- Changed the education requirement to BSN for Clinical Nurses – Through the recommendation of Patient Care Leadership Council (PCLC), consisting of Chief Nursing officers (CNO) across the system, Human Resources (HR) department revised the RN job description in February 2012 to reflect BSN as the preferred entry level educational requirement. This requirement is waived in certain “hard-to-fill” positions and only with the approval of the CNO so as not to cause staffing shortages, particularly in specialty areas such as Intensive Care Unit (ICU), Emergency Department (ED), Surgical and Perinatal Services. In this case, a contract is signed by the nurse delineating her agreement to the expectation of obtaining her BSN within 3 years of hire. (OO7 01 RN Job Description) Although Homestead Hospital’s turnover rate for nurses is below national benchmark averaging at 3% (Magnet benchmark for bed size 101-199 = 12.22%), this tactic is useful in replenishing the BSN pool due to attrition.
- Updated Tuition Reimbursement and Nurse Scholars Program Policy – The tuition reimbursement and scholars programs have been very successful programs in incentivizing nurses to go back to school with monetary tuition assistance. The Tuition Reimbursement and the Nurse Scholars Program policies were revised in May 2014 and March 2013, respectively, reflecting an increase in tuition assistance benefits across all programs (BSN, MSN and Doctorate). At the end of FY 13, 91 Homestead Hospital nurses participated in these programs with a total of $274331.69 aid given. These programs will continue to be nurses’ favorites and will be mainstays in achieving the 80% BSN target.
- Existing Collaboration with Nursing Schools – Through the Scholars Program, BHSF and Homestead Hospital have established agreements with local universities and colleges for the on-site programs as well as online programs for off-site scholarships. These programs are all focused on transitioning nurses to BSN degrees or higher and do not support the Associates degree programs. Furthermore, students who are enrolled in schools affiliated with BHSF can complete their practicum hours in any BSHF facility. (OO7 02 Nursing Scholars Program Overview and List of Affiliated Schools) These existing collaborations with nursing schools allow convenient on-site or online programs for the nurses, which decrease barriers to pursuing their BSN, and thus, will be continued.
- Six-Month Conversation with Direct Reports – As mentioned above nurse leaders conduct frequent dialogues with their nurses about their professional development goals to support and encourage them. One of these conversations transpires formally during the annual performance evaluation. To increase the frequency of these formal conversations, Homestead Hospital nurse leaders implemented the six-month conversation with direct reports. This transpires 6 months after the employees’ annual performance evaluation. This mid-year touch point provides an opportunity for the supervisor to give feedback to employees about performance and to solicit information about their professional development goals; follow-through on established action plans; and develop new ones, as needed, to further support the employees’ goals. The ongoing conversation has helped increase the awareness and the importance of education in the professional nursing practice and will be continued.
- Credit Union Loan – Baptist Health South Florida Federal Credit Union offers personal loans to Homestead Hospital employees. They offer competitive rates through its convenient, on site locations. Although, not frequently used by nurses to pay for tuition and school-related expenses, it is a good back-up program that can be easily tapped.
- Web Scheduler – Nurse leaders have continued to support flexible work schedules that enable nurses to pursue their formal education goals. Through web-scheduler, it became easier for the nurses to schedule work hours and time off to accommodate school schedules.
- Reward and Recognition – The Nursing Service Department has engaged several activities to encourage and recognize nurses who have achieved their degrees. For example, an email to the entire department is sent out; thank you note written by the chief nursing officer and sent to their homes; publicizing accomplishments in the hospital and system nursing newsletters; and announcing them in various shared governance, hospital-wide and staff meetings.
- Determining Internal Motivators to Pursue Nursing Education – Based on the recommendations of aforementioned research, the PDC will embark on a follow-up study or survey to determine what type and how much internal motivators are needed to persuade a nurse to go back to school.
Appraisal of Targets to Meet Organization’s Strategy (Projections)
Based on numbers described above, the PDC has made the following projections in order to meet the 80/20 IOM goal.
Year |
Projected % of RNs with BSN and Higher Degree at Beginning of Calendar Year |
% of RNs Finishing their Degrees |
Average Yearly Turnover Rate |
% of New Hires Finishing their Degrees |
% of RNs with BSN and Higher Degree at End of Calendar Year |
% of New Enrolments Needed |
2014 |
58% |
+5% |
-3% |
Already factored in |
60% |
|
2015 |
60% |
+10% |
-3% |
Already factored in |
67% |
3% |
2016 |
67% |
+9% |
-3% |
Already factored in |
73% |
3% |
2017 |
73% |
+5% |
-3% |
Already factored in |
75% |
3% |
2018 |
75% |
+3% |
-3% |
+3% (2015 new hires) |
75% |
Nurses lost through attrition will be replaced by nurses with BSN or required to obtain BSN within 3 years of hire. |
2019 |
75% |
+3% |
-3% |
+3% (2016 new hires) |
78% |
As above |
2020 |
78% |
+3% |
-3% |
+3% (2016 new hires) |
81% |
As above |
Summary
The strategies implemented above has engendered a lot of nurses in the existing workforce to go back to school as reflected in the increase of overall BSN and higher percentage over the past 4 years and the high proportion of nurses who are expected to matriculate from 2014-2017. The average yearly 3% turnover rate of nurses can be addressed with the revised job description that requires BSN as the entry-level and for those hard-to-fill positions, achieve their BSN after 3 years of hire. This requirement will ensure replenishing nurses who left with a new pool of BSN nurses. Since it takes approximately 3 years for a nurse to matriculate and complete a degree, their needs to be 3% more nurses enrolling for the BSN and higher programs from 2015 to 2017 in order to proactively replace 3% lost through attrition in 2018-2020. Thereafter, following the BSN requirement for new hires can be relied on as the primary tactic in maintaining the BSN or higher degree at 80% or above. The PDC approved this plan during the December 2014 meeting.
Summary of Attachments/Hyperlinks/Evidences
OO7 01 RN Job Description
OO7 02 Nursing Scholars Program Overview and List of Affiliated Schools