PICOT Paper

Accountability for Continued Education: A Legislative Issue Nathaniel KalilBowie State UniversityDr. ArchieIntroductionThe United States has made efforts to develop its health care industry with a focus on quality, affordability, and access to healthcare services. The increasing demand for health care services over the past decade(s) and the demand for quality medical care have stimulated the growth of the nursing population. Issued in a 2010 report by the Institute of Medicine (IOM), called The Future of Nursing: Leading Change, Advancing Health, highlighted the complexities of care have been evolving; therefore, nursing education must also advance to meet the needs of future healthcare requirements. The recommendation sought to increase the number of nurses to obtain their bachelor’s degree to 80% by the year 2020. With more than 3 million members and counting, the number of nurses embody the largest sector of healthcare industry according to the IOM (2010). At the time of this report’s release, approximately 50% of nurses achieved their bachelor’s degree or had their bachelor’s degree. Currently, in 2019, a 10% increase in nurses with a BSN evolved making the total percentage to 60%. Consequently, the goal has not been met; however, the initiative has made some strides (Schneider, 2016). Such demand requires the federal government, state department, and other policy-related bodies to make decisions geared toward closing the nursing educational gap. The demand has also triggered professional training of nurses in various certified nursing institutions and organizations. Through research, the federal government of the U.S, American Nurses Credentialing Center (ANCC) and other legal bodies supported an increase in nurses requiring a four plus year education to obtain a bachelorette’s degree. A push for new legislation requires participation by state governances along with enough documented proof to convince states to adopt this new policy. This paper aims to address the PICOT formulated question: In nursing practice, how does clinical competence of BSNs compared to that of RNs with an associate degree influence the rate of mortality among patients over time? ProblemThe pivotal work of Aiken, Clarke, Cheung, Sloane, and Silber gathered a critical finding of evidenced based research conducted by Olga Yakusheva, researcher at the University of Michigan. The study concluded solidly that for every 10% increase in the amount of BSN nurses working in a hospital, patient mortality would decrease by approximately 10% as well. Another statistic worth mentioning is a decrease of approximately 5% in a failure to rescue case. A condensed report using these research studies provided by the Institute of Medicine offers compelling evidence to support a larger quantity of nurses entering the workforce to pursue a Bachelorette’s degree. Thus, legislators have been prompted even more now to make legal discussions over the level of education required for the RN to fully practice their scope. According to Zittel et al. (2016), the barrier to the full practice by RN nurses to the BSN’s level is the lack of education in the following competencies: “leadership, systems reasoning, quality improvement, community care, health policy, and health policy finances” (Zittel, 2016). The aforementioned skills are essential to meet the exponentially increasing complexities of today’s diverse population. InterventionThe Scope and Standards of Practice of an RN according to ANA (2015), emphasizes the RN’s responsibility to continue their education and competency of nursing practice, this includes an ongoing pursuit of credentials and simply, a lifetime of learning. With consideration to the standard of education and educational profession, an issue found by Panel members is the rather confusing non-standardized educational requirements of an RN. A group of legislators asked a rather compelling question, what type of examination is given to a BSN vs. an RN to determine the difference in credentialing? A strong advocate explained that the same examination for licensure was given to associate level nurses and bachelor level nursing. The legislators were baffled by this profound indifference (Zittel et al., 2016) because the lack of clear differentiation in the practice of an ADNs vs. a BSN is unclear to the public.The strongest advocates that support the legislation for all nurses to require a bachelorette’s degree were educators themselves– Faculty and deans from associate degree programs (Zittel et al., 2016). Though, Unions of different sorts opposed the idea, stating that “a baccalaureate of science (BS) in Nursing is not essential; that is, the bachelor’s degree could be obtained in any major” (Zittel et al., 2016). These Unions also claim that any new legislation include funding to RN’s with an associate degree who are required to continue their education to earn a Bachelor’s (Zittel et al., 2016). Subsequently, Healthcare advocate, medical associations and other healthcare professional bodies, and the federal government have the task of discussing limiting factors to earning a BSN; cost and time. Tuition for BSN trainees is high, and the difference in payment between a BSN and an ADN is low or equivalent (Matthias, 2015). Nonetheless, AACN now requires hospitals hoping to earn Magnet status to provide proof of plans to meet the 80% recommendation (2014) and some facilities like the VA (Veterans Administration) enacted a policy to increase the entry level pay for BSN nurses as an incentive (Schnieder, 2016). Furthermore, states with combined interests known as compact states allow BSN nurses to qualify to practice in those states without additional licensing requirements (The College for the People, 2017). These nurses can simply move to another state with a transferable, ‘universal’ license. ComparisonThe nursing practice or a BSN and an ADN both practice within the same scope. There is no clinical difference and licensure; but the education requirements/credentials for the BSN are practically doubled in comparison. A nurse with a BSN performs in more complex procedures, utilizing critical thinking skills while under the doctor’s supervision; along with obtaining a leadership position as a charge nurse in most facilities (The College for the People, 2017). Olga Yakusheva, researcher at the University of Michigan, mentioned above found an alarming correlation between patient mortality and educational preparedness. A decrease of 5% failure to rescue scenarios and a 10% reduction of deaths. This is a significant percentage, last updated four years ago so one could assume the percentage has increased. Outcome/TimeAfter a 14-year struggle, lobbyists succeeded. New York State finally passed their “BSN in 10” law. This means that a Baccalaureate Degree in nursing is a mandatory requirement within a 10-year window after receiving their initial license (Maracrac, 2017). Though, New York is just one state out of 50. Noteworthy, it took approximately 120 organizations to write letters in support of this new legislation including the “medical society, the healthcare association representing acute and long-term care facilities, and from the councils for both the associate degree and baccalaureate degree and higher programs” (Maracrac, 2017). Strong advocates contested that the only way to ensure that every RN will earn a BSN is to make it a mandatory requirement. This can only be accomplished in some jurisdictions though passing a bill by the state (Zittel et al., 2016). A new prediction forecasts that by the year 2025, the 80% benchmark will be reached.Conclusion This paper aimed to address the PICOT formulated question: In nursing practice, how does clinical competence of BSNs compared to that of RNs with an associate degree influence the rate of mortality among patients over time? The study concluded solidly that for every 10% increase in the amount of BSN nurses working in a hospital, patient mortality would decrease by approximately 10% as well. Another statistic worth mentioning is a decrease of approximately 5% in a failure to rescue case. After a 14-year struggle, lobbyists succeeded. New York State finally passed their “BSN in 10” law. This means that a Baccalaureate Degree in nursing is a mandatory requirement within a 10-year window after receiving their initial license (Maracrac, 2017). Though, New York is just one state out of 50. Perhaps, more states will follow the trend and mandate this requirement, especially when people’s lives are at stake. ReferencesAiken, L. H., Clarke, S., Cheung, R., Sloane, D., & Silber, J. (2003). Educational levels of hospital nurses and surgical patient mortality. Journal of the American Medical Association, 290(12), 1617-1623.American Association of Colleges of Nursing (AACN), (2014). Fact sheet: The Impact of Education on Nursing Practice. Retrieved from http://www.aacn.nche.edu/media-relations/fact-sheets/impact-of-educationAmerican Nurses Association. (2015). Nursing: Scope and standards of practice (3rd ed.). Washington, DC: Author.Institute of Medicine (IOM), (2010). The future of nursing, leading change, advancing health. Retrieved from http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2010/The-Future-of-Nursing/Future%20of%20Nursing%202010%20Report%20Brief.pdfMaracrac, M. (2017, December 30). New York’s ‘BSN in 10’ Law And The Push For 80% Of Nurses To Hold BSN By 2020. Retrieved from https://nurse.org/articles/BSN-initiative-80-2020/Matthias, A. D. (2015, February 6). Making the case for differentiation of registered nurse practice: Historical perspectives meet contemporary efforts. Journal of Nursing Education and Practice, 5(4), 108-114.Schneider, A. (2016). Driving Factors Behind the 80% BSN by 2020 Initiative. Retrieved from https://www.rn.com/headlines-in-health/driving-factors-behind-the-80-percent-bsn-by-2020-initiative/The College for People. (2017, January 31). The Real Differences between ADN and BSN Nurses … Retrieved from https://nightingale.edu/blog/adn-vs-bsn-differences/Zittel, B., Moss, E., O’Sullivan, A., & Siek, T. (2016, September 30). Registered Nurses as Professionals: Accountability for Education and Practice. The Online Journal of Issues in Nursing, 21(3).

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