Baccalaureate Preparation of Nursing Staff Underpins Quality Outcomes: One Hospital's Journey

Purpose:
This work addresses nursing roles and models, with an educational foundation, that support changes in bedside care and improved outcomes. It also links a planned change in the educational levels of nurses we recruit to key nursing sensitive clinical outcomes.

Significance:
A number of research studies have demonstrated that hospitals with greater numbers of nurses educated at BSN or higher levels report higher quality, safer patient care. AONE and AACN also support BSN-prepared entry to practice as essential in the care of patients in very complex healthcare arenas.

Strategy and Implementation:
In 2006, we began to target baccalaureate-prepared nurses in our recruitment efforts. At that time only 8% of our direct-care nursing staff had completed a BSN program. First, we partnered with 3 regional schools of nursing who prepared students at the BSN level, providing them with a variety of sites for clinical rotations. We then began interviewing a larger percentage of BSN-prepared graduates for open staff positions. The hospital's generous tuition-reimbursement program provided greater financial support for nurses returning to complete a degree than our competitor hospitals. We then we negotiated a tuition reduction with one of our nursing program partners to make additional education more affordable. Our initial interviews with possible new graduate hires now focus on critical thinking skills, solutions for safety-related problems and the degree to which they believe they can implement EBP. Finally in late 2009 we implemented a clinical development ladder that rewards education.

Evaluation:
55% our staff now hold a BSN degree. Success is evident in: CAUTI rate 1.3/NHSN 4.9; VAP 2 cases/2 yrs; reduction in central-line related bacteremia to <1.5/1000 pt days; staff-led Nursing Peer Review Council; bedside handoff reflecting critical thinking. Ethnicity of staff mirrors our patients.

Implications for Practice:
Practice implications include continued improvements in nursing sensitive outcomes and professional staff growth on a clinical practice ladder. And, as the percentage of BSN-prepared nurses increases, we will implement a CNL program in which MSN-prepared nurses lead outcomes-focused teams.