Guest Column | September 11, 2017

Ahead Of The Curve — Education And The Evolution Of Nursing

Healthcare Vertical Promises Big Growth For Beacons Through 2019

By F. Patrick Robinson, PhD, RN, FAAN

Education and tuition assistance programs were once thought of simply as nice-haves in the human resource package. However, their importance is evolving as major workforce challenges continue to impact the nursing profession. Consider these numbers:

  • An estimated 17.5 percent of newly-licensed registered nurses (RNs) leave their first nursing job in the first year and 33.5 percent leave within two years — according to a 2014 article published in Policy, Politics & Nursing Practice.
  • The nursing shortage is expected to rise to a deficit of at least 725,000 nurses across the country by 2030 per estimates published in 2012 in the American Journal of Medical Quality’s workforce report card and shortage forecast.
  • In a recent study that garnered national attention, it was argued that medical errors are now the third leading cause of death in the U.S. suggesting that patient safety remains a recalcitrant challenge 17 years following the Institute of Medicine’s (IOM) To Err is Human report.

In the context of these challenges, education assistance isn’t simply a benefit that provides a personal stepping stone, but rather a core organizational strategy with potential implications for everything from employee engagement and hospital budgets to driving patient outcomes. This shift positions education as a strategic asset from which health care organizations may be able to reap a number of overarching benefits. Chief among these potential benefits include:

  1. Patient outcomes — A well-developed body of peer reviewed research suggests that specific patient outcomes improve as the proportion of nurses with baccalaureate degrees or higher increases in the staffing mix. For example, data suggest that patient mortality, failure to rescue, pressure ulcers, and post-operative deep vein thrombosis and pulmonary embolism are lower in medical settings that have a higher proportion of more highly educated nurses.
  2. Costs — In a 2016 survey of 138 healthcare facilities published by Nursing Solutions, Inc. in its National Healthcare Retention and RN Staffing Report, respondents reported that the average cost of turnover for a bedside RN ranged from $37,700 to $58,400. Based on this feedback, the report suggests that each percent change in RN turnover will cost the average hospital an additional $373,200. In addition, evidence suggests that an increasing proportion of RNs with baccalaureate and higher levels of nursing education is associated with decreased length of stay in acute care settings.
  3. Nurse retention — The relationship between tuition benefits and nursing retention is poorly understood. For example, data from the Lumina Foundation suggests a slight positive (1.5%) impact of tuition assistance on retention among nurses; however, overall return on investment was negative with a resultant $5.6 million loss. Furthermore, research on the Magnet Recognition Program indicates Magnet designation correlates to positive work environments and nurse satisfaction, both of which may influence nurse retention. Given that Magnet organizations employ nurses with higher levels of education, an association between retention and education exists. However, the causal link is unknown.

As adult learners with demanding careers and complicated personal responsibilities, nurses are challenged to fit into educational systems that were not designed with them in mind. However, the momentum of change to flexible and adaptable models of higher education is accelerating as even what were once considered traditional college students are far from who they were a short generation ago. In many ways, nursing education emerged as an early adopter of higher education innovation in response to its core constituency — full-time practicing nurses. Nursing education leaders must continue to innovate while partnering with colleagues in practice to ensure practice-relevant competencies to help drive desired patient, systems, and population outcomes in the emerging nursing workforce.

Additionally, practice- relevant competencies that focus on quality care and patient safety that are developed collaboratively with leaders in practice should be a priority at all levels of nursing education. Plus there must be further commitment to principles of seamless academic progression among degree levels with rigorous and valid methods of granting credit for prior learning.

Formal higher education coupled with ongoing professional development and when needed, technical training is crucial to any nursing workforce strategy aimed at improving quality and efficiency. This is the definition of the proverbial model of life-long learning. Both health care organizations and institutions of higher education benefit when they come to the table together to problem solve. But the real winners? Patients and nurses!

About The Author

Dr. F. Patrick Robinson serves as Dean of the School of Nursing and Health Sciences at Capella University. He obtained his bachelors and masters in nursing from Indiana University, holds a PhD in Nursing Science from Loyola University Chicago and completed a post-doctoral fellowship in biobehavioral nursing research at the University of Illinois at Chicago. He maintains certification as an AIDS nurse (ACRN) from the HIV/AIDS Nursing Certification Board and is a Certified Nurse Educator (CNE) through the National League for Nursing.