By BETSY TAYLOR
When Jaclyn Czerski graduated with her associate's degree in nursing 15 years ago, she told herself she'd get a bachelor's degree one day.
Then, "the house, the marriage, the kids pushed it further down my list," she said. She works two 12-hour shifts a week as a surgical intensive care nurse at Presence Resurrection Medical Center in Chicago. But she now also visits the medical center on her days off to take classes for nurses returning to school to earn a bachelor of science in nursing through Resurrection University. Resurrection University is part of Presence Health and it is based at the Presence Saint Elizabeth campus of Presence Saints Mary and Elizabeth Medical Center in Chicago. The university also offers classes at other Presence Health facilities.
Nurse Jaclyn Czerski works at Presence Resurrection Medical Center in Chicago and takes classes there as she pursues her bachelor of science in nursing degree.
Presence Health employees receive tuition discounts and may be eligible for tuition reimbursement up to $5000 a year. The convenience and tuition breaks help busy nurses return to school. "I have great things to say about the program; it was too good of an opportunity to pass up," Czerski said.
In the United States, students traditionally have taken one of three academic paths to become a registered nurse: completing a three-year diploma program in a hospital setting, completing an associate degree nursing program at a community college, or completing a baccalaureate nursing program at a college or university. From there, they take the National Council Licensure Examination. Many hospital-based nursing schools were phased out beginning in the 1950s and '60s, said Susan Hassmiller, the Robert Wood Johnson Foundation senior adviser for nursing and director of the Future of Nursing: Campaign for Action.
Call for more nurses with bachelor's degrees
In 2010, an influential report called The Future of Nursing: Leading Change, Advancing Health included a recommendation that school of nursing leaders should work to increase the proportion of nurses with a baccalaureate degree from 50 percent of the nursing workforce to 80 percent of the nursing workforce by 2020. The report was issued through a partnership by The Robert Wood Johnson Foundation and the Institute of Medicine.
Resurrection University President Beth Brooks notes that a number of studies show a relationship between the level of a registered nurse's education and patient outcomes. For instance, Linda Aiken and colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found patients experienced lower mortality and failure to rescue rates in hospitals where more highly educated nurses were providing direct patient care. It's not entirely clear why that's so, though some studies suggest baccalaureate-prepared nurses may have more education in areas like effective communication and problem solving.
Many nurses are returning to school. Hassmiller said "a lot of hospitals are mandating that nurses go back" and earn a BSN, often stipulating that new hires without the degree should earn it within a certain number of years. (The systems in this story are encouraging, but not mandating, such degrees.)
The number of students enrolled in RN-to-BSN programs increased 57 percent from 77,259 in 2010 to 121,677 in 2014, according to preliminary data from the American Association of Colleges of Nursing described on the Robert Wood Johnson Foundation's website. Hassmiller said it often takes working nurses several years to complete their bachelor's degrees, which is why the overall percentage of nurses with BSNs has just increased from 49 percent around the time of the 2010 report to about 52 percent in 2013. (The 2014 figure for completed degrees isn't yet available.)
She said a bachelor's degree often affords nurses greater professional opportunities. As part of health care changes under the Affordable Care Act, health care chief executives are looking for employees who can work across the health care system in a variety of environments, such as acute care, outpatient or home-based care. Hassmiller said today's bachelor's degree programs are preparing nurses in areas of increased focus, such as serving as care coordinators or providing transitions between care settings.
Time and money
Yet, for working nurses, who are already skilled at patient care and have years of clinical experience, "it's often an adjustment to get back into the school mode," Brooks said.
Chris-Tenna Perkins, associate dean of nursing of Bon Secours Memorial College of Nursing in Richmond, Va., said, "We have learned time and finances are the two big barriers for our nurses to return to school." Bon Secours Memorial College of Nursing developed an RN-to-BSN program that is offered completely online, so students can learn and study on their own schedule. Bon Secours Health System employees receive a 20 percent discount from their hospitals off the RN-to-BSN program cost and are eligible to receive a $5,000 a year tuition reimbursement, Perkins said.
Nursing school leaders say RN-to-BSN curricula acknowledge the clinical aptitude of experienced nurses. "Our program is purposely designed so the nurse in the classroom never repeats content they already know," said Brooks, who also serves as an executive nurse fellow for the Robert Wood Johnson Foundation. Instead, the programs focus on topics like teamwork, verbal and written communication skills, leadership, quality and safety, the business of health care, policy and finance. Students often complete research and projects on subjects related to their jobs. The number of courses nurses must take for a bachelor's degree varies based on what courses they completed for their associate's degree or nursing diploma. Some students must supplement the nursing school offerings with classes at an area college.
Kristen Darby completed her BSN through Bon Secours Memorial College of Nursing online program last year, in between her three, 12-hour shifts a week as a labor and delivery nurse at Bon Secours St. Mary's Hospital in Richmond. At a time when universities also are encouraging nurses to pursue advanced degrees beyond their bachelor's to increase the number of people ready for nursing leadership roles, Darby plans to continue on with her education to become a family nurse practitioner.
She said the bachelor's degree course work provided her with a "broad picture" of nursing. She felt she especially advanced her abilities in patient advocacy. "I'm constantly advocating for laboring mothers," she said, by discussing their needs with them and sharing their wishes with other clinicians.
St. Louis-based SSM Health found a systemwide way to offer convenient course work and financial assistance to incent its nurses to pursue bachelor's degrees in its Missouri, Illinois, Wisconsin and Oklahoma service areas. It partnered with Southern Illinois University Edwardsville in 2014 to offer an online BSN. The classes began in January with 34 students. SSM Health will provide partial tuition reimbursement to its participating nurses. Amber Wood, system director of clinical education for SSM Health, said employees also can receive tuition reimbursement for classes they take on college or university campuses, if they prefer that to online courses.
Kristin Ryan, a nurse at SSM Health's St. Mary's Hospital in Madison, Wis., chairs a professional nursing development council and holds a BSN. She said nurses often are treating more complex cases than they used to, such as patients with more chronic complications. They want a better grounding in cultural competencies and how to treat patients from diverse backgrounds as well as skills to teach patients how to better care for themselves. She said of the nurses she knows who have the communication and leadership skills of a bachelor's degree, "The more well-rounded you are as a nurse, the better you can take care of your patients."
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