Letters of Support Needed (S6768;A1842A)
We need to get out our letters this week!!
The Advancing Nursing Education Bills “BS in Ten” have passed both houses of the NYS Legislature. Now is the time to send updated letters of support to Governor Cuomo calling on him to sign the bill into law!
Please write a personal and/or organizational letter of support. In order to secure his signature please select from the list of bullets that follow and write a message that personalizes a few of those that best fit your/your organization’s experience that will allow you to attest to the value of the proposal.
Thank him for his unwavering leadership and for keeping New York State at the forefront of the nation in protecting our most vulnerable populations and ensuring the best healthcare for all residents. Point out that New York can be the first in the nation to implement this recommendation and bring the United States closer to other nations in preparing RNs to provide the best possible patient care while reducing the cost of healthcare.
Address your letter to: Honorable Andrew M. Cuomo
Governor of the State of New York
New York State Capitol Building
Albany, New York 12224
AND so that we may share this support with the sponsors of the legislation please ALSO email a copy to: firstname.lastname@example.org
All responses will be collected and presented to the Governor when the bill reaches his desk.
Thank you in advance for your participation. Please direct any questions to me, Barbara Zittel at email@example.com
Guidance for Letters and Position Statements in Support of
A1842-B / S6768 BSN in 10 Bill
Quality & Safety:
Increased levels of education among registered nurses results in better patient outcomes.
“BS in 10” is predicated on multiple research studies replicated in a variety of countries that demonstrate a clear improvement in patient outcomes, as well as fewer complications and deaths, with increasing percentages of baccalaureate-prepared nurses.
Advances in health care, science, technology; increasing patient complexity, and a more diverse population, require registered professional nurses to practice with enhanced and advanced skills.
The shift from acute care being the locus of care to the community and population health requires new RN skill sets, not just clinical, but also managerial and supervisory as community health care provider roles and teams are created.
The IOM in the 2010 report “The Future of Nursing” findings included:
· RNs are the profession to intercept medical errors, which cost $3.5 billion a year.
· Medical errors kill more people than breast cancer, AIDS, and motor vehicle accidents combined.
· RNs prevent hospital acquired pneumonia that increases hospital costs by 84% (Institute of Medicine (2010).
· A 10% increase in the proportion of BS prepared nurses decreases the risk of patient death by 5%.
Impact on the Health of New Yorkers:
· A 10% increase in the proportion of Baccalaureate (BS) prepared nurses decreases the risk of patient death by 5% (Aiken, et al. 2003, 2007, 2008, 2011, & 2014; Estabrooks, et al. 2005; Tourangeau et al. 2007; Blegen & Goode, 2009).
· With 60% of nurses prepared at the BS level, 6,000 fewer surgical deaths are projected for NYS annually.
· Hospitals with a higher proportion of BS educated nurses have lower rates of congestive heart failure mortality, hospital acquired pressure ulcers, failure to rescue, and length of inpatient stay.
Nursing Workforce Development:
A critical mass of nurses prepared at the baccalaureate level or higher level, credentialed to enter graduate programs and move into faculty roles, is needed to ensure the ability of nursing programs to expand and maintain current levels (AACN).
As workforce numbers decline due to baby boomer retirements from leadership and advanced practice (APRN, CRNA, CNS, CNM) roles, there will be demand to expand and maintain the capacity of nursing education programs at all levels to prepare staff RN’s, APN’s and faculty.
Minimum BS entry into practice exists in other countries including 27 in the EU, the United Kingdom, Canada, New Zealand, Australia, Philippines, Korea, and India.
The IOM report recommended that by 2020, 80% of RNs should be prepared at the baccalaureate level or higher. Today’s healthcare environment requires nurses to work in collaboration with other professions to jointly manage individuals’ healthcare needs across all settings. Associate Degree programs by design, prepare inpatient, acute care nurses. There is insufficient time in AD settings to prepare them to fulfill roles and meet the demands for practice in other settings where 50% of nurses now practice.
Associate Degree Programs Vital Role
· The bill emanated from a 2003 NYS Board for Nursing recommendation and is modeled after teacher education requirements in NY.
· The bill applies to only “future” graduates of Diploma and Associate Degree (AD) nursing programs.
· The bill preserves AD, diploma, and baccalaureates nursing education. No AD or diploma school would be closed.
· Due to a liberal grandparent clause, the bill would not intensify any potential nursing shortage.
· No licenses would be “removed”.
· Each future diploma and AD prepared new RN will have 10 years from initial licensure to complete a baccalaureate degree in nursing.
Adequate Capacity Exists Statewide to Educate RNs
As a result of thoughtful planning and preparing with this legislation, AD programs continue to be a vital entry to practice. The higher education, nursing, and hospital communities have been collaborative in preparing for the transition to BS in 10 credentialing. Work has been done across NYS to provide seamless transition from AD to RN/BS completion programs. It is easier now, to advance to the BS degree in nursing through RN/BS completion programs than ever before. The following are some of the available resources:
Standardized admission criteria and application procedures
Endorsement of common pre-requisites
Development of standardized competencies
New York Deans have implemented a statewide articulation agreement and developed a process for a standardized curriculum, concurrent admission to AD and BS programs, and standardization of pre-admission prerequisites.
New York has 47 programs for RNs pursuing the BS degree and 19 one-year programs for students entering nursing with a bachelor’s degree in another field.
There are more than 340 RN to BS programs that are offered at least partially on line.
RN/BS programs are not faculty intensive because students are licensed as RNs and need minimal clinical supervision which is the cost and resource intensive aspect of pre-licensure programs.
Economic Benefits to New York
Improved patient outcomes reduce the cost of healthcare and avoid payment reductions per the Center for Medicare & Medicaid Services guidelines.
With 60% of nurses prepared at the BS level, a 10% reduction is projected in the 200,000 hospital acquired pressure ulcers, potentially saving $17.5 million annually from reduced length of stay.
Reduced readmissions eliminate payment penalties.
BS prepared RNs have higher job satisfaction and longer job tenure. Every 1% reduction in RN turnover saves $12.9 million statewide.
A better-educated nursing profession will achieve the Medicaid Redesign Team goal of shifting health care to a less expensive more efficient primary care model.
Regarding Specific Concerns Raised about the Legislation:
1. The proposal is perceived by some to be a universal requirement for licensure:
· The bill would not impose a mandatory requirement of a BSN for licensure of all registered nurses. The bill’s grand-parenting provision exempts all registered nurses, and even current students, from ever having to meet the requirement. Future individuals will be required to achieve the BSN degree within ten years of initial licensure.
2. The proposal is perceived to potentially intensify the nursing shortage
· Over the course of the last 15 years, the nursing community has heeded warnings about the aging of the nursing workforce and has taken a number of measures to plan and therefore mitigate the shortage.
· Specifically, in recent years both shortages and surpluses have been predicted depending upon the mathematical predictive model used. The Bureau of Labor Statistics 2014-2024 projects that between 2014 and 2024 1,182,000 vacancies will emerge. However, for the last four calendar years at least 150,000 nurses have passed the NCLEX RN exam. Ten years of 150,000 new grads could yield 1.5 million new RNs. If that occurs, in addition to filling vacancies there’s room for many nurses going back full-time for additional education, or dropping out, or raising a family, etc. Surplus, shortage depends upon one’s interpretation. [Peter McMenamin, Ph.D., Senior Policy Advisor-American Nurses Association Health Economist].
· This legislation will NOT negatively affect the predicted nursing shortage because all existing educational programs will continue. No diploma or associate degree nursing programs will close as a result of this legislation.
· This legislation is NOT a barrier to entry into the profession as no new requirements are mandated to be licensed as an RN. The new requirement of this legislation begins only after the new nurse is licensed and requires completion of one three-credit course a semester for 10 years.
· This legislation has the potential to POSITIVELY affect the predicted nursing shortage by educating more baccalaureate-prepared RNs who can obtain Master’s and Doctoral degrees needed in order to be faculty in schools of nursing. It is the lack of availability of more faculty that is preventing the profession from preparing a larger percentages of RN graduates.
· The NYS Council of Baccalaureate and Higher Degree Deans indicates a capacity to accept more candidates for BS completion programs due to the decreased amount of clinical supervision of those individuals who are already licensed.
3. There is concern that there is insufficient capacity in nursing education programs to meet the
demand for nurses.
· This legislation would require future nursing graduates to obtain their BS in nursing degree AFTER they are licensed. Because they would be licensed to practice nursing, the 10 students to one faculty ratio, required by the NY State Education Department for clinical supervision of unlicensed students, does not apply. Therefore, nursing programs are able to teach a larger number of licensed students than pre-licensure students using the same number of faculty.
· One of the major factors preventing schools of nursing from admitting a greater number of students is lack of credentialed faculty. This legislation would educate RNs to the baccalaureate level. In the past, approximately 25% of BS nurses advanced their education to the Master’s and Doctoral degree level. These nurses credentialed to serve as faculty would contribute to increasing capacity.
· The availability of considerable numbers of on-line programs also positively impacts capacity for individuals already licensed as RNs advancing their education.
4. There is concern that the ability of women of color and minorities to enter the nursing profession
will be limited.
· This legislation does not impact changes in the requirements to enter the nursing profession. Diploma and AD programs that are locally available and affordable would continue to accept, educate, and graduate students including women [and men] of color and other underrepresented groups.
· Although the nursing profession doesn’t reflect the State’s demographics, of all professions licensed by the NYS Education Department, including medicine, podiatry, engineering, pharmacy, physical therapy, occupational therapy, etc., nursing is THE most diverse by significant percentages: The 2016 report A Profile of Registered Nurses in New York State published by the Center for Health Workforce Studies indicates that while Hispanic/Latino RNs remain under-represented compared to their presence in the state’s population, progress has been made…that now “Black RNs are similar to their percentages in the state’s population” http://www.chwsny.org/wp-content/uploads/2016/10/RN-Profile-NY-2016_-1.pdf
· The nursing profession is aware of the need to continually make efforts to maintain a workforce reflective of the state’s diversity. The profession has been working collaboratively with organizations such as Men in Nursing, the Black Nurses Association, the Hispanic Nurses Association, the Philippine Nurses Association, and the Indian Nurses Association toward that end. These groups were early supporters of this legislation and continue their support today.
· The BS requirement could empower more minority RNs to move more quickly to BSN completion.
5. There is concern about the ability of working class and lower income women to enter the nursing
As stated above, this legislation does not impact changes in the requirements to enter the nursing profession. Diploma and AD programs that are locally available and affordable would continue to accept, educate, and graduate students including individuals from all socioeconomic groups.
Some schools have partnered with health care systems to provide significant direct tuition discounts for RNs returning to school for RN/BS completion programs through Academic Practice Partnerships.
Once these individuals graduate and obtain licensure, they are able to be employed in a profession whose average statewide salary is $80,090 [ranging from $60,700 in the Southern Tier to $90,460 in NYC]. A Profile of Registered Nurses in New York State. 2016. Center for Health Workforce Studies]. http://www.chwsny.org/wp-content/uploads/2016/10/RN-Profile-NY-2016_-1.pdf In addition, other avenues are available to assist in paying for the RN/BS degree completion including:
Federal Pell Grant
New York State Tuition Assistance Program (TAP)
William D. Ford Federal Direct Student Loan Program
William D. Ford Federal Direct Parent PLUS Loan Program
Private Alternative Loan Programs
6. There is concern about potential for increased strain on financially distressed safety net agencies.
· The differential in the salary between an AD and a BS educated nurse in marginal, hence this legislation should have minimal effect on distressed hospitals as it relates to salary and tuition. The greater concern for distressed safety net hospitals is the financial burden from poor patient outcomes and the loss of revenue as the State changes its reimbursement mechanisms and moves to value-based payment (VBP) systems. VBP programs reward health care providers with incentive payments for the quality of care. VBP also support better care for individuals, better health for populations, and lower costs. These programs are part of a larger quality strategy to reform how health care is delivered and reimbursed.
· The bill could actually generate more revenue for all hospitals, including distressed agencies, through improved patient outcomes as a result of nurses who have advanced training and education that decrease readmissions and attendant penalties or lower reimbursement rates.
· All NYS citizens deserve the same level of nursing care regardless of geographic location. There should be one level of care for All New Yorkers. This bill elevates the education requirements statewide so all patients have cutting edge healthcare no matter the region in which they live.
· Healthcare accountability is changing with a greater accountability for community wide emphasis on health maintenance and prevention vs. illness care.
· More highly educated nurses will be prepared to meet those needs.
7. Concern has been expressed about financial burdens of attaining BS completion degrees and who
will bear the burden.
· Unlike most other health-related professions such as medicine, pharmacy, dentistry, podiatry, physical therapy, occupational therapy, and psychology, the profession of nursing, and this legislation, permits an individual to become licensed as a RN with an AD and then advance one’s education over time. Newly licensed RNs educated with an AD are afforded the same salary as an RN with a BS degree. That average statewide salary is $80,090 [see above]. This legislation allows an RN to meet the 10-year BS degree requirement with as little as one course a semester while the individual is licensed and employed.
· Employment affords the added benefit of tuition assistance provided by over 97% of state facilities as identified in a recent study (Zittel, 2016).
· Many employers support “Grow Your Own Programs” that assist current employees to attend educational programs with individualized scheduling and mentoring often in partnerships with educational institutions that offer reduced or delayed payment until tuition reimbursement is received.
· The number of available scholarships is staggering including those targeting racial and ethnic minorities and the military.