In 2008, the Thomas Edison State College W. Cary Edwards School of Nursing had 942 students pursuing baccalaureate or master's degrees in nursing. By this year, that number increased to 3,252, as hospitals have begun to demand a nursing work force with training beyond the more typical associate degree.
"With an associate's degree, you're really focused on just nursing … you miss all of the general education classes," said Richard Hader, chief nursing officer at Meridian Health. A four-year program provides "a more in-depth knowledge base, more opportunity to learn critical thinking."
Meridian worked with Georgian Court University, in Lakewood, to create a BSN program, since there were only associate degree and diploma programs in Central Jersey, and the increasing complexity of care required from nurses means they "really need a minimum of a bachelor's degree to keep up."
Hader said Meridian started working on the program six years ago, and members of its first class of graduates are taking their board exams. The system is providing the funds to staff the nursing program at Georgian Court, as well as provide scholarships in order to recruit students to do their clinical rotations at a Meridian facility, and eventually to seek employment with the facility.
Hader said an additional benefit from collaborating with Georgian Court on BSN degrees is being able to groom students to become care coordination leaders in accountable-care organizations and patient-centered medical homes. "These are the people we need to hire to be able to deliver care across the continuum," Hader said.
Thomas Edison's programs, meanwhile, are partially facilitated through Capital Health, which stopped its own nursing education program this year. The school offers a program for registered nurses looking to complete their bachelor degrees, and earlier this year, it introduced an accelerated BSN program for professionals with degrees in other fields in order to meet ongoing demand for nurses.
Other hospitals are developing closer relationships with schools offering BSN degrees: Hackensack University Medical Center hosts several College of St. Elizabeth nursing classes on campus, and University Medical Center of Princeton at Plainsboro has strong relationships with nursing programs at The College of New Jersey and Mercer County College.
Dr. Phyllis Marshall, dean of the Edwards School of Nursing at Thomas Edison, said the phenomenon started in 2010, when the Institute of Medicine and the Robert Wood Johnson Foundation issued recommendations for increasing the education level requirements for nurses. The IOM report found a correlation between improved patient outcomes and nurses with four years of schooling, and recommended 80 percent of all nurses delivering bedside care should have at least a BSN by 2020.
Marshall said at the same times, hospitals increased their interest in Magnet accreditation — a national system that rewards certain quality standards — which increased pressure on schools to produce BSN graduates. But the pressure from the medical community is a positive for academic change, Marshall said.
"One can't exist without the other," she said. "I can't say I'm going to prepare nurses this way without knowing the external forces."
And while Denise Occhiuzzo, administrative director of nursing and head of Hackensack UMC's Magnet program, said Magnet has never mandated a percentage of nurses with BSNs to be accredited, she's "trying to raise the percentage as much as possible." Hackensack is the longest-tenured Magnet hospital in the state.
Marshall said hospitals are becoming much more aggressive in increasing the education level of nurses already employed. She said she's seen hospitals tell nurses that if they do not begin classes to transition from RN to BSN within two years of employment, they are laid off.
Susan Lorenz, chief nursing officer at University Medical Center of Princeton at Plainsboro, said she prefers to hire BSN-prepared nurses, and candidates who do not hold a baccalaureate degree are asked about their intention to complete the remaining two years of school during the interview process.
"The more knowledge you have, the more you can do and advocate" for patients, Lorenz said.
But hiring selectively has come at a challenge for hospitals around the nation.
The move to get entry-level candidates to complete BSN degrees has been slowed by a national nursing shortage, as well as older nurses delaying retirement in the ailing economic climate. Lorenz said a large percentage of the nursing work force at Princeton is 50 or older; as they retire, it won't be a question of if there are enough BSNs, but whether there are enough candidates in general. In the next 10 years, she said, she'll be asking herself if Princeton can continue to "afford to be picky."
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