Transcription:

Bill Klaproth: (Host) Educational advancement is crucial for better outcomes and the health of our communities. So let's learn about BS in 10: One State to all 50, with Diane Cooney-Miner, founding Dean, Wegman School of Nursing at St. John Fisher College. This is today in nursing leadership, a podcast from the American Organization for Nursing Leadership. I'm Bill Klaproth. Diane, great to talk with you. Thank you so much for your time. So first off, can you explain to us just the first part of this, what is BS in 10?

Diane Cooney-Miner: (Guest) Absolutely, so BS in 10 is actually a law that was passed in New York state in December of 2017. Which requires all registered nurses to complete a bachelor's degree within 10 years of graduation in order to maintain active licensure in New York State.

Host: Wow. Really interesting. So how did you, how did you go about ensuring the success of this initiative? How did you make this come about?

Diane: Nothing worthwhile is ever easy. So I will tell you that it took us a number of years to do this because it's so interesting that when nurses want to do things, a lot of people kind of come out of the woodwork and want to comment on that, which I think is an indication of how important our work is. There were a group of us, part of the New York state board for nursing, who began to look at how the majority of the nurses in New York state we're really prepared at the associate's degree level, the two-year level. And when we thought about workforce and development, moving forward, we realized that we couldn't do the things we needed to do as a profession. In order to continue to educate the nurses of the future, as well as to make sure that in all the different care settings, where we practice, we were providing the highest quality. In highly safe care and the care that was given by science and technology and recognize the transformation that was happening in healthcare. So in New York, we had a particular law that was passed that required all teachers to get a master's degree in order to teach, and so we thought following that model, we could do the same in New York. We would say that you can enter the profession, let's say with a two-year degree, but it a particular period of time after that you needed to have a bachelor's degree in order to understand the full experience of nursing, not just in the technical aspects of care, but the science that drives it and the technology that was transforming it and more and more of a focus on prevention, not just intervention, and population-focused care. So that's what got us started around 2003. I brought the proposal to this New York state board for nursing as the chair of the education and credentialing committee. I brought it to our board for nursing, and we hope that we could get it passed through regulation, and have the New York state education department recognized the importance of this and change the regulations. The board for nursing passed it unanimously, but the state education department really felt the change was significant enough that needed to be legislative in nature, not regulatory. And so that began our work then of getting the message out, talking to the multiple stakeholders, making sure the evidence was there to prove that this was not just an intuitive change, but it changed that really could drive the profession forward, make sure that we had a, we could continue to develop new nurses for the workforce, as well as have the real attention at patient safety and quality outcomes.

Host: So BS in 10, one state to all 50, is the name of the session. So your goal is to get this enacted in all 50 States.

Diane: That's what our goal would be. I mean, we would like to see the United States follow the path that's happening around the world. I happen to have the real privilege of being part of a European union group of nurse educators, it's called UDANE, understanding development, and nursing education. And I see in the European Union, this model has moved forward where more of the countries that are part of the EU, have adopted a baccalaureate model for education, recognizing that a university preparation leads to better prepared workforce and a workforce that can participate in the changes and transformation that needs to happen. So as part of the work that we did in New York and getting the message out, I had a wonderful opportunity to be invited to multiple States in the United States to share the New York experience, because there was a lot of interest in what we were doing. Recognizing how unimportant it was not only for the profession but for patients.

Host: Right. So in your session, in the description, there's a line that says the health of our communities will improve, only when education is advanced in every area where nurses practice. What do you mean when you say education is advanced in every area where nurses practice?

Diane: So I think, you know, all of us, who were part of this healthcare world, have recognized that there is transformation that needs to have it. Under President Obama, you know, we had a law that helped us begin to focus on how important primary care and prevention is. And not just this, the science and technology and intervention that we recognize. It happens in our acute care settings. But we also began to change our focus now on population-focused health. And recognizing too, that special populations have very special needs and those needs may not just be around their physical health, but there's social-emotional health. Their access to clean water, to good food, to safe housing, to good education models for their children. So this expanded notion of health really driven by what we call the social determinants of health is critically important to the transformation of the healthcare system in our country. And so that is a model of baccalaureate education. That's not a model of a two-year technical degree that happens at the associate level, but an expanded model where you need to think about economics. You need to think about social justice. You need to think about the environment. As well as, the healthcare that happens. And so with that in mind, That, that sort of drives this, this focus now on expanding nursing education. So whether you are a nurse and a critical care setting, in a community health setting, a school health setting, wherever you are you're driven by population-focused health and social determinants of health, as well as facile with the science and the technology now that keeps moving us forward.

Host: Right. I'm curious, is there data that shows better outcomes with better education of nurses like you're talking about?

Diane: Yes, and honestly that it wasn't until we had the compelling data to shift to this different stakeholders, and by that, I mean, you know, the hospitals and healthcare systems that employ nurses, the insurance, the third-party payers who reimburse, to the different education models, for example, the associate to be models. All those people were part of the conversation. and the public. We needed the data to show them that this was not just nursing education, being self-serving, but this was nursing as a profession saying, look what happens when you have a workforce that has a critical mass of baccalaureate-prepared nurses in terms of patient quality, quality outcomes, patients' safety and financial health of organizations. So, you know, we were talking certainly as a nation around this triple aim around health. Patients are satisfied. Quality is high, you know, economics are healthy, finances are healthy in the system. And so we, we could gather the data that showed where there are healthcare systems where they're about 60% or more of nurses had baccalaureate degrees. We had much better patient outcomes. And concurrently too, we were working sort of in unison or side by side with the American Nurses Association and its magnet hospital designation. So the magnet hospital designation that ANA began to provide for hospitals around the nation, really featured the importance of baccalaureate-prepared workforce, in terms of the magnet mission. And so while we were talking about a law to make this happen in New York, and the data That we could show how it would make a difference. The magnet hospital designation was doing the same thing with us. And where do we see the difference? We saw fewer falls, fewer pressure ulcers, fewer medication errors? We saw certainly a lot more statutes from patients around the education and support they were getting in hospitals. More seamless discharges and a lot more collaboration as part of the interprofessional team, which, you know, communication and collaboration and team is really the way you get the best outcomes for patients and systems.

Host: So you've mentioned a few times social determinants of health and prevention as well as intervention. Can you summarize once again, how BS in 10 relates to social determinants of health prevention and intervention?

Diane: If you really are talking about health, you are talking about an experience of not only physical health but mental health. And you're also talking about the experience where in your life and in your world, you have safe housing, an environment free from violence, clean water, access to healthy foods, good educational systems. Just work. That whole of the experience really drives, not just, you know, your blood pressure is high, we're going to take your blood pressure and we're going to give you an antihypertensive. Your blood pressure might be high because you live in an environment where there's toxic stress, where you do not have access to good food, where you potentially are buying something from a convenience store that is full of salt, where you've perhaps you don't have the resources necessary in order to get transportation, for example, to get to a place where you can buy healthy food. So when you begin to think about populations and their particular needs around maintaining and promoting health, you have to have a wider perspective. What kind of housing do they live in, do they have public transportation, is there healthy food that's available at a cost that they can afford, is their clean water, is there clean sanitation, is there a great school, a model that they can send their kids to, is it a safe environment where they don't have to worry about violence? That's a real model of health. And the baccalaureate education and nursing is where that model takes place. And I see that as the vision, for now, as well as the future of healthcare in our country.

Host: Right. And it's a good vision, Diane, we like it. So lastly, then attendees will be provided materials to inform their journey toward creating a more highly educated nursing workforce in their States. Can you just wrap up with what attendees will leave with a little more detailed description than when I just read?

Diane: So what were, what my colleagues and I are going to talk about is clearly, you know, the journey that we took and believe when we got some dirt on our news over time. Because, you know, there were things that we didn't necessarily recognize that would be barriers, but we learned how to overcome them. We learned about the importance of being a very good lobbyist and, and talking to elected officials about the things that they were concerned with. We learned about how we collaborate as a profession and include everyone in a career model that says wherever you enter nursing, there's a wonderful model for you to follow that's going to lead to a, an advancing your career, you know, strengthening your education and moving forward, giving you a leadership role and opportunity around clinical advancement. So that's what we're going to share with people, almost a tool kit for how what we did in New York that they could use to take the same journey themselves in their own States.

Host: Wow. Very useful. Diane, thank you so much for talking with us about this today. BS in 10: One State to all 50. It's going to be a great session. Diane, thank you again for your time. We appreciate it.

Diane: I'm very grateful for this opportunity. Thanks again.

Host: That's Diane Cooney-Miner. And for more information, please visit AONL.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Today in Nursing Leadership. Thanks for listening.