Health care systems in Northeast Ohio are encouraging more of their nurses to obtain higher levels of education.
In 2010, a national report set a lofty goal to, by 2020, have 80% of the nursing workforce holding a bachelor’s degree in nursing or higher. The recommendation was laid out in “The Future of Nursing: Leading Change, Advancing Health,” issued by the Institute of Medicine, which has since been renamed the Health and Medicine Division of the National Academies of Sciences, Engineering and Medicine.
MetroHealth just passed that threshold this year — a significant feat, given that the system was at 48% in 2012. University Hospitals Cleveland Medical Center is in the high 80s, while the rest of the system is still below the threshold. Cleveland Clinic’s rate varies by hospital, but its leadership is confident it will reach 80% across the system by the end of next year.
“The literature and research that’s out there has indicated that nurses with a baccalaureate degree perform better and are safer in the clinical setting than an associate-degree nurse,” said Patricia Sharpnack, dean of the Breen School of Nursing at Ursuline College.
Many systems require incoming nurses to have a bachelor’s of science in nursing (BSN) or commit to obtaining one within a set timeframe of their hire. Nurses are supported through tuition-reimbursement programs at the systems, as well as flexible work hours to accommodate finishing their degree.
“Ideally, yes, we would love to hire all BSNs, but that’s not necessarily what’s always available,” said Holly Ma, system director of nursing education for UH.
Throughout the region, a network of partnerships connects associate’s degree programs, four-year universities’ nursing schools and health care systems to help support nurses through the various steps in their education.
Ma, who recently moved to the region to join UH, said she was impressed by the levels of connections and partnerships.
“I don’t think it’s as robust in other places,” she said.
The baccalaureate degree makes a difference, said Joan Kavanagh, associate chief nursing officer for nursing education and professional development at Cleveland Clinic. As health care continues to change, including the explosion of data and technology, the need for higher degrees and advanced preparation is becoming “more and more critical,” she noted.
Kavanagh pointed to research by Peter Buerhaus, a researcher in nursing workforce, which found that in 2011, the number of baccalaureate nursing degrees eclipsed the number of associate-degree graduates. His research also showed that the number of master’s and doctoral nursing degrees awarded has quadrupled since the mid-2000s.
As the number of BSN-educated nurses in the region climbs, some also are noticing more interest in higher levels of education: master’s of science in nursing (MSN), doctorate of nursing practice (DNP) or Ph.Ds, a research degree.
The Center for Health Affairs, a nonprofit advocate for Northeast Ohio hospitals, analyzed data from the Ohio Board of Nursing and looked at the highest degree attained by Northeast Ohio nurses. It found that in 2017, 41.9% of the area’s nurses had a bachelor’s degree in nursing, while 12.9% had a master’s degree in nursing as their highest obtained degree — up from 36.3% with a BSN and 10.4% with an MSN in 2015.
The center’s report, released last year, also projected a shortage of 2,850 registered nurses by 2020. Given that reality, hospitals continue to rely on hiring associate-degree nurses and then supporting them through their BSN.
“So we still depend on the associate-degree nurse, who’s a great nurse,” said Marti Bauschka, chief nursing officer at Southwest General. “They’ve got everything we need to come in and provide great bedside care, but then we want them to advance in their profession as well.”
At Southwest General, 45% of its nursing staff has a bachelor’s in nursing — up from 40% three years ago — and another 6% have master’s degrees.
The complexity of health care is helping drive nurses to pursue master’s or doctorate degrees, both of which are “vital support” in the future of health care, Kavanagh said.
Those higher levels open up new opportunities for nurses. Clinically, many master’s programs propel them into advanced practice roles, such as nurse practitioners or nurse anesthetists. There are also master’s programs in nursing leadership and education.
Master’s and doctoral degree programs in Northeast Ohio aren’t seeing universal growth, with some remaining relatively flat, but there are signs of growing interest.
Ma said a “fair amount” of the nursing staff at UH are now pursuing master’s degrees in either leadership or education or to become a nurse practitioner.
Right now, 11.6% of MetroHealth’s nursing staff is enrolled in a master’s program — double the percentage in 2012, said Melissa Kline, senior vice president of patient care services and chief nursing officer.
This is driven in part by a shortage in primary care physicians; nurse practitioners can help fill that role. Also driving growth is the fact that there are new employment needs that simply didn’t exist a decade ago, such as data analytics and electronic medical records, Kline said. Nurses can get a master’s degree in nursing informatics. MetroHealth has a department of roughly 20 nursing staff in clinical informatics — an opportunity that didn’t exist 10 years ago.
Plus, she said, the frontline staff has grown more educated, which helps push some of the nursing managers and leaders to go back to further their education.
Kent State University’s nursing enrollment grew from 438 bachelor’s students and 456 master’s students in the 2016-17 academic year to 559 bachelor’s and 566 master’s students in the current academic year.
“Every year, we have been trying to increase our enrollment to try to meet the demand,” said Tracey Motter, associate dean of undergraduate programs for the College of Nursing at Kent State.
Latina Brooks, director of the MSN and DNP programs at Case Western Reserve University, said that, nationally, there hasn’t been a huge growth in terms of MSN programs, but DNP programs are growing.
Cleveland State University this fall began its doctorate of nursing practice program, with two post-baccalaureate options of family nurse practitioner and psychiatric-mental health nurse practitioner, as well as a post-master’s option in health systems nursing leadership. The school’s master’s nursing program has 81 currently enrolled, more than double the number in 2016, said Timothy Gaspar, dean and professor in CSU’s school of nursing.
“I think what you’re going to see is some leveling off of the master’s program and growth at the DNP level,” Gaspar said.
And growth continues at the BSN level as hospitals tighten requirements for baccalaureate training. CWRU, for instance, two years ago increased the number of students it admits each academic year from 80 to 120.
For the foreseeable future, Kline said she expects BSN to continue to be the ideal level of education for bedside nurses.
At Ursuline, Sharpnack said the goal is not simply to recruit students and get them to the college for four years, “but also see that there is an increase in the number of BSNs in the workforce because our goal is to improve health care for our community.”
