George M. Walsh, Michael Gormley, AP
New registered nurses would have to earn bachelor's degrees within 10 years to keep working in New York under a bill lawmakers are considering as part of a national push to raise educational standards for nurses, even as the healthcare industry faces staffing shortages. The "BSN in 10" initiative backed by nursing associations and major health policy organizations aims to attack the complex problem of too few nurses trained to care for an aging population, which includes hundreds of thousands of nurses expected to retire in the coming years.
Some in the healthcare industry worry that increased education requirements could worsen the problem by discouraging entrants into the field. Currently, most registered nurses have two-year associate's degrees. No state requires a four-year degree for initial licensing or afterward, though New Jersey and Rhode Island have considered proposals similar to New York's over the past several years. New York's legislation died in committee last session, but it has bipartisan support in both chambers this year and could be debated as early as January.
Demand for more skilled nurses is increasing as the population gets older and has more chronic diseases, and as the new federal healthcare law promises to help 32 million more Americans gain insurance within a few years. Federal health officials have recommended upgrading nurse education to BSNs for more than a decade, and the idea got a boost in a 2010 report, The Future of Nursing, by the National Academy of Sciences non-profit Institute of Medicine and the Robert Wood Johnson Foundation. As of 2008, about one-third of RNs had bachelor's degrees or higher, according to federal statistics. The institute recommended increasing that to 80 percent by 2020.
Advocates say that in addition to improving patient care, a key reason for requiring more education is to put more nurses in position to move on to jobs in administration and in-demand specialties like oncology, and to teach at nursing schools, where the average faculty age is 53. "More and more hospitals are looking to hire BSNs, but the catch is that not that many schools offer the RN-to-BSN program or have the faculty to teach it," said Sharon Shockness, an adjunct teacher at Mercy College in Westchester County.
The New York bill's main sponsors, Democratic Assemblyman Joseph Morelle of Rochester and Republican Senator James Alesi of Monroe County, said the bill is needed to further professionalize nursing. Both serve on their respective higher education committees and represent districts that include University of Rochester Medical Center and St. John Fisher College, which have BSN programs.
In addition to helping provide future teachers, the lawmakers say the added education and critical thinking skills are needed as patient care has become more sophisticated and studies show staff with higher levels of education serve patients better. In a memo supporting the bill, the New York State Nurses Association cites a 2003 University of Pennsylvania study that found every 10 percent increase in staffing by nurses with bachelor's degrees results in a five percent decrease in surgical deaths.
Current registered nurses would be exempt from the education requirement to prevent driving more nurses from the field. "This bill shouldn't discourage anyone at this point because it doesn't involve anyone even applying for licensure right now ... and 10 years is a long time to get a degree that will give you better pay," Alesi said. Alesi contends the measure will "improve the landscape of nursing" by increasing the pool of RNs who can go on to obtain master's degrees and teach.
Researchers say almost 900,000 of the nation's roughly three million licensed RNs are older than 50, and while there's been an uptick in new, younger nurses, shortages are still expected as the healthcare industry continues to add nursing jobs. The federal Bureau of Labor Statistics estimated in 2009 that almost 582,000 new RN jobs would be created by 2018.
Federal projections in 2004, the most recent available, forecast a shortfall of 54,000 RN jobs in New York by 2020; the state currently has about 170,000 working nurses. The state and national shortage estimates have varied greatly as the overall economy and national health policy have changed. A study published this year in the journal Health Affairs reports a surge among younger RNs entering the workforce, pointing to an easing of a national shortage previously forecast to reach 400,000 by 2020.
That shortage concerns New York's health care providers. William Van Slyke, spokesman for the Healthcare Association of New York State, said the organization representing healthcare networks and hospitals supports having a better educated nursing workforce, but opposes a four-year degree mandate. One problem, he said, is the lack of nursing faculty — the same issue advocates say the bill would address. "If you start the clock and you don't have the educational system, we may find ourselves having to turn away staff and have shortages," Van Slyke said.
The association has proposed legislation that would provide incentives like loan forgiveness to encourage people to become nurse educators, he said, but lawmakers haven't taken up the idea. Morelle, the Assembly sponsor, said the state's community colleges also have expressed concerns that the requirement will cut into the number of people seeking the 2-year degrees they offer. "Their classes are overflowing," Morelle said, and there is a "whole host of programs" that allow students to progress from a 2-year to a 4-year program.
A spokesman for the New York nurses association said New York City metropolitan area hospitals are increasingly requiring new RNs to have a bachelor's degree or earn one within five years, creating a disparity in standards between downstate and upstate, where fewer candidates have four-year degrees.
"Even without the legislation in place, hospitals and other medical facilities are making hiring decisions that favor those with BSN degrees over those without them," said Dr. Peggy Tallier, program director and associate professor in nursing school health at Mercy College.