ACHIEVING 80% BSN by 2020: Gaining and Maintaining the Momentum 1
Wisconsin Center for Nursing, Inc. Mission: Assure an adequate, well-prepared and diverse nurse workforce for the people of Wisconsin Designated 501(c)(3) state nursing workforce center Board of Directors = nursing stakeholder groups Contract w/ WI Dept. Workforce Development Re-licensure fees for mandated workforce surveys under WI Stat Chap 106.30 for RNs & LPNs Analyze RN/LPN survey data w/volunteer researchers & make recommendations to ensure future workforce Annual Education Surveys IOM Future of Nursing Report 2
Data-based Workforce Planning WI population - 1.3 million increase by 2035 111% increase - people 65+ 133% increase - people 85+ Changing demographics; increasing diversity Complex health needs, changing care delivery systems Aging workforce RNs & LPNs Aging educators National recommendations 2011 IOM Report - The Future of Nursing 3
WCN Data Model RN and LPN Surveys Diversity Education Surveys DWD Forecasting Models IOM Report Recommendations Workforce Reports 4
2014 Wisconsin RN Survey 2014 WI RN Survey Report http://www.wisconsincenterfornursing.org/2014_wisconsin_rn_su rvey_reports.html Drs. Rachel Schiffman, UW-Milwaukee, Susan Zahner, UW-Madison, Judy Westphal, UW-Oshkosh & Susan Breakwell, Marquette. Statistician Jeff Henriques, UW Madison 83,918 responses/73,136 valid (living & working in WI) 2015 WI LPN Survey Report http://www.wisconsincenterfornursing.org/2015-lpn-survey.html Dr. Josie Veal, Milwaukee Area Technical College. Statistician Jeff Henriques, UW Madison 12,987 responses/11,158 valid (living & working in WI) 5
Wisconsin RN Forecast Model 6
2014 Wisconsin RN Survey 12000 Registered Nurses by Age (n=73,136) 10000 8000 9.7% 11.6% 10.4% 10.5% 9.9% 12.9% 13.8% 11.7% 6000 4000 5.6% 2000 0 1.5% 1.9% 0.5% < 25 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+ 7
2014 Wisconsin RN Survey 60.0% % RNs 55 & Older by Work Setting (w/average age) 50.0% 40.0% 30.0% 20.0% 49.5%(53) 31.9%(47) 32.7%(47) 22.9%(43) 31.4%(46) 39.8% (49) 43.5%(41) 10.0% 0.0% 8
2014 Wisconsin RN Survey Highest Nursing Degree Earned 2012 2014 43.7% 44.1% 37.0% 36.2% 9.4% 7.8% 11.1% 9.2% 0.6% 0.6% 9 Diploma ADN BSN MSN Doctorates
2014 Wisconsin RN Survey % Race - Ethnicity Caucasian African American Hispanic Asian Other 2014 95.1 1.8 1.6 1.4 1.6 % Gender Female Male 2014 93.1 6.9 10
2014 Wisconsin RN Survey Plans to Leave Direct Patient Care (DPC) 6.4% 58.0% 2012= 43.5% 13.7% 21.9% 2012 = 16.4% Less than 2 years 2-4 years 5-9 years 10 or more years 11
2014 Wisconsin Regional Data WI RNs South Southeast Northeast West North Median Age 48 48 47 49 48 % Female 93 93.7 93.6 91.9 92.7 % White 96.1 91.9 97.4 97.7 97.9 % Unemployed 1.9 2.1 1.9 2.1 1.5 % ADN 35.9 31.7 37.7 48 45.7 % BSN 45.2 49.7 44.4 33.7 37.5 12
IOM Report 80% BSN by 2020 Aiken & colleagues: Links educational levels to patient outcomes in acute care settings, including mortality rates In Wisconsin: 76% of RNs reported working in direct patient care 53% Wisconsin nurses work in hospitals Wisconsin 2014 Dashboard WI BSN = 44.1% (varies 34-50% across regions) WI BSN & higher = 55.8% National 2014 Dashboard BSN or higher = 51% 13
Advancing Education in Wisconsin 2014 Wisconsin RN Survey: 75% most recent nursing degree earned in Wisconsin 4-6% of respondents enrolled in BSN program across all regions (up 2%) 23.5% plan to pursue further education Most frequent barriers to advancing education: 32% Cost - tuition & fees 23% Lost work time & benefits Followed by: Family/personal Commuting/access Lack of flexibility WCN RWJF Grant: Taking the LEAD for Nursing in Wisconsin Developed CNO Toolkit to assess BSN status for meaningful approaches to achieve 80% 14
Achieving 80% BSN by 2020: Your Resources & The Bellin Story Laura Hieb, BSN, MBA, NE-BC Bellin Health Chief Nursing Officer & Chief Executive Officer Bellin Health Oconto Hospital 15
Resources to help you on your journey! WONE website http://w-one.org/ Academic Progression 16
The Bellin Story Cohort 2 January 2016 Cohort 1 August 2015 17
Bellin Health Over 3,700 Employees 1,007 nurses (65% BSN or Higher)
The Journey 2010-2011 2012 Read the IOM Report Understood our gaps gathered data on our current state Held focus sessions 2013 Incorporated into Nursing Professional Development Council and annual nursing goals Picked our focus area of 80% BSN by 2020 Held focus sessions again 2014 with staff Partnered with local Bellin College 2015 Created a proposal - calculated costs and developed ROI Presented to Senior Leadership Launched first cohort in August 2015 Hiring process changed to require BSN within 5 years 19
The Journey Continues 2016 2017-2019 2018-2020 2 nd cohort started in January 1 cohort will start in each of the next 3 years Pay split 20
Did the Math! Number of RN s that are currently Diploma, ADN, BSN, or higher Projected RN turnover through attrition/retirement Number of BSN s versus ADN s being hired Number of currently employed RN s enrolled in higher degree programs Number of RN s willing to go back to school Implementation of new ADN s needing to obtain a BSN within 5 years of hire Calculated if we maintain current education ratios and support enrolling 100 RN s in the BSN Completion Program, we will hit 80% by 2020 21
Return on Investment Bellin to cover 70% of students tuition and book fees, student to cover remaining 30% Bellin s approximate cost per student is $19,600 Monetary investment for Bellin = $1.96 million over 5 years (100 nurses) Approximate cost of RN turnover today = $50,000 Students sign a retention commitment of 2-4 years post-graduation, dependent on dollars received Projecting to decrease turnover by 40 nurses in 5 years (using current predicted shortages and Bellin data against current state demographic data) BSN Completion Program projects are Bellin related and focus on our strategic goals, therefore creating benefit to the system Continue work to solicit funds from outside sources 22
It s a Win-Win! Win for the Employee 70% of their tuition and book expenses are covered Participating in a Bellin specific program that will optimize work and academic opportunities Cohorts consist of their colleagues from across the organization, creating a support system Blended curriculum approach of on-line curriculum and classroom to optimize work/life balance Win for the Organization Enhanced partnership with Bellin College on a unique program that optimizes current work Completed projects impact the Quadruple Aim for the system (cost, population health outcomes, experience, and joy in work) Assists in a retention strategy for when retirements begin to hit Supports achieving IOM recommendations of 80% BSN by 2020 23
Success Stories.. 24
The BSN Progression Taskforce Proposal for the Aspirus System Deanna Wilson, V.P. Patient Care Services Aspirus Ontonagon Hospital Peggy Ose, V.P. Patient Services & Chief Nursing Officer Aspirus Riverview Hospital Ruth Risley-Gray, SVP, Aspirus System Chief Nursing Officer John Heisler, SVP, Chief Human Resource Officer 25
8 community directed, nonprofit hospitals and 50+ clinics serving North Central Wisconsin and the Upper Peninsula of Michigan Headquarters Newly Added Full continuum of healthcare services offered: two acute care hospitals, six critical access hospitals, over 50 multi-specialty clinics, ambulatory surgery centers, home health, hospice care, pharmacies, medical equipment, & skilled nursing homes More than 7,000 employees
Aspirus BSN Progression Taskforce Aspirus is a healthcare system with more than 7,000 employees located in North Central and Northeast WI, and the western UP There are 8 hospitals in the Aspirus system, 4 in each state. Six of these are CAHs. The CNOs from each Aspirus Hospital, along with the system CNO, and the Directors from PAC and Clinics, meet on a monthly basis either in-person or via videoconference Develop system-wide initiatives that all hospitals work on collaboratively 27
Aspirus BSN Progression Taskforce As part of the CNO Strategic Planning session, BSN progression was identified as a high-priority goal for FY 17, as well as for future long-range planning. Determined that the Aspirus system was lagging in driving BSN prepared nursing education as recommended by the IOM Report (2010) In order to plan effectively, a task force was selected to move this initiative forward. The Task force had representatives from: CNO group, Human Resources, Legal, Finance, Education Services, and Nurse Recruitment. 28
Aspirus BSN Progression Taskforce The first step was completing a gap analysis to determine the current Aspirus nursing workforce educational level. This was a manual, time-consuming process since we didn t have an effective electronic HR system that could easily extract this information. We found that we have a high percentage of ADN prepared nurses. 29
Aspirus System Nurse Education Matrix 30
Aspirus BSN Progression Taskforce The CNOs and HR representatives presented the IOM recommendations, along with supporting research, to our Corporate Executive Council on December 16, 2015. We also provided demographics on the nursing population from information in WONE toolkit Lastly we provided the Aspirus Nurse Education matrix to show how our system compared to the Wisconsin demographics. 31
Aspirus BSN progression Taskforce At the December 16 th, CEC meeting, we presented the Why, and the current state of nurse education at Aspirus to lay the groundwork for the Ask. At the January 20th CEC meeting, we went in with the Ask a request to increase the tuition amount and the rate of reimbursement for BSN completion, along with rough draft financial information. 32
Aspirus BSN Progression Taskforce The rough estimate cost to get to 80% BSN workforce was initially determined to be approximately $6.125 Million for Aspirus. A Nursing Tuition reimbursement policy was written and reviewed with the BSN Progression Taskforce, and after some revisions, was presented to the CEC, as well as the System CNO group in January, to outline how Aspirus would reimburse for BSN education. 33
Aspirus BSN Progression Taskforce Increase tuition reimbursement to $12,500 per ADN nurse for BSN completion Assumption that average time to complete would be 3 years No limitation on $ amount received per year, but must be actual costs. Same reimbursement for FT or PT nurses. Repayment following BSN completion would be $2 for every hour worked. If FT (2080 hrs per year), repayment of $4,160 per year. 34
Aspirus BSN Progression Taskforce We prepared to go back to the CEC on 3/23/16 to provide a more detailed cost projection over the next three years We also prepared to address other questions from the CEC. This decision had a huge financial impact to our healthcare system, so an in-depth analysis was necessary. Determined the number of nurses each hospital could monetarily support each year Timeline for achieving 80% BSN nursing staff 35
Projected Costs Entity # of Nurses 1st year Potential Total per EE $12,500 Year 1 Year 2 Year 3 Year 4 Year 5 5 Year Projected Cost Year 6 Year 7 Year 8 Year 9 Year 10 10 Year Projected Cost AWH 30 12,500 125,000 250,000 375,000 375,000 375,000 1,500,000 375,000 375,000 375,000 375,000 375,000 3,375,000 ARV 10 12,500 41,667 83,333 125,000 125,000 125,000 500,000 125,000 125,000 125,000 125,000 125,000 1,125,000 AKH 6 12,500 25,000 50,000 75,000 75,000 75,000 300,000 75,000 75,000 75,000 75,000 75,000 675,000 ALH 6 12,500 25,000 50,000 75,000 75,000 75,000 300,000 75,000 75,000 75,000 75,000 75,000 675,000 AGV 6 12,500 25,000 50,000 75,000 75,000 75,000 300,000 75,000 75,000 75,000 75,000 75,000 675,000 AMH 6 12,500 25,000 50,000 75,000 75,000 75,000 300,000 75,000 75,000 75,000 75,000 75,000 675,000 AIR 6 12,500 25,000 50,000 75,000 75,000 75,000 300,000 75,000 75,000 75,000 75,000 75,000 675,000 AOH 4 12,500 16,667 33,333 50,000 50,000 50,000 200,000 50,000 50,000 50,000 50,000 50,000 450,000 Totals 74 308,333 616,667 925,000 925,000 925,000 3,700,000 925,000 925,000 925,000 925,000 925,000 8,325,000 Number BSN Completed - - 74 74 74 222 74 74 74 74 74 592 Five Year Projected Cost $3.7 Million and 222 BSN Graduates Ten Year Projected Cost $8.3 Million 592 BSN Graduates Annual Cost of $925K starting Year 3 36
Aspirus BSN Progression Taskforce Timeline for Completion Business Unit Total RN's # of A.D.N.'s % of A.D.N.'s # of B.S.N.'s or Higher* % B.S.N.'s or Higher* # of A.D.N.'s x.80 # of Nurses First Year Total # of Years Plus 3 Yrs Grand Total # of Years CALENDAR YEAR OF COMPLETION AGV 93 68 73% 25 27% 54 6 9 12 12 2028 AKH 85 48 56% 37 44% 38 6 6 9 9 2025 ALH 137 89 65% 48 35% 71 6 12 15 15 2031 AMH 131 78 60% 53 40% 62 6 10 13 13 2029 AOH 33 22 67% 11 33% 18 4 4 7 7 2023 AWH 646 307 48% 339 52% 246 30 8 11 11 2027 AIR 56 29 52% 27 48% 23 6 4 7 7 2023 ARH 153 105 69% 48 31% 84 10 8 11 11 2027 ACI 72 33 46% 39 54% 26 N/A N/A N/A N/A N/A PAC 47 39 83% 8 17% 31 N/A N/A N/A N/A N/A Total 1453 818 56% 635 44% 74 37
Aspirus BSN Progression Taskforce The CEC had many questions and needed more information prior to voting on the BSN proposal 38
1. Should this proposal be limited to nurses pursuing a BSN or also be offered to nurses pursuing MSN or DNP? 39
2. How does this impact other staff? What are the tuition reimbursement opportunities for others in the organization? How might this impact morale? Why is nursing getting this bump and not others? 40
3. What is the actual cost for an ADN to BSN program? Have we canvassed the various schools to get an accurate amount? 4. What % of costs will the proposed tuition reimbursement cover for the student? Feel they should have some skin in the game and pay for some of their own. 41
5. What budget impact (now & future) would this initiative have on individual business units? 42
6. What is the plan to work in synchrony with the clinic s plan coming forward to incentivize BSNs to get their APNP? How can we do this together to ensure a win/win for both efforts? 43
7. Why do FT and PT get same amount? Should a pro-rated amount for PT be considered? 44
8. What is the Nursing Model of Care that this effort is supporting? What s the end in mind? 45
9. How will you demonstrate quantifiable benefit and outcomes in terms of improved patient care quality outcome measures/improved cost of care measures/safety and patient experience measures? 46
10. How does the differential impact salary/wage to market by BU vs. midpoint? 47
Become a LEAD Organization WCN RWJF Round 2: Wisconsin Nursing LEADs the PACC: Partnerships in Action for Community Care Goal: Recognize organizations who are paving the way to advance levels of nursing education Provide platform to recognize & share what orgs are doing around BSN completion and other educational advancement Committee work by WCN & WONE; vetted thru WONE members for feedback Result: Leading by Example to Advance Degrees 48
Become a LEAD Organization IOM recommendations around education: 1. Increase the proportion of nurses with a baccalaureate degree to 80% by 2020. 2. Double the number of nurses with a doctorate degree by 2020. 3. Ensure that nurses engage in lifelong learning. No set criteria for program specifics, requirements Any organization working on education advancement is eligible Plan to showcase a gallery of organizations w/ their exemplars Webpage http://www.wisconsincenterfornursing.org/wcn_organization_r ecognition_program.html Need brief summary of activities, contact info & photo 49
LEAD Organization - How to Submit No requirements, no timeline, open submission Simply go to: http://www.wisconsincenterfornursing.org/wcn_organizat ion_recognition_program.html Question: Would you like to be recognized for what you are doing to advance nursing education? Click Tell us about it. Submit brief summary of activities (300 words or less), contact info & leader or hospital photo, link to your org website Send to info@wicenterfornursing.org For questions, please contact Judith Hansen judi@wicenterfornursing.org or 414-801-6877 50
Questions 51
Presenters Contact Info Judith Hansen, MS, BSN, RN WCN Executive Director judi@wicenterfornursing.org 414-801-6877 Peggy Ose, RN, MSN, FACHE Vice President-Patient Services/CNO, Aspirus Riverview Hospital & Clinics, 715-421-7427, Peggy.Ose@aspirus.org Deanna Wilson, RN, MSN, CPPS, LNHA, VP of Patient Care Services/Site Manager, Aspirus Ontonagon Hospital, 906-884-8109, Deanna.Wilson@aspirus.org Laura Hieb, Chief Nursing Officer, Bellin Health System, CEO Bellin Health Oconto Hospital, 920-433-7436, laura.hieb@bellin.org 52