NUR 7120 Module 4 Intellectual Resources Paper: Investing in BSN Education, Certification and Evidence-Based Practice Example

What Nurses Know: Budgeting for Education, Certification and Evidence-Based Practice

Student Name

M.S. in Nursing, Nursing Administration, Thomas Edison State University

NUR-7120: Nursing Administration: Resource Acquisition and Management

Mentor Name

Month Day, Year

What Nurses Know: Budgeting for Education, Certification and Evidence-Based Practice

The Problem

Our telemetry unit has 42 registered nurses. Of them, 22 hold a bachelor's degree, five hold progressive care or cardiac certification and none has led an evidence-based practice project in the past two years. Policies on the unit are updated mainly when regulations change. When I asked staff why so few pursue a degree or certification, the answers were cost, time and uncertainty about whether it would make a difference.

Education and Patient Outcomes

Aiken et al. (2014) linked records for about 420,000 people who had surgery, in 300 hospitals spread over nine European countries, with survey responses from the hospitals' nurses. With patient and hospital differences taken into account, every extra patient per nurse made death within 30 days 7 percent more likely in odds terms, while each additional 10 percent of nurses holding a bachelor's degree cut those odds by 7 percent. By their estimate, a hospital where six in ten nurses had a degree and each cared for six patients would see nearly 30 percent fewer deaths than one where three in ten had a degree and each cared for eight.

Certification and Outcomes

Kendall-Gallagher et al. (2011) studied surgical patients in 652 hospitals in the United States, examining nurse specialty certification alongside education. Each 10 percent increase in nurses who were both bachelor's-prepared and specialty certified went with 2 percent lower odds of in-hospital death and of death following a complication. Certification was not linked to better outcomes among nurses without a bachelor's degree, suggesting that certification adds the most when built on baccalaureate preparation.

Evidence-Based Practice

Melnyk et al. (2012) surveyed a national sample of more than 1,000 registered nurses who were members of the American Nurses Association. Most valued evidence-based practice and wanted to use it, but many reported not consistently implementing it. The obstacles they named most were too little time, a workplace culture that did not support it and pushback from managers and leaders. Nurses with higher education were more likely to report using evidence, and respondents wanted more access to mentors and resources.

Knowledge as a Resource

Budgets usually count nurses as hours and salaries. Treating their knowledge as a resource means investing in it, protecting time to use it and measuring its effect, just as a unit would for equipment. The evidence above suggests that such investment can affect mortality and rescue, outcomes leaders care most about.

The Proposal

I proposed three investments for the coming fiscal year. First, tuition support of up to $5,000 a year for registered nurses enrolled in RN to BSN programs, with flexible scheduling around class times, in exchange for a two-year commitment to the hospital. Second, payment of certification exam fees, about $300 per nurse, and a $1,000 annual differential for certified nurses, with study groups led by certified colleagues. Third, two evidence-based practice mentors, experienced nurses trained through a hospital course, each given four hours a month of protected time to guide small teams through practice questions.

Costs and Return

For an expected eight nurses using tuition support, ten taking certification exams and two mentors, the first-year cost is about $59,000. The return comes partly through retention, since development opportunities and tuition commitments help keep nurses whose departure would cost about $95,000 each, and partly through outcomes, which we will track.

Addressing Barriers

Melnyk and colleagues found manager resistance among the barriers, so my own role matters. I will attend the first project meeting of each mentor team, add evidence-based practice time to the schedule and recognize completed projects at staff meetings.

Fair Access

Night-shift and part-time nurses often miss development opportunities scheduled during the day. Study groups and mentor meetings will alternate between day and evening times, recorded sessions will be available and tuition support will be open to part-time nurses on a prorated basis. Repayment terms for nurses who leave early will be prorated rather than all-or-nothing, so the commitment supports retention without trapping anyone.

A First Project

The first mentor team, three staff nurses and a mentor, chose a question raised at a staff meeting: whether patients were staying on cardiac monitoring longer than their indication required, which adds alarm burden and limits beds. They will review published practice standards, audit 50 patients and propose a daily monitoring review at huddle. The project gives the program an early, visible result.

Recognition

Nurses who complete a degree or earn certification will be recognized at a staff meeting and in the hospital newsletter, and certification will appear on name badges. Completed evidence-based practice projects will be presented at the hospital's annual nursing research day, giving staff a visible reason to take part.

Partnering With Schools

Two local universities offer online RN to BSN programs with tuition discounts for hospital partners. Formalizing those agreements, and scheduling clinical hours around shifts, lowers the cost of the tuition benefit and makes completion more realistic for working nurses.

Measuring Results

We will track the proportion of nurses with a bachelor's degree and certification each year, the number of evidence-based practice projects and resulting policy changes, retention of participants and unit outcomes such as failure to rescue, rapid response calls and falls.

Limits

The European and US studies are observational, and outcomes depend on many factors. Tuition commitments can feel coercive if not designed fairly. The unit and figures are invented.

Conclusion

Aiken and colleagues linked more bachelor's-prepared nurses to lower mortality, Kendall-Gallagher and colleagues showed that certification adds the most when built on a bachelor's degree and Melnyk and colleagues showed that nurses need time, culture and mentors to use evidence. Tuition support, paid certification and funded mentors treat nurses' knowledge as a resource worth budgeting for.

References

Aiken, L. H., Sloane, D. M., Bruyneel, L., Van den Heede, K., Griffiths, P., Busse, R., Diomidous, M., Kinnunen, J., Kózka, M., Lesaffre, E., McHugh, M. D., Moreno-Casbas, M. T., Rafferty, A. M., Schwendimann, R., Scott, P. A., Tishelman, C., van Achterberg, T., & Sermeus, W. (2014). Nurse staffing and education and hospital mortality in nine European countries: A retrospective observational study. The Lancet, 383(9931), 1824-1830. https://doi.org/10.1016/S0140-6736(13)62631-8

Kendall-Gallagher, D., Aiken, L. H., Sloane, D. M., & Cimiotti, J. P. (2011). Nurse specialty certification, inpatient mortality, and failure to rescue. Journal of Nursing Scholarship, 43(2), 188-194. https://doi.org/10.1111/j.1547-5069.2011.01391.x

Melnyk, B. M., Fineout-Overholt, E., Gallagher-Ford, L., & Kaplan, L. (2012). The state of evidence-based practice in US nurses: Critical implications for nurse leaders and educators. Journal of Nursing Administration, 42(9), 410-417. https://doi.org/10.1097/NNA.0b013e3182664e0a