Academic journal article Journal of Healthcare Management

Healthcare Employers' Policies on Nurse Education

Academic journal article Journal of Healthcare Management

Healthcare Employers' Policies on Nurse Education

Article excerpt


The 2010 recommendation that the proportion of registered nurses with BSN (bachelor of science in nursing) degrees in the nursing workforce should increase from the current 40% to 80% by the year 2020 has shifted the focus on nurses' educational progression from state legislatures-where changes in entry-level requirements were debated for decades-to the executive suites of large healthcare providers. The recommendation, contained in the report titled The Future of Nursing: Leading Change, Advancing Health, by the Robert Wood Johnson Foundation Initiative on the Future of Nursing at the Institute of Medicine, suggests that human resources policies for nurses have the potential to double the rates of college degree completions (IOM, 2010).

We surveyed 447 nurse executives in hospitals, nurse-led clinics, and home and hospice companies to explore the current practices of healthcare employers with regard to this recommendation. Almost 80% of respondents reported that their institution either preferred or required newly hired nurses to have a bachelor's degree, and 94% of the facilities offered some level of tuition reimbursement. Only 25%, however, required their nurses to earn a BSN or offered salary differentials on the basis of educational attainment (9%).

We conclude that if employers are serious about wanting a more highly educated nurse workforce, they need to adopt requirements for degree completion and wage differentials in the coming years. The likelihood that such policies will be widely adopted, however, is dramatically affected by the dynamics of nursing supply and demand.


The historic controversy over whether registered nurses (RNs) should be required to obtain a baccalaureate degree has been laid to rest, at least for now, by the 2010 report by the Institute of Medicine (IOM) titled The Future of Nursing: Leading Change, Advancing Health. The report recommends, and the nursing community appears to be united in support of, an incremental approach to increasing the proportion of RNs with BSN (bachelor of science in nursing) degrees from the current 40% to 80% of the nursing workforce by the year 2020.

The recommendation places the onus on healthcare employers, rather than on individual nurses (many of whom are mid-career or nearing retirement age and may, therefore, never recover the additional costs of returning to school), to ensure that nurses have a bachelor's degree. Specifically, the report recommends that employers (1) encourage nurses with associate and diploma degrees to enter baccalaureate nursing programs within five years of graduation, (2) offer tuition reimbursement, (3) create a work culture that fosters continuing education, and (4) provide salary differentials and promotions to nurses who advance their education. The rationale for the recommendation rests on two assumptions: ( 1 ) Better health outcomes are achieved by nurses who have complete a BSN degree, and (2) if more nurses complete a BSN, then more will continue on to graduate school, which will increase the number of advanced practice nurses and nurses who can serve as faculty.

In September 2011, less than a year after the release of the IOM report, we surveyed nurse executives in three settings-hospitals, nurse-led clinics, and visiting nurse care associations-to explore the current practices of healthcare employers with regard to the report's recommendation. We asked if the healthcare organizations require or prefer a BSN when hiring nurses, and we explored the range of policies they might consider to advance nurse education. Our findings suggest that most healthcare employers are already using "soft" incentives (such as tuition reimbursement) to encourage nurses to continue their education, but the policies proposed by the IOM (such as pay differential and promotion requirements) are infrequently used.


In healthcare, as in any industry, employers welcome research that seeks to define their return on investment in employee education (McMahon, 1993). …

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