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With development and widespread distribution of the Institute of Medicine’s “The Future of Nursing: Leading Change, Advancing Health” (2011), focus on the need to increase the level of nursing education to meet demands of today’s and tomorrow’s health system needs has never been stronger. Recommendation and Key Message #2 in the report presents evidence and a clear message that “nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.” While this factor has broad delivery system and academic program implications, more specifically, a goal of 80 percent rate Bachelor of Science in Nursing (BSN) or higher across all nursing roles by the year 2020 calls to action those who educate and employ registered nurses (RNs).
 
The Business Case for Change
In years past, rationale for requiring advanced education was not clear, but that is no longer the case. Studies and evidence that links RN educational preparation to critical clinical outcomes is solid. There are numerous studies today across hundreds of hospitals, thousands of nurses, and hundreds of thousands of patients demonstrating this correlation. Specifically BSN education is directly linked to:
• Shorter lengths of stay
• Decreased infection rates
• Lower incidence of injury
• Lower probability of post-surgical mortality
• Lower incidence of “failure to rescue”
 
BSN nurses are shown to hold higher competencies in communication and problem solving abilities, higher proficiency in assessment of patients, and higher proficiency to impact nursing care and quality outcomes. Additionally, BSN prepared nurses have increased capacity to work across the continuum of care, in the community, and in alternative settings which are experiencing a growing demand.
 
Scanning the Environment
Across the United States, there is significant variation in how nurses themselves view educational advancement, on what education programs are available at the local level and in the hiring practice of health care organizations. In some regions, many organizations’ hiring practices have evolved to employing only those nurses with the BSN. While the majority of RNs in the United States today begin their careers in community college associate degree programs, educational progression is a necessity. The Institute of Medicine (IOM) report and this entry level fact is a call to action for organizations to understand their own workforce and strategically address capability to reach the 2020 goal. Additionally, individual organizations need to emerge deep into their quality indicators directly related to nursing education and determine potential impact, developing their own case for change.
 
To implement the IOM recommendations, action coalitions have formed in every state. Forming a strong alliance across the nation, the action coalitions are addressing the recommendations from the IOM Report. With assistance from the national offices housed in AARP and supported by the Robert Wood Johnson Foundation, state teams collaborate with leaders from across the nation to make the recommendations reality. In Florida, the Action Coalition (FL-AC) was formed under the umbrella of the Florida Center for Nursing with a mission “to provide leadership in advancing the nursing profession so that Floridians can access safe, high quality health care.” The Florida Blue Foundation partners with the Center to lead the state effort. With participation of other state organizations, the FL-AC has three active teams addressing the recommendations regarding leadership, clinical practice and regulation, and the issues of education. More information on the FL-AC and activities of the teams can be found at http://www.flcenterfornursing.org/FLActionCoalition/AbouttheFLAC.aspx.
 
Nurses from many backgrounds provide much needed services across a wide spectrum of delivery systems, in leadership, in the home, the community and in health care related industries. The progression of nursing education is intended to better prepare nurses for the demands of an evolving system, lifting up and supporting continued learning and practice for the benefit of health systems and people who need expert nursing care at important times in their lives.