Nurses in New York State will be required to complete a Bachelor’s of Science in Nursing (BSN) within a decade of getting their licenses thanks to a new law that was approved at the end of 2017.
The BSN in 10, as the law has become known, could put additional pressure on an industry already facing a labor crunch. However, many are supportive of advanced degree requirements, and the push for additional standardization is one that runs across the in-home care space. The rest of the country should take notice of New York’s law, as trends often start in the Empire State before spreading to other states.
New York law
In December 2017, New York lawmakers passed the legislation, citing long-term care trends that patients with higher acuity levels need more sophisticated levels of care. Currently, only 55% of nurses have a four-year degree and less than 45% have a BSN, according to a 2016-2017 report by Nursing.org.
On its face, many industry stakeholders agree with the additional standardization of health care, particularly for the home care setting, where nurses and aides often face many unexpected heath events and are typically alone in the home with a patient or client.
“This has been a long-time debate to name a standard practice as the minimum of a bachelor’s degree,” Bridget Gallagher, vice president of New York City-based home care company Americare, told Home Health Care News. “Conceptually, I am behind this. Especially in home care, where it’s a very autonomous practice, the more you can enhance the skill set of the nurses going out into the community in the patients’ homes, it’s beneficial for the patient.”
Gallagher is also a former board chair of the Home Care Association of New York State (HCA-NYS), and current chair of HCA’s Nurse Advisory Committee.
The push toward higher education could also follow the trends toward value across the general health care space.
“[That component] is part of where the bachelor’s degree goal is coming from,” Gallagher said. “Everything is moving toward value-based [care] and clinicians with evidence-based packages and research.”
While the aim of the law to push higher standards in nursing are agreeable, some question the need for such a broad mandate across the space.
“The home care industry feels constrained and feels under threat often,” Helen Adeosun, CEO and co-founder of caregiver education company CareAcademy, told HHCN. “The intention, I think, is to help, and make sure these folks have some basis of knowledge and level of mastery. I think there are other ways to deliver on that intention beyond a mandate.”
Nurses, along with other in-home care jobs, are some of the most in-demand positions—and some of the toughest to fill. Adding more requirements could potentially squander some of the pool of available workers down the road, as some future nurses might not be able to afford a bachelor’s degree.
“The concern is there is a workforce shortage going on right now,” Gallagher said. “Home care is niche within the aging population in America. Everybody wants to stay at home. With the tsunami of aging happening, we desperately need skilled nurses, and its hard to recruit for the home care environment even in the best of circumstances.”
This notion is especially true for niche sectors within home care, such as caregivers who speak other languages and serve a specific patient base.
“The cost is going to be a challenge for some people,” Gallagher said. “We have a diverse patient population; we’re costly recruiting Asian nurses, Hindi-speaking nurses, Russian-speaking nurses. A lot of the time, a four-year college stint is a big leap for them. That’s why nursing is frequently attractive—because it’s a two-year program and then they can take next steps. I do believe there is a portion of the population that this [law] might close doors to.”
Indeed, questions have risen about whether the law will actually have a positive impact on the workforce or squander creative recruitment.
“The greater population of the U.S. is facing a crunch in terms of getting people who come into homes,” Adeosun said. “Think through the intention and have communication with our industry before imposing another mandate. I think the intention is good, but [within] the execution, there needs to be a thinking-through. Are there more dynamic and cost-effective ways of acheiving an intention of having a workforce that’s prepared? There’s already a shortage of RNs. Are we doing ourselves a disservice, are there smart and creative ways of attracting people and making sure we have the standards we need?”
Regardless of whether the law spreads to other states in other forms, additional standards in personal care are also underway. Michigan State University researchers are tackling the need for more personal care aides by developing training programs.
Not only are the programs aimed at improving care, but they also seek to boost recruitment, as education and training resources are frequently listed as must-haves among caregivers and employers. Training and higher education for workers can lead to better outcomes for patients and lower turnover among staff.
“The baby boomer demographic has been coming for years, and people haven’t wanted to deal with it, and now we have this worker shortage,” Clare Luz, PhD, assistant professor of family medicine at MSU, told HHCN. “People are beginning to wake up and do something about it. The conversation still revolves around the licensed professionals—doctor, nurses—and little attention is paid to the direct care worker, who is really in a pivotal position to increase the utility and outcomes of care, and they are the lowest-cost workforce.”
MSU has a grant to continue its training programs and photograph direct care workers and tell their stories to further Luz’s mission. However, how the institution will continue to pay for its program after the grant expires is still up in the air.
Similarly, how nurses will pay for a bachelor’s degree is unknown, and questions still remain about whether in-home care providers in New York will pick up some of the cost over time.
Interestingly, the education and recruiting issue in New York is one that has been ongoing for some time, with records dating back more than 100 years.
During another period marked by a shortage of nurses in 1912, Clara Noyes, superintendent of the Training School for Nurses of Bellevue and the Allied Hospitals in New York, said that education requirements should not be lowered, even in times of need for more nurses, who were mostly women at the time. Higher standards were actually more likely to attract higher quality students of nursing, she argued.
“By the maintenance of high standards,” she told the paper, “we make our schools more attractive to a high class of women. As a matter of fact, the dearth of pupils appears to be greater in the schools of low standards. Almost the only schools that appear to have no difficulty in getting enough students are the schools having stricter requirements.”
Written by Amy Baxter