Benefits of Advanced Nursing Degrees Outweigh Staffing Squeeze

A landmark law in New York State could present additional challenges for skilled nursing providers, but major industry trade groups say that the potential benefits for residents could outweigh the staffing stress.

Late last year, the Empire State passed a sweeping law that will require nurses to obtain Bachelor’s of Science in nursing degrees within 10 years of their initial licensure — the so-called “BSN in 10” measure.

Lawmakers cited trends in the long-term care space in the legislation, saying that demand for shorter lengths of stay and increasing patient acuity required more sophisticated levels of care.


“Several recent research studies clearly demonstrate the added value of additional education in relation to improved patient outcomes,” the bill reads. “The legislature finds that expanding the educational requirements for the profession or nursing, while maintaining the multiple entry points into the profession, is needed.”

Research indeed backs up the potential for achieving improved outcomes through the use of nurses with higher-level degrees: An initiative in Missouri to embed advanced practice registered nurses (APRNs) in skilled nursing facilities resulted in a 48% reduction in potentially avoidable hospitalizations. And with new payment models rewarding SNFs that can cut rehospitalizations — and punishing those that can’t — more educated employees could prove to be a valuable addition.

Still, a law instituting new restrictions on who can work as a nurse can raise concerns in a space dominated by a persistent labor shortage. In the state of Indiana, for instance, registered nurses had the highest vacancy rate of all positions in the long-term care space, with 22% of needed positions open.


“It’s a reasonable thought to have,” American Health Care Association associate vice president for quality and clinical affairs Holly Harmon told Skilled Nursing News. “Certainly, requiring a bachelor’s could exclude individuals who want to become a nurse but are not able to financially afford [it].”

Currently, skilled nursing facilities generally have a mix of nurses on staff, from licensed practical nurses (LPNs) to those with bachelor’s and master’s degrees, Harmon said. As of about a decade ago, just 36.8% of working nurses in the United States had a bachelor’s degree, and a four-year diploma is not required to become a registered nurse.

Harmon commended New York officials for instituting a grandfather clause in the legislation: All active nurses and nursing students in the state are exempt from the requirement, with the rule applying only to those who begin to pursue a career in the field 18 months after the law was instituted.

LeadingAge New York, the state-level branch of the nationwide trade group that represents non-profit long-term care providers, actively supported the legislation, according to vice president for advocacy and public policy Ami J. Schnauber.

In fact, LeadingAge New York president James W. Clyne, Jr. sent a letter of support for the bill to state Gov. Andrew Cuomo’s office in December, which included nearly identical language to that of the proposal.

“Additional educational preparation would enable nurses to better meet the demands of a changing health care system and improve outcomes for patients across New York State,” Clyne wrote, going on to urge Cuomo to sign the bill.

The governor indeed signed the bill, but only on the condition that the legislature would provide a second piece of legislation that would allow for more time before the requirement took effect, Schnauber told SNN. That additional legislation would also empower the state’s Education Department to provide waivers for nurses who can’t find appropriate BSN programs.

While AHCA didn’t take a stand on the bill, Harmon also pointed out that many of its member providers offer long-term learning opportunities — and said that states are best positioned to make decisions related to long-term care staffing.

“We really recognize that each state has different needs, so we acknowledge the importance of state-based decisions on issues like this,” Harmon said.

Written by Alex Spanko

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