NYONE Talking Points: Agency Benefit/Expense from BS in Ten passage


CNOs should consider several facts in calculating future incremental expense for “BSN in Ten” education:


  • Sixty percent of the 8000 new graduate Registered Nurse in NYs are prepared at the associate degree (AD) level. Therefore the number of new grads annually that would have to pursue the BS in the future would be 4800 annually for all of NYS. Additionally 20% of AD grads have pursued higher education of their own volition and are therefore being reimbursed with tuition reimbursement. There would be no additional cost for those nurses.
  • Organizations have made the strategic decisions to offer tuition reimbursement as a means of recruiting and retaining nurses thereby reducing turnover costs.



  • The bill applies only to future graduates of AD and diploma programs. If this proposal were passed by the legislature and signed by the Governor in 2014, the earliest the new requirement would apply to any AD or diploma student entering school would be two years after the bill becomes law or 2016. Then the BS would need to be achieved within ten years of their licensure or 2026. All current RNs and students are exempt.
  • The bill will not intensify any potential shortage due to the grandfather clause. No nurse currently licensed or preparing to become a nurse in any nursing program would ever have to meet this requirement.
  • Future RNs prepared at the associate degree and diploma level would be given 10 years from initial licensure to complete a baccalaureate degree in nursing. . There cannot be any one calculation of incremental cost after 2014 as each nurse would proceed on different timelines over the 10 years to complete the BSN.  However, a minimum of one course per semester would be the necessary.


Research Linking Nursing Education to Patient Outcomes:

Improved patient outcomes reduce the cost of healthcare.

  • In a study published in the September 24, 2003 issue of the Journal of American Medical Association, Dr. Linda Aiken identified a clear link between higher levels of nursing education and improved patient outcomes in a study of 230,00 patients in 163 hospitals.  A 10% increase in the proportion of BSN prepared nurses decreased the risk of patient death and failure to rescue 5%.
  • Dr. Carol Estabrooks replicated the Aiken study with 18,000 patients at 49 Canadian hospitals and found identical results which were published in the March/April 2005 issue of Nursing Research.
  • In the January, 2007, Journal of Advanced Nursing, Dr. Ann Tourangeau published the results of a study of 46,993 patients and found hospitals with higher proportions of BS prepared nurses had lower rates of 30 day mortality.  There were 9 fewer deaths per 1000 discharges for every 10% increase in BS prepared nurses.
  • In May, 2008 Dr. Aiken released a study confirming her earlier findings which were published in the Journal of Nursing Administration.
  • In 2009, Drs. Mary Blegen and Colleen Goode completed a longitudinal study of 21 US hospitals over 84 quarters.  The researchers found hospitals with a higher proportion of BSN educated nurses had lower rates of congestive heart failure mortality, hospital acquired pressure ulcers, failure to rescue, and length of inpatient stay.  Their study has been submitted for publication.
  • In a 2002 New York Study (Ingersoll), a 2005 study published in the Journal of Nursing Scholarship (Rambur) and a 2008 survey of 5000 New York Registered nurses (McGinnis), the more highly educated nurses were more satisfied and employed longer than AD prepared nurses.  Because baccalaureate prepared RNs score significantly higher in job satisfaction related to autonomy and growth, job stress and demands, they were therefore more likely to have been in their jobs more than ten years.
  •  The bill will not intensify any potential shortage due to the grandfather clause. No nurse currently licensed or preparing to become a nurse in any nursing program would ever have to meet this requirement.


Benefits to New York

 If one extrapolates the research to the NYS population/admission statistics, there are multiple positive effects for agencies FINANCIALLY.

  • Project 6000 fewer surgical deaths annually when 60% of nurses are prepared at the BS level.
  • Project a 10% reduction in the 200,000 hospital acquired pressure ulcers (HAPU) each year.  The published additional length of stay from HAPUs is 3.98 days, thus the potential savings is 17.5 million dollars annually.
  • With the reduction of the LOS by .2 days there is a potential capacity for 400,000 patient days.
  • A reduction in reimbursement associated with readmissions will require an increase in baccalaureate prepared RNs to identify actual or potential complications prior to release.
  • Every 1% reduction in RN turnover saves $12.9 million statewide.