www.advanceweb.com | 2018 | FOCUS ON EDUCATION 25 • HAPU (r = -0.500). • DVT/PE (r = -0.289). • Decreased length of stay/hospitalization (r = -0.333). The UHC data analysis suggested that the facilities that employed a higher proportion of baccalaureate-prepared or higher prepared nurses contributed to the improved patient outcomes for the study participants (Blegen, Goode, Park, Vaughn, & Spetz, 2013). In the review of this research, one point of interest discussed indicated that years of clin- ical practice experience did not provide a sig- nificant indicator of mortality rates. However, the review was concerned that for each level of initial level of education (associate’s degree, diploma program, BSN degree), the higher the nurse-to-patient ratios, there appeared to be a correlating higher level of patient complication reported. In fairness to previous observations, improved patient outcomes, decreased mortal- ity rates, and decreased readmission rates were not solely predicated on educational prepara- tion levels. Other factors that enhanced the studies’ review related to the nurse’s work- load and the quality of the work environment where the nurse practiced (National Institutes of Health, 2014). The nurse-to-patient ratio was an independent measured variable and was considered in the different levels of aca- demic preparation (associate’s degree, diploma program, BSN degree). This and the quality of the work environment appear in the liter- ature as common themes that may have con- tributed to the lower mortality rates (National Institutes of Health). To summarize, the analysis of the data sets reviewed and the studies presented pro- vided insight into the findings and supported common themes with nurses with baccalau- reate education or higher practicing in these health care facilities. These presented as the following: • Decreases in mortality rates. • Decreases in postsurgical procedure complications. • D e c r e a s e s i n l e n g t h o f s t a y/ hospitalization. • Decreases in hospital-acquired pressure ulcers. Supporting evidence also suggested con- tributing factors included stable nurse-to-pa- tient staffing ratios, and that the quality of the clinical practice environment affected patient outcomes (Aiken, Sloane, Bruyneel, & Van den Heede, 2014). A final important administrative point was made relative to concerns on the impact of the cost of adding nursing resources. The link was made to cost avoidance for the patient and the facility and the additional resource required. Specifically, readmission rates for the same disease process or a hospital-acquired issue (pneumonia, pressure ulcer, infection) was bal- anced when considering the addition of nurs- ing resources and the financial implications. Simply stated, the patient and the facility did not have to absorb the cost for the complica- tion/treatment or the extended length of stay. This balanced the cost of the nursing resources through cost avoidance. In retrospect, the conversation shift was beginning to see perspective change. The Aikin’s studies and Institute of Medicine (IOM) reports each validated that the health care system would unconditionally benefit from nursing by raising the minimum entry level to nursing practice. However, the chal- lenge presented by lobbying efforts from previous attempts still remained as barriers for progressive movement (IOM, 2010). The details of each of these studies are very much worth the reading time and highly recom- mended, as they provide a fair and honest eval- uation of the patient outcomes. The evidence suggested that there were patient outcome dif- ferences in the various levels of nurse educa- tion (Aiken et al., 2003; Aiken et al., 2011). RECOMMENDATIONS FROM THE 2010 INSTITUTE OF MEDICINE REPORT As the Aiken studies were analyzed and being released, a new entity emerged for discussion from the IOM. In 2010, the IOM released an evaluation report titled “The Future of Nursing Leading Change, Advancing Health.” This significant contribution was strongly seen as a pathway for change that could actually be placed onto an actionable construct. From the prospective of education recom- mendations, the IOM report cited action that included the following: • Create and fund transition-to-practice residency programs. • Encourage nurses to pursue master’s and doctoral degrees. • Promote continuing education and life- long learning. • Continue the trend toward increasing the number of nurses with a baccalaureate education. Similar to the 1964 federal Nurse Training Act, the IOM committee’s thinking suggested managing one of the specific barriers to bac- calaureate education: cost. The frequently discussed topic of the cost of education after completing an associate’s or diploma program can be prohibitive for members of the profes- sion. For some prospective nursing students, theprospectofattendingafour-yearuniversity program cannot be realistically entertained. The IOM discussion is very matter-of-fact in that pathways to higher education and tran- sition to practice would benefit greatly when health care organizations and government agencies lead the way forward. This collabora- tive approach would keep a dialogue going to pursue the objective of attaining a BSN as the minimum level of entry to practice. Investing in these efforts would be an investment in the overall future of nursing practice or perhaps incentivizing students contemplating this career. The ANA recently observed that more than 50% of nursing grad- uates are prepared with an associate’s degree in applied science (nursing) (The American Nurse, 2018). In addition, the ANA has indi- cated nurses graduating from these programs are less likely to return to the academic setting to complete a BSN or higher. The IOM committee also addressed an area where it felt that the nursing field was lacking in census volume (IOM, 2010). Specifically, the number of master’s- and doctoral-prepared nurses is relatively small. Doctoral programs are available, but the census number of nurses holding this academic qualification is lim- ited. The IOM report emphasized this level of education as essential to the nursing field to support progressive growth in health care facilities, clinical care models, research-based initiatives, faculty positions at academic col- lege and universities, and leadership positions in health care. As a point of interest, the IOM report’s recommendations brought to light the focus shifting away from acute care setting to encompass a more global perspective. The language in the IOM report does not FOCUS ON EDUCATION  |  CONTINUING EDUCATION