Organizational Overview 7

Structural Empowerment


An action plan that includes a target and demonstrates evidence of progress toward 80% of registered nurses obtaining a baccalaureate or graduate degree in nursing by 2020. Include an assessment of the current status; an evaluation of methods and strategies to increase the educational level of the workforce; and an appraisal of established, realistic targets to meet the organization's strategy to increase the number of registered nurses with a degree in nursing (baccalaureate or graduate degree).



Spectrum Health Grand Rapids Baccalaureate or Graduate Degree in Nursing Action Plan

Dramatic changes in health care in recent years, and the challenges it will face in the future, require more highly skilled and educated nurses. Nurses need to deliver high-quality care, fill expanding roles, master technological tools and information management systems, and collaborate and coordinate care across teams of health professionals. Nurses are expected to lead changes to help transform the health care system.


To respond to these increasing demands, the Institute of Medicine (IOM) recommends the proportion of nurses with a bachelor’s degree in nursing be increased to 80% by 2020. In addition, research has shown that nurses with higher levels of education have better patient outcomes.


Ongoing Assessment of Status
Nursing at Spectrum Health Grand Rapids (SHGR) recognizes the importance of education. The value it places on nursing education is demonstrated by the longstanding minimum education requirement of a baccalaureate or graduate degree in nursing for nurses in leadership roles, as depicted in the table below.



SHGR Education Requirements for Nurses in Leadership Roles



Minimum Education Requirement for Role

Nursing Supervisor

Bachelor’s degree in nursing

Nurse Educator

Bachelor’s degree in nursing

Nursing Practice Associate

Bachelor’s degree in nursing

Clinical Nurse Specialist

Master’s degree in nursing

Nurse Manager

Bachelor’s degree in nursing

Nursing Director

Master’s degree in nursing, healthcare administration, business administration or a related field. If master’s degree is not in nursing, then a BSN or DNP is required.

Chief Nursing Officer

Master’s degree in nursing, healthcare administration or a related field. If master’s degree is not in nursing, then a BSN or DNP is required.


Beginning in January 2013, all newly hired clinical nurses entering SHGR are required to have a BSN upon hire or be willing to complete a BSN program within seven years of hire.


The Nursing Executive Council (NEC) set incremental targets in 2015 to achieve the goal of 80% of SHGR registered nurses at all levels holding a baccalaureate or graduate degree in nursing by 2020. Annual targets were as follows:  


SHGR Baccalaureate or Graduate Degree in Nursing Targets
















At the request of the NEC, a subgroup from the Nurse Manager Council convened in July 2015 and September 2016 to evaluate the current state as a part of a periodic review process. It was noted in 2016 that the progress in increasing the rate of baccalaureate or graduate-prepared clinical nurses had plateaued:







% Clinical RNs with BSN





% Clinical RNs with MSN






Evaluation of Strategies
In September 2016, Laurie DeSota-Stults, MSN, RN, NE-BC, Director of Nursing Operations and the Magnet Program, convened a subgroup of nurse managers and a Human Resources (HR) generalist to review the progress toward goals, action item list and hiring requirement. (Evidence OO7-1, BSN Action Plan Committee Meeting Minutes and Attendance, September 22, 2016) The subgroup then conducted a literature review and queried other hospitals hiring practices.


A major topic of this meeting was the group of nurses who had been hired in 2013 with the understanding that they must obtain a BSN degree by 2020. The number/percentage of registered nurses who are currently pursuing advanced education is critical to the progress toward the goal. It is not known whether the number of nurses who have not completed but are pursuing a degree will result in meeting the organizational goal. In subsequent meetings, the concern was raised that there is no accurate way to track who is enrolled in a degree program, as managers are using various unit-level tracking tools. The group therefore deemed it imperative to develop a consistent method for identifying nurses who are already pursuing a degree, as this will directly affect efforts to increase enrollment in BSN programs if needed. Julie Kobes, HR generalist, will investigate with the Benefits Team whether ED Assist, the HR system for managing tuition reimbursement, can provide an accurate way to determine how many RNs are in school for a BSN. Reporting of clinical nurses affected by the degree completion requirement was implemented through the Human Resources Workforce Planning Portal in 2018.


Another possible strategy the team discussed was to limit the clinical nurse candidate pool to BSN-prepared nurses only. Kobes noted that the SHGR Talent Acquisition team is hesitant to do this because of the educational demographics of the RN pool in SHGR’s geographical area. Less than 50% of the Michigan Board of Nursing-approved educational programs in SHGR’s area offer baccalaureate degree programs. Spectrum Health (SH) supports the local ADN programs and are committed to their development as community partners. Further, SH is well ahead of the statewide percentage of BSN-prepared RNs, which was 48.1% in 2016. The group therefore determined to work within the profile of the community by promoting educational advancement of nurses hired into the system rather than excluding them from meaningful employment.   



Michigan Board of Nursing-approved Education Programs –
Registered Nurse Programs in the Greater Grand Rapids Area


Baccalaureate Degree

Baker College – Muskegon, School of Nursing

Calvin College, School of Nursing

Davenport University – Grand Rapids, Mable Engle School of Nursing

Ferris State University, School of Nursing

Grand Valley State University, Kirkhof School of Nursing

Hope College, School of Nursing

Western Michigan University, Bronson School of Nursing

Associate Degree

Grand Rapids Community College, School of Nursing

Muskegon Community College, School of Nursing

Westshore Community College, School of Nursing

Lansing Community College, School of Nursing

Kalamazoo Valley Community College

Kellogg Community College


OO7, Registered Nurse Programs in the Greater Grand Rapids Area


2016 Survey of Michigan Nurses
The Survey of Michigan Nurses has been supported by the Michigan Department of Health and Human Services (MDHHS) annually since 2004 to gather information about the supply of and demand for nurses in Michigan. Information gathered from this survey is used to inform state and local decision making about the recruitment, education and employment status of the nurse population. Surveys are completed at the time of license renewal. The tables below are excerpts from the 2016 Survey of Michigan Nurses Survey Summary Report.


Table 3: Educational Background of Michigan Nurses


Education Level

RN = 17,216


95% CI

LPN diploma/certificate


(2.8%, 3.3%)

RN diploma in nursing


(12.4%, 13.4%)

Associate’s degree in nursing


(39.1%, 40.5%)

Bachelor’s degree in nursing


(47.4%, 48.9%)

Master’s degree in nursing


(9.7%, 10.6%)

Master’s degree in other field


(4.4%, 5.0%)

Doctorate in nursing


(0.9%, 1.2%)

Doctorate in other field


(0.5%, 0.7%)

*Because nurses had the option to select more than one response, percentages sum to more than 100%.



Table 5: Current Enrollment in Nursing Educational Programs



RN = 17,244


95% CI

Bachelor of Science in Nursing (BSN)


(5.2%, 5.9%)

Master of Science in Nursing (MSN)


(3.0 %, 3.6%)

Doctor of Nursing Practice (DNP)


(0.7%, 1.0%)

Doctor of Philosophy in Nursing (PhD)


(0.1%, 0.2%)


OO7, 2016 Survey of Michigan Nurses Survey Summary Report


The BSN Action Plan Committee evaluated requiring BSN completion within three years of hire or within four years. To increase the BSN rate, the committee recommended changing the requirement of BSN completion from within seven years to within four years. The recommendation of four years, rather than three years, was made for the following reasons:

  • There is a six-month waiting period before staff members are eligible for tuition reimbursement.
  • A four-year time frame helps foster work-life balance for the employee beginning a new job. (New nurses already have, for example, classes possibly required for their role, and a typical orientation of three to six months).
  • Required certification may create competing educational requirements within the same time frame.
  • One significant life event during this time could sabotage the employee’s ability to be successful.
  • A four-year time frame fosters an environment that supports Benner’s novice to expert philosophy for new graduate nurses.


The committee determined that this change would be implemented in January 2017. They developed a BSN Rate Leader Conversation Guide to facilitate individualized conversations between nurse managers or nursing supervisors and clinical nurses hired after January 1, 2017 who do not currently have their BSN to encourage BSN completion. (Evidence OO7-2, BSN Rate Leader Conversation Guide)


The committee also evaluated and revised the Action Plan Strategies listed below.


Action Plan Strategies

  • Effective January 2017, all newly hired RNs entering SHGR are required to have a BSN upon hire or be willing to complete their BSN within four years of hire.
  • Tuition reimbursement is available to current staff who have a 0.5 FTE or higher.  Staff may receive up to $3,000 annually for tuition, or may choose to sign a three-year contract for a shortage position and receive up to $5,000 annually for tuition.
  • Resources such as the Spectrum Health Life Sciences Library and access to clinical experts such as clinical nurse specialists are available to support degree requirements.
  • Various schedule options are available for those attending school. Employees may request that they not be scheduled on their school days, trade with another staff member or request time off for school functions.
  • SH has contracts with many colleges and universities for clinical sites, allowing many employees who are in school to stay in the organization for their required clinical time. 
  • School fairs are offered twice a year on site, enabling employees to speak with representatives from a number of colleges and universities in one setting. 
  • Nursing administration is partnering with HR to create a standardized tracking mechanism for nurse managers to easily identify RNs pursuing a BSN degree and their status toward completion. This will facilitate nurse managers’ ability to support clinical nurses.
  • Verbiage on ADN nurses’ pursuit of a BSN has been added to the Documentation Orientation Validation Tool (DOVR), helping nurse managers to consistently and intentionally connect with new nurses regarding the expectation of BSN completion.
  • Ensuring nurses interested in pursuing a BSN are aware of available resources such as:
    • Nursing Education Programs in Michigan: Lists nursing education programs in Michigan
    • Discount Directory – Education: Outlines the universities that have a partnership with Spectrum Health


The Nursing Executive Council approved the BSN Action Plan Committee’s proposal to decrease the BSN completion time frame from seven to four years. (Evidence OO7-3, Nursing Executive Council Meeting Minutes, November 8, 2016) The clinical nurse job description was revised to reflect new hiring requirements. (Evidence OO7-4, Registered Nurse Job Description) The hiring requirement changes were implemented on January 1, 2017. Communication of the change in new RN hiring requirements included a memo from Shawn Ulreich, DSc, MSN, RN, NEA-BC, Chief Nursing Executive/Senior Vice President, Clinical Operations, to SHGR leaders. (Evidence OO7-5, Memo from CNO); a Change to BSN Requirement decision document (Evidence OO7-6, Change to BSN Requirement Decision Document); and a Frequently Asked Questions document. (Evidence OO7-7, Frequently Asked Questions Document) 


Appraisal of Target
In December 2017, DeSota-Stults reviewed current SHGR demographic trends at the NEC meeting. SHGR had surpassed the previous 2017 target, and is currently at 76% of nurses at all levels prepared at the baccalaureate level or higher. (Evidence OO7-8, NEC Meeting Minutes, December 12, 2017) NEC voted to set education targets at a 0.5% annual progression toward the goal of 80% of nurses with a baccalaureate or graduate degree.Education targets were reset at follows:



SHGR Baccalaureate or Graduate Degree in Nursing Targets
For Nurses at all Levels























With revisions to the clinical nurse BSN Action Plan, in conjunction with all nursing leadership roles requiring a BSN or MSN, the goal for SHGR nurses at all levels holding a baccalaureate or graduate degree in nursing is 77.5% by 2020 and 80% by 2025.  Education targets will continue to be reviewed annually and more often as needed.








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