Date of Paper/Work


Type of Paper/Work

Doctor of Nursing Practice Project

Degree Name

Doctor of Nursing Practice



First Advisor

Roberta Hunt


Doctor of Nursing Practice


There is currently a crisis in health care related to the quality of patient care and the subsequent patient outcomes. The Institute of Medicine (IOM) addressed many of these concerns in a report focused on strengthening the profession of nursing while partnering with other leaders in health care to improve health care systems and the delivery of health care (IOM, 2010). This report was released following the largest reform to the health care system since the development of Medicare and Medicaid in 1965, The Affordable Care Act (ACA; IOM, 2010). Despite generating some improvements, the ACA has created many challenges for an already overwhelmed and increasingly complex health care system.

The IOM has made several recommendations to health care facilities based on a body of research that suggests there is an inverse relationship between the educational preparedness of the patient care nurse and adverse patient outcomes. Several researchers have concurred there is a need to focus on improving the education level and educational opportunities of nurses (IOM, 2010). A formal recommendation for health care facilities to improve the proportion of nurses with baccalaureate of science in nursing (BSN) degrees by 2020 was made by the IOM in 2010.

The aim of this systems change project (SCP) was to collaborate with a rural North Iowa health care facility with a current BSN rate of 25.5% to survey direct care nurses from 21 departments in order to identify what they reported were the barriers to returning to school. Barriers for both nurses currently enrolled in or accepted into a BSN program as well as nurses not currently enrolled in or accepted into a BSN program were identified. This information was used to make preliminary recommendations to facility administrators and to seek input for the next steps for possible program development. From this process a final set of recommendations was created.