Variation in academic preparation and progression of nurses across the continuum of care

Changing health care needs are driving new models of care that emphasize care coordination, health promotion, and disease management by registered nurses (RNs). A skill-mix favoring professional (baccalaureate or above) over technical (less than baccalaureate) education is promoted by national initiatives.

To examine the academic preparation and progression of general practice RNs in practice settings across the care continuum.

Secondary analyses of data from the Texas Board of Nurses RN Licensure databases in 2008 and 2014.

Overall the professional skill-mix for general practice RNs improved from 47.1% to 50.2%. Disparities were identified in home health (31.6%), long-term care (27.8%) and nonmetropolitan areas (31.7%). Role change was the strongest correlate of academic progression.

Non-hospital and rural practice settings may be vulnerable to the effects of an undereducated RN workforce. More effective reimbursement policies and employer incentives are needed to drive academic progression and address disparities across practice settings.