Healthcare is a rapidly evolving field. Consequently, the nursing profession is also advancing. Recently, the demand for nurses is higher, education became more competitive, and employers set out to employ the best nurses possible. In order to select the best nurses, employers should seek out candidates with a bachelor's degree or higher, with a specialized skill set, and have a nurse residency program after the nurse is hired. The employers can find and select the nurses they want using a new technique called RPO's that go more in-depth and search deeper and wider than the average human resources department.

In the past nurses could obtain an associate degree and that would be enough to secure a job. That concept is changing today for many reasons. More hospitals are employing nurses with at least a four-year degree in order to maintain magnet status, an award given to hospitals that have satisfied a set of criteria measuring the strength and quality of their nurses (Boyington, "How Employers View an Associate Degree"). I believe that a baccalaureate degree in nursing should be the bare minimum for all nurses. Not only will this ensure that nurses obtain a well-rounded education, but it could potentially decrease deaths in hospitals. Employers tend to look over associate degree nurses and lean towards the candidates with a bachelor's degree or higher. Devon Haynie, a U.S. News and World Report Education news editor, published an article that discusses the competition and issues of obtaining an associate degree today. She interviewed Susan Peterson, the interim director of nursing at American River College. Peterson stated, 

"aspiring nurses should expect to pursue education beyond an associate degree if they want to be competitive in the marketplace" ("Prepare for Stiff Competition to Get an Associate Degree in Nursing"). Peterson also declared that employers actively search for nurses with bachelor's degrees or higher ("Prepare for Stiff Competition to Get an Associate Degree in Nursing"). Nurses should obtain higher degrees because that is what employers look for. It would be the most logical option to attend a 4-year program if one is sure that will increase their chances of employment after graduation. From the employers' perspective, nurses with more education underwent more training and can handle a wider variety of situations. 

A bachelor's degree as opposed to an associate degree can also decrease the likelihood of patient deaths in hospitals. Three nurses, Linda H. Aiken, Sean P. Clarke, and Robyn B. Cheung, and two doctors, Douglas M. Slone and Jeffrey H. Silber conducted a study that measured the education levels of hospital nurses and patient mortality. The group studied 168 Pennsylvania hospitals to determine if the level of the nurses' education had a role in the number of patient deaths. The results of the study concluded "a 10% increase in the proportion of nurses holding a bachelor's degree was associated with a 5% decrease in both the likelihood of patients dying within 30 days of admission" ("Education Levels of Hospital Nurses and Surgical Mortality"). The team of doctors and nurses also concluded that their results "suggest that employers' efforts to recruit and retain baccalaureate-prepared nurses in bedside care and their investments in further education for nurses may lead to substantial improvements in the quality of care" ("Education Levels of Hospital Nurses and Surgical Mortality"). A nurse with more education is beneficial for oneself, and also for the patient's safety and well-being. Hiring a nurse with more knowledge only further ensures that he or she is capable of making sure patients stay alive longer. 

The clinical skills gained from additional education is obviously a result of the bachelor's degree program, but the liberal arts components also play a role in the future nurses' career. In the article, "The Baccalaureate Degree in Nursing As an Entry-Level Requirement for Professional Nursing Practice," the authors state how "a liberal education broadens students' view of the world and help them to see where their professional discipline fits within that world" and how a "liberal arts education fosters the attitude that learning is a life-long enterprise" (Jacobs, DiMattio, Bishop, and Fields). Nurses should be familiar with both valuable aspects of education. Implementing classes such as history, economics, and communications in addition to the nursing courses gives the student nurse an opportunity to explore other aspects of education that can be applied into his or her future career. Colleges and universities require additional classes like these to graduate with a bachelor's degree, whereas the associate degree curriculum does not include these courses. Only one state, North Dakota, changed laws so that only baccalaureate programs can provide education for nurses. Martha Nelson stated that this change resulted in "raising the proportion of nurses with baccalaureate degrees or higher to 54%" ("Education for Professional Nursing Practice: Looking Backward into the Future"). If every state changed its rules and regulations the number of nurses with advanced degrees would skyrocket, which would improve patient care dramatically. 

Likewise, the American Association of Colleges of Nursing states, "in addition to the liberal learning and global perspective gained from a four-year baccalaureate education, the BSN curriculum includes clinical, scientific, decision-making, and humanistic skills, including preparation in community health, patient education, and nursing management and leadership" ("The Baccalaureate Degree in Nursing as Minimal Preparation for Professional Practice"). The BSN curriculum prepares the future nurse in clinical abilities, and also in areas such as 

leadership and other human interaction skills. Aside from searching for a nurse with a bachelor's degree or higher, employers should also look for a nurse with specialized skill set. A nurse can have a 4.0 GPA and good clinical skills, but that does not mean he or she is compassionate, sensitive, a team player, or a good communicator. According to Greg Nelson, the vice president 

of the health care practice group for Development Dimensions International, "competencies such as judgment, sensitivity, teamwork, quality orientation, critical thinking, and communication capture the qualities and abilities a nurse must have in addition to clinical competencies" ("Hiring the Complete Nurse"). A nurse could effectively perform a procedure on a patient, but if he or she does not have good communication skills, he or she will not be able to explain what happened or what to expect next to the patient or the caregiver. Nelson gives an example about how a nurse may be able to take blood, but he or she may not be able to clearly communicate the results to whoever needs the information. Nelson provides a holistic view about what each nurse should bring to the table ("Hiring the Complete Nurse"). He explains, "behavioral competencies capture the knowledge, behavior, and modifications that make a nurse a good employee, allow her or him to work cooperatively and effectively with others, and embody the organizations values" ("Hiring the Complete Nurse"). A team of nurses that do not work as a team is the definition of ineffective. With a profession as rigorous and demanding as nursing, nurses should help and support one another to ensure that the jobs are being done correctly. Through good communication and behavioral skills, nurses can help deliver the best patient care and teamwork possible. 

Similarly, the American Association of Colleges of Nursing agrees, stating "today's registered nurse not only must communicate effectively with patients and other health care professionals, but also must have a broad competency as a provider, designer, manager, and coordinator of care" ("The Baccalaureate Degree in Nursing as Minimal Preparation for Professional Practice"). Hiring a nurse with a BSN degree and special skills like communication, teamwork, and compassion, ensures that the employers have found the most well rounded nurse possible to improve patient care. 

Sometimes finding well rounded nurses with more education and specialized skills can be tough for the human resources department in a hospital, because spreading the word to find the best nurse can be problematic. Adam Rubenfire, a reporter for the supply chain division of Modern Healthcare, published an article on how hospitals use outsourcing firms to find permanent nurses with the specialized skills. He discusses how the Princeton Healthcare System had difficulties finding qualified registered nurses, so the system contacted a staffing firm to hold an online recruitment fair. The fair brought in many candidates from across the United States, and the hospital system filled the positions with the most desirable nurses ("Help Wanted in Hiring RNs: Hospitals Outsource Recruitment of Permanent Nurses with Hard-to-Find Skills"). Rubenfire explains how some healthcare systems use recruitment process outsourcing firms, or RPOs, rather than their human resources departments to get one-step ahead in the hiring process. He also explains how human resources departments don't have the time or resources to attract nurses from across the world, but recruitment process outsourcing firms do ("Help Wanted in Hiring RNs: Hospitals Outsource Recruitment of Permanent Nurses with Hard-to-Find Skills"). Outsourcing firms have the ability to draw in nurses from different areas and maintain relationships with them, which can be extremely beneficial for smaller hospitals that want the best nurses, but don't have the manpower to help attract them. 

Recruitment process outsourcing firms find experienced nurses, but one firm, referred to as AMN, "has a residency-type program to facilitate training of new nurses" ("Help Wanted in Hiring RNs: Hospitals Outsource Recruitment of Permanent Nurses with Hard-to-Find Skills"). This program recruits around fifty graduates of four-year nursing schools to train and work at the New York-Presbyterian Healthcare System. After about a year of training, the hospital can either hire the nurses, or the nurses can stay with AMN and find a job at a different hospital ("Help Wanted in Hiring RNs: Hospitals Outsource Recruitment of Permanent Nurses with Hard-to-Find Skills"). This opportunity is amazing for new nurses, because nurses right out of school have no solo experience besides what he or she has done in clinical rotations. Joanne Spetz, a professional who studies the economics of the nursing profession states, "hospitals have been really reluctant to hire new graduates, and they're preferring expert nurses" ("Help Wanted in Hiring RNs: Hospitals Outsource Recruitment of Permanent Nurses with Hard-to-Find Skills"). Residency-like programs available in hospitals for new graduate nurses can eliminate the reluctance when hiring a new graduate. 

Other hospital systems offer programs similar to the New York-Presbyterian Healthcare System. In 2009, CHI St. Vincent Infirmary launched a registered nurse residency program to help ease the transition from "new nurses to competent practitioners," as well as improve graduate nurses' retention in their first professional job. This residency program differs from the New York-Presbyterian program. CHI St. Vincent Infirmary instructs the nurse to choose a broad nursing area and calls this the "clinical track" such as critical care, medical, and surgical, with each track consisting of a few more specific units. The nurse spends twelve weeks rotating through each unit, and at the end of the program he or she is matched to a specific unit, where the formal six to twelve week orientation program begins for that unit. The nurse get matched to his or her "best fit" unit, but he or she also undergoes an additional twelve weeks of practice, plus another six to twelve weeks of orientation in the specific matched unit (Brandenburg, Jane, "A Nurse Residency Program Model for Hiring Graduate Nurses Into Clinical Tracks"). The time spent rotating and learning in a specific field of nursing only adds to the ability of the nurse to feel secure and confident after the transition from graduate nurse to competent nurse. The Cleveland Clinic posted a YouTube video discussing their residency program, which is similar to

the two previous residency programs. This hospital interviews students and instructors, and furthermore explains how "the program goes beyond basic training in order to solidify the new graduate nurses' knowledge and confidence." The video also states that the Cleveland Clinic "attempts to form holistic, well-rounded nurses." Residency programs also help bring out those specialized skill sets discussed previously in addition to confidence and more knowledge.

 Once the nurse completes the residency program, he or she would benefit from having a mentor during the training process on a specific unit. Anu-Marja Kaihlanen, Riitta-Lise Lakanmaa, and Leena Salminen conducted a study involving nursing students writing essays on the transition from nursing student to registered nurse and how their mentor supported the change. The students reported that "the best way to experience the reality of nurse's work would be by having the mentor give them opportunities to work independently and assume responsibility" and that the mentor's feedback "has a crucial impact on their self confidence" ("The Transition from Nursing Student to Registered Nurse: The Mentor's Possibilities to Act as a Supporter"). By having an encouraging mentor supportive of the student's independence, the transition from student to practicing nurse is eased even further. After participating in a nurse residency program, on the job training, and having a mentor, the graduate nurse will be significantly more prepared and confident than he or she would be without these programs, and the transition from student to practicing nurse becomes dramatically smoother. 

Some may argue that the selection and hiring process I am proposing is too selective, especially with only selecting nurses with bachelor's degrees or higher. One major issue with requiring nurses to have a bachelor's degree is the cost of education. Not everyone can afford to attend a 4-year school. "According to the College Board, the average cost of tuition and fees for the 2015-2016 school year was $32,405 at private colleges, $9,410 for state residents at public

colleges, and $23,893 for out of state residents attending public universities (College Data, "What's the Price Tag for a College Education"). This means that the cost of a 4-year degree can range anywhere from $37,640 to $129,620 on average. Arguing that everyone can afford these overwhelming prices would be incredibly wrong, however, there is a way to improve this problem. Susan Peterson explained that students currently in an associate degree program should make sure their school offers a connection program a 4-year college or university to ensure their community college credits will count towards their degree ("Prepare for Stiff Competition to Get an Associate Degree in Nursing"). Peterson brings up a valid point, because if someone cannot afford a bachelor's program for all four years, he or she would benefit from going to community college for two years and then transferring into a four-year program. This would save the student money while also preparing him or her for their future degree. Many community colleges have agreements with public instate universities, so as long as the student confirms his or her credits will transfer, he or she could save thousands of dollars. To cut down on the cost even more, students can apply for scholarships, financial aid, and student loans. One can easily search for scholarships online, and a lot of schools offer academic scholarships as well. A four-year degree is possible if students do their research and put time into finding a way to cover the costs.

The nursing profession is quickly progressing along with healthcare. Although the process of selecting and hiring the best nurses may seem trivial and time consuming, the new graduate nurses hold the future of patient care in their hands. Hospitals desire nurses who provide the highest quality patient care. Finding and selecting nurses with a bachelor's degree or higher, with a specialized skill set, and placing the nurse into a residency program ensures that hospitals find the best nurses to care for patients. The troubles, including time and energy, of finding the best nurses are taken away if hospitals also use recruitment process outsourcing firms to search for the nurses. Following the plan I presented, hospitals and employers would be doing everything in their power to guarantee they are hiring the best nurses.

