Initiative Overview

Background Summary

Nurses provide approximately 95 percent of all patient care in hospitals and are on the front lines of rapid changes affecting the health care industry. Registered Nurses (RNs) are essential to safe, effective, timely and patient-centric care. However, RNs are challenged in delivering this care as:

• Patients have multiple and more highly acute illnesses, yet treatment is limited to shorter hospital stays;
• The work environment continues to become more complex and technologically advanced, fostering a growing need for continuing RN education to adequately prepare nurses to deliver high quality patient care, and
• The U.S. is projected to experience a shortage of 500,000 RN FTEs by 2025 due to increased demand for nursing services, a significant projected retirement of the aging workforce, and limited educational capacity.

As a result, avoidable medical errors claim up to 98,000 lives in the U.S. every year and serious preventable

complications affect many more lives, according to the Institute of Medicine. 

The Response

After suffering adverse consequences from a medical error, Betty Irene Moore made improving nursing care in her community a priority. As a result, the Gordon and Betty Moore Foundation established the Betty Irene Moore Nursing Initiative (BIMNI) in 2003.

The Betty Irene Moore Nursing Initiative (BIMNI) seeks to improve nursing-related patient outcomes in adult acute care hospitals in five San Francisco Bay Area counties (Alameda, Marin, San Francisco, San Mateo and Santa Clara) and five Greater Sacramento counties (Amador, Nevada, Placer, Sacramento and Yolo). From the time that BIMNI was approved by the Foundation’s Board of Trustees in late 2003, through the end of 2008, over 100 grants have been awarded, totaling more than $100 million.

Fixing a Broken Pipeline

The U.S. faces a long-term nursing shortage, with experts projecting a deficit of 285,000 FTE RNs by 2020, expanding to 500,000 FTE RNs by 2025.

At a time when a large percentage of hospital RNs are approaching retirement age, nursing schools are constrained in their capacity to enroll new nursing students. In some cases, it takes qualified nursing applicants up to five years to be admitted to nursing school. In 2008, nursing schools turned away almost 50,000 qualified applicants because schools were unable to either secure the nursing faculty to instruct a larger class or provide students with the clinical training opportunities required.

To help generate more new RNs in the Bay Area, BIMNI supports programs to:

• Train and fund more RN educators. BIMNI is creating additional nurse educator programs and incentives for graduates to spend three years instructing.
• Expand pre-licensure nursing school programs. BIMNI-funded programs are expanding entry-level nursing programs and clinical placement opportunities for nursing students.
• Expand continuing education for new nurses. By easing the transition from education to the hospital setting, BIMNI programs aim to increase retention of new nurses within hospitals.
• Increase collaboration between nursing schools and hospitals. To increase the efficiency of the education system, BIMNI programs are increasing collaboration between schools and hospitals through technology and new centralized community resources.

Higher Standards—Better Care

Approximately 30 percent of all healthcare costs, equivalent to $390 billion in 2000, are the direct result of poor quality care, according to the Midwest Business Group on Health. Unfortunately, hospital culture and processes are not consistently oriented towards patient safety. In addition, while nurses provide the majority of direct care, the quality of care they deliver is directly influenced by the effectiveness of the healthcare team with which they work—physicians, pharmacists, respiratory therapists and other healthcare professionals—and the supporting processes in the workplace.

BIMNI is working towards ensuring more thorough and reliable implementation of hospital best practices, with the goal of increasing the quality of patient care and achieving better outcomes. It seeks to:

• Implement more effective RN best practices. BIMNI supports the development of skills and resources enabling RNs to consistently deliver effective clinical practices.
• Create systems to support patient safety. BIMNI is working to implement standardized systems-wide best practices, improved work processes and an organizational focus on patient safety in its target hospitals.
• Improve discharge planning for high risk seniors. BIMNI is identifying and supporting dissemination of new models of effective discharge planning for senior patients.