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Degrees matter

Ratios of BSN-prepared nurses affect patient mortality rates

Tuesday April 15, 2014
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Linda Aiken, RN
Nurse researcher Linda H. Aiken, RN, PhD, FAAN, FRCN, has published a study that presents the latest in growing body of evidence to suggest a more highly educated nursing workforce saves lives.

“Our research shows that each 10% increase in the proportion of nurses in a hospital with a bachelor’s degree is associated with a 7% decline in mortality following common surgery,” said Aiken, professor of nursing and sociology and director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania in Philadelphia.

“More education, and particularly university education, enhances critical thinking. Professional nurses are called upon to quickly synthesize a large amount of clinical information about acutely ill patients, process this information in the context of scientific evidence, reach evidence-based conclusions, communicate salient information and their conclusions to physicians, and act in the absence of a physician at the bedside, which is most of the time.”

Aiken said the study, published Feb. 26 on the website of The Lancet, was designed to account for other possible explanations for lower mortality, including patient-to-nurse ratios, presence of physicians, availability of high technology and how sick the patients are on admission.

“After taking into account these other factors, nurses’ education is a very important factor in patient outcomes,” Aiken said.

The researchers combed through more than 420,000 patient records of discharged patients following common surgeries, such as knee replacements, appendectomies and vascular procedures.

This isn’t the first such finding for Aiken.

“In U.S. research, we have established a causal linkage between better-educated nurses and patient deaths by studying hospitals over time, showing that hospitals that actually increase their hiring of bachelor’s nurses have greater declines in mortality than hospitals that have not increased BSN employment over the same time period,” she said.


Jane Kirschling, RN
A signficant impact

American Association of Colleges of Nursing President Jane Kirschling, RN, PhD, FAAN, said the fact Aiken publishes in such high-end journals as the Journal of the American Medical Association and The Lancet shows her findings stand up to rigorous scientific reviews.

The message for associate degree-prepared nurses, according to Kirschling, is to continue their education.

“We’re the largest single group of healthcare providers in the United States, and we’re there 24-7, 365 days a year for the care that’s provided,” Kirschling said. “That’s in hospitals, community settings and long-term care settings. So, we have to make that commitment as a discipline and as professional nurses to continue to expand our knowledge and our critical thinking skills, and we do that through advancing nursing education.”

Donna Meyer, RN, MSN, president, National Organization for Associate Degree Nursing, said that while the N-OADN supports higher-education initiatives in nursing, community colleges are crucial to meet the nursing care needs of the U.S. healthcare system. Community colleges graduate quality nurses representing 60% of the nursing workforce, according to Meyer, who is dean of health sciences at Lewis and Clark Community College in Godfrey, Ill.

“Community colleges provide entry points for students moving into the nursing profession to practice, [and] provide a pathway to higher education and advanced practice, research and faculty positions,” Meyer said. “Many community colleges are embedded in rural and-or medically underserved communities, and without them and the nursing graduates they produce, healthcare provider shortages would continue to impair access to care.”

Meyer said N-OADN is working with the National League for Nursing, AACN and the American Nurses Association to find ways to encourage students to continue their education. A-OADN also is working with the Robert Wood Johnson Foundation’s Future of Nursing: Campaign for Action to support recommendations in the Institute of Medicine report, “The Future of Nursing: Leading Change, Advancing Health.”

The study supports the importance of IOM recommendations that 80% of the U.S. nursing workforce be bachelor’s-educated by 2020, Aiken said. Nurses should help their institutions use this strong evidence base to improve nurse staffing adequacy and facilitate the transition to a BSN workforce.

“There are now quite a few large, well-designed studies by different research teams and in different countries documenting the relationship between more BSNs in hospitals and better patient outcomes,” Aiken said. “These studies were mentioned in The Lancet article and include at least multiple studies in the U.S., research in Canada, Belgium, China and now in nine countries in Europe. That is a substantial evidence base, sufficient to guide policy and practice decisions.”

To hospital and other employers, this and other studies show that nursing education really does matter, Kirschling said.

Healthcare stakeholders need to “make the investment in our associate degree-prepared nurses by providing tuition support for them to go back to school … [and] to provide flexibility in the workplace” to allow them to continue their education, Kirschling said.

Lancet study abstract: http://bit.ly/1k7O3nR

For further reading, see “An increase in the number of nurses with baccalaureate degrees is linked to lower rates of postsurgery mortality,” by Ann Kutney-Lee, RN, PhD, Douglas M. Sloane, PhD, and Linda H. Aiken, RN, PhD, FRCN, FAAN, Health Affairs, March 2013 (study abstract): http://content.healthaffairs.org/content/32/3/579.abstract?sid=32bce161-cc20-4fd2-837b-577d651033f0

Engaged in education

This article is part of a series that will periodically examine issues affecting the future of nursing education in the U.S.

Previous articles:

RWJF offers funding for 'Future of Nursing' implementation
http://news.nurse.com/article/20140317/NATIONAL05/140314005#.U0v7j1eRceU

Study looks at implementation of recommendations on BSNs
http://news.nurse.com/article/20140120/NATIONAL05/140117004#.UyMdfYWRceU


Lisette Hilton is a freelance writer. Send comments to editor@nurse.com or post comments below.