By Kelly Phillips, staff writer
Hospital nurses’ education levels play a role in
determining whether patients survive common surgeries, according to a recent
University of Pennsylvania School of Nursing study.
Researchers found that raising a hospital’s percentage of
bedside RNs with at least a bachelor’s degree from 20 percent to 60 percent
would save four lives for every 1,000 patients undergoing common surgeries.
The findings were published in the Sept. 23 issue of The
Journal of the American Medical Association.
“It says that we have a responsibility to go on and seek
additional education so we can be the best provider we can be,” said Geraldine
Bednash, executive director of the American Association of Colleges of Nursing.
“If we fail to assure that we have the most expert knowledge to care for
people, then we are failing in our social contract with patients.”
The study used information from 168 Pennsylvania hospitals,
comparing it with a survey of nurses from that state completed in 1999. It was
funded by the National Institutes of Health, the Agency for Healthcare Research
and Quality and the Robert Wood Johnson Foundation.
Researchers, led by Linda Aiken, Ph.D., RN, found a large
variation in nurses’ education levels among the hospitals, with some employing
no nurses with a BSN or higher, and others with as many as 77 percent.
The study found the effect of education was independent of
a nurse’s experience level, said Robyn Cheung, Ph.D., RN, a study co-author
and research fellow at the Center for Health Outcomes and Policy Research in the
University of Pennsylvania School of Nursing.
Recruiting and retaining baccalaureate-prepared nurses, and
encouraging their own nurses to go back to school is an “investment in
quality,” for hospitals, Cheung said.
“The message is that hospitals need to encourage nurses
prepared at the ADN or diploma level to go back to school,” Cheung said.
Combining the results of this study with those of another
from the same data set, Cheung said the difference between the best and worst
staffing and education scenarios could translate to 1,700 preventable deaths in
Pennsylvania each year.
Individuals become registered nurses through hospital-based
schools, associate degree programs, Bachelor of Science in Nursing programs or
baccalaureate programs at universities. Nationwide, 43 percent of hospital
nurses have at least a bachelor’s degree.
The study’s authors believe this is the first study to
provide evidence that employment of more nurses holding BSN and higher degrees
is associated with improved patient outcomes.
Bednash said the AACN was pleased that the long-standing
question of the effect of education has been answered.
“What Linda Aiken’s article has done is show us the
data and...a critical analysis of this issue,” Bednash said. “Clearly, it is
an exercise in proving what ought to be considered the obvious.”
But while some organizations lauded the research, the
American Association of Community Colleges called the study an example of
efforts by four-year nursing programs to discredit other routes to RN status.
“This study maligns the millions of ADN nurses who
historically pass their state licensure exams with scores as good or better than
their four-year counterparts, and have the same responsibilities on the job,”
American Association of Community Colleges President George Boggs said in a
The American Association of Community Colleges said the
study was flawed in part because it dismissed the effect of board-certified
surgeons on patient outcomes, and because it didn’t account for the fact that
hospitals with low numbers of baccalaureate nurses also tend to be smaller and
more rural. The American Association of Community Colleges also said the survey
didn’t demonstrate that the ratio of ADN to baccalaureate nurses actually
causes patient outcomes.
The majority of feedback has been positive, Cheung said,
though she added she wasn’t surprised by some of the negative comments.
“We knew it was going to be controversial, but sometimes
that’s what it takes to create change,” she said.
The study’s message isn’t that there shouldn’t be ADN
programs, or that hospitals shouldn’t hire nurses prepared that way, Cheung
“Hospitals should set realistic goals for nurses to
continue their education, and make those goals achievable to them,” Cheung
said. “It’s really in the best interest of the patients that that hospital
provides care for.”
She urged hospitals to create flexible schedules for nurses
going to school, provide daycare, tuition reimbursement and other financial
A Sigma Theta Tau International director said the nursing
honor society promotes leadership and scholarship in practice, education and
research to improve health.
“We support the professional development of each nurse,
including furthering their academic education,” said Linda Finke, Ph.D., RN,
director of the honor society's Professional Development Center.
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