Nursing News

Study Says Nursing Degree Pertinent to Patient Outcomes


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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 statement.

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 said.

“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 incentives.

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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