Nursing News:
Patients have better outcomes with more highly educated RNs

Hospitals that employ a higher proportion of nurses with education at the bachelorıs degree or higher have lower rates of death for surgical patients, according to a study in the September 24 issue of The Journal of the American Medical Association (JAMA).
³Nurse understaffing is ranked by the public and physicians as one of the greatest threats to patient safety in U.S. hospitals,² the authors write. ³Nurses constitute the surveillance system for early detection of complications and problems in care, and they are in the best position to initiate actions that minimize negative outcomes for patients.² The authors go on to describe the three types of programs from which registered nurses (RNs) in the U.S. receive their basic education: three-year diploma programs in hospitals, associate degree nursing programs in community colleges, and baccalaureate nursing programs in colleges and universities. The training has shifted from hospital-based diploma programs to associate and baccalaureate degrees in the past 50 years, according to the authors.
Linda H. Aiken, PhD, RN, from the University of Pennsylvania, Philadelphia, and colleagues analyzed outcomes data for 232,342 general, orthopedic, and vascular surgery patients discharged from 168 non-federal adult Pennsylvania hospitals between April 1, 1998 and November 30, 1999. The researchers also surveyed more than 10,000 Pennsylvania nurses in 1999 through a questionnaire sent to the nursesı homes. The researchers examined the association between the educational attainments of nurses across hospitals and both deaths within 30 days of hospital admission and deaths within 30 days of admission among patients who experienced serious complications. ³The proportion of hospital RNs holding a bachelorıs degree or higher ranged from zero percent to 77 percent across the hospitals,² the authors report.
³After adjusting for patient characteristics and hospital structural characteristics (size, teaching status, level of technology), as well as for nurse staffing, nurse experience, and whether the patientıs surgeon was board certified, a 10 percent increase in the proportion of nurses holding a bachelorıs degree was associated with a five percent decrease in both the likelihood of patients dying within 30 days of admission and the odds of failure to rescue [deaths in patients with serious complications].²
³Our findings indicate that surgical patients cared for in hospitals in which higher proportions of direct-care RNs held bachelorıs degrees experienced a substantial survival advantage over those treated in hospitals in which fewer staff nurses had BSN (bachelorıs degree) or higher degrees,² the authors state. ³Similarly, surgical patients experiencing serious complications during hospitalization were significantly more likely to survive in hospitals with a higher proportion of nurses with baccalaureate education.²
³Finally, our results suggest that employersı 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 quality of care," the authors conclude.