BSN-prepared nurses’ rates impact patient mortality rates

Linda Aiken, Nurse

Nurse researcher Linda H. Aiken, RN, PhD, FAAN, FRCN, published a study presenting the newest, growing evidence suggesting that a better-educated nursing workforce saves lives.

“Our research shows that for every 10% increase in the number of bachelor’s degree-educated nurses in a hospital, there is a 7% decrease in mortality from common surgeries,” said Aiken, a professor of nursing and sociology and director of the Center for Health Outcomes Research and Policy on the University of Pennsylvania in Philadelphia.

“More education, especially university education, enhances critical thinking. Professional nurses are called upon to rapidly synthesize large amounts of clinical information about acutely ill patients, process this information in the context of scientific evidence, draw evidence-based conclusions, communicate pertinent information and their conclusions to physicians, and operate in the absence of a physician at the bedside, which is most often the case.”

Aiken said the study, published Feb. 26 on the Lancet website, aimed to think about other possible explanations for the lower mortality rate, including the patient-to-nurse ratio, the presence of physicians, the provision of advanced technology and the severity of patients’ illness after they were admitted to hospital.

“Once these other factors are taken into account, nurse education is a very important factor in patient outcomes,” Aiken said.

Researchers analyzed greater than 420,000 medical records of patients discharged from hospital after common surgical procedures resembling knee replacements, appendectomy and vascular procedures.

This shouldn’t be the primary such discovery regarding Aiken.

“In studies in the U.S., we have established a causal relationship between more highly educated nurses and patient deaths by examining hospitals over time, showing that hospitals that actually increase their employment of bachelor’s-degree nurses have greater declines in mortality than hospitals that did not increase their employment of bachelor’s-degree nurses over the same time period,” she said.

Education matters

Jane Kirschling, nurse

Jane Kirschling, RN, PhD, a member of the American Association of Colleges of Nursing, said the proven fact that Aiken publishes in such prestigious journals because the Journal of the American Medical Association and The Lancet is proof that her findings delay under rigorous peer review.

Kirschling said the message for nurses with a bachelor’s degree is to proceed their education.

“We are the single largest group of health care providers in the United States, and we are there 24/7, 365 days a year to provide the care that is being 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 critical thinking skills, and we do that by advancing nursing education.”

Donna Meyer, RN, MSN, president of the National Organization for Associate Degree Nursing, said that while the N-OADN supports higher education initiatives in nursing, community colleges are key to meeting the nursing needs of the U.S. health care system. Community colleges produce high-quality nurses, who make up 60 percent of the nursing workforce, in keeping with Meyer, who’s dean of health sciences at Lewis and Clark Community College in Godfrey, Ill.

?Higher education institutions provide students starting a profession in nursing with the chance to practice their occupation, [and] provide a pathway to higher education and advanced practice, research and school positions, Meyer said. “Many community colleges are located in rural and/or medically underserved communities, and without them and the nursing graduates they produce, provider shortages would continue to make access to care difficult.”

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

The study supports the importance of the IOM’s advice that 80% of U.S. nurses have a bachelor’s degree by 2020, Aiken said. Nurses should help their institutions leverage this strong evidence base to enhance nurse workforce adequacy and ease the transition to a BSN.

“There are now a number of large, well-designed studies by different research teams and in different countries documenting an association between more BSN nurses in hospitals and better patient outcomes,” Aiken said. “These studies were cited in the Lancet article and include at least multiple studies in the U.S., studies in Canada, Belgium, China and now nine countries in Europe. This is a solid evidence base, sufficient to guide policy and practice decisions.”

For hospitals and other employers, these and other studies show that nurse education really does matter, Kirschling said.

Healthcare providers must “invest in college-educated nurses by providing them with financial support to enable them to return to school,” [and] provide flexibility within the workplace? To enable them to proceed their education, Kirschling said.

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

To learn more, see the article, “An increase in the number of nurses with a baccalaureate degree is linked to lower rates of postsurgery death,” 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