RN education: a matter of degrees

Until recently, no research had been done to explore the effect of nurse education on patient care. In a study published in JAMA in September 2003, nursing researcher Linda H. Aiken, RN, PhD, led a study to determine the association between the educational levels of hospital RNs and the mortality of surgical patients. The study examined 168 adult acute care hospitals in Pennsylvania reporting a total of 232,342 surgical discharges to the Pennsylvania Health Care Cost Containment Council in 1999. The researchers also surveyed a random sample of 50% of hospital nurses who live in Pennsylvania and were registered with the Pennsylvania Board of Nursing. In all, 10,184 nurses (52% of nurses surveyed) responded. According to the survey results, the average age of respondents was between 40 and 41 years, and between 30% and 31% of respondents had earned a BSN or a higher degree. Hospital nurses who participated in the study had 14.2 years' nursing experience with a mean patient load of 5.7 per day. The researchers examined how the education of hospital nurses affected the death rates of surgical patients within 30 days of admission and death rates within 30 days of admission among patients who experienced complications. The study also took into consideration whether a board-certified surgeon performed the surgery. The types of surgeries examined included general surgery, orthopedic, and vascular procedures. The study found that years of nursing experience don't predict a patient's outcome and that patients cared for in hospitals with a higher proportion of nurses holding a BSN degree or higher have a better chance of postsurgical survival. Specifically, the study stated that "a 10% increase in the proportion of nurses holding a bachelor's degree [in hospitals] was associated with a 5% decrease in both the likelihood of patients dying within 30 days of admission and the odds of failure to rescue." Failure to rescue was defined as "deaths in patients with serious complications." The researchers recognized two limitations to their study: the low (52%) response rate of the nurses surveyed, the examination of hospitals from only one state. The researchers concluded that although these preliminary findings raise concern over nurse education as it relates to patient outcomes, further study of nurses and hospitals nationwide would be required to make these results irrefutable.