Education Level of Nurses Relates to Quality of Care Provided, Study Finds

Hospitals with low percentages of nurses who have bachelor's degrees have nearly twice as many surgery patient deaths as those with high percentages of nurses with bachelor's degrees, according a study published today in the Journal of the American Medical Association, the AP/Philadelphia Inquirer reports (Tanner, AP/Philadelphia Inquirer, 9/24). Researchers from the University of Pennsylvania examined the outcomes for 232,342 surgery patients discharged from 168 hospitals in Pennsylvania between April 1, 1998 and Nov. 30, 1999, along with administrative and survey data about nurses at each hospital (Snowbeck, Pittsburgh Post-Gazette, 9/24). Patient outcomes were studied for common operations including knee replacements, appendectomies and gallbladder removals. Registered nurses can obtain degrees through four-year bachelor's programs, two-year associate programs or three-year hospital diploma programs (AP/Philadelphia Inquirer, 9/24). One of the hospitals considered had no nurses with bachelor's degrees, while at other facilities the percentage of nurses with bachelor's degrees ranged as high as 77% (Stewart, Newark Star-Ledger, 9/24). Researchers adjusted for hospitals' size, teaching status, level of technology and nurse staffing as well as for nurse experience and board certifications of patients' surgeons (Aiken et al., Journal of the American Medical Association, 9/24). The study found that hospitals with fewer than 10% of nurses with bachelor's degrees had patient death rates of about 3%, while those where more than 70% of nurses had bachelor's degrees had patient death rates of about 1.5% (AP/Philadelphia Inquirer, 9/24). For every 10% increase in the proportion of nurses with bachelor's degrees, there was a 5% decrease in the likelihood of patient death within 30 days of admission (Pittsburgh Post-Gazette, 9/24). According to national 2001 data, 61% of new registered nurses came from associate-degree programs, 36% came from bachelor's degree programs and 3% came from hospital diploma programs (AP/Philadelphia Inquirer, 9/24). The study is available online.

Linda Aiken, a professor of nursing at the University of Pennsylvania and one of the study's authors, said, "The conventional wisdom that a nurse's education doesn't matter -- it's only the nurse's experience -- is really not true. ... [H]ealth care is getting more and more complex. For the future, this research suggests there should be progress toward moving the education of nurses up, as it has been in all the other health professions" (Pittsburgh Post-Gazette, 9/24). However, Sharon Bernier, president of the National Association for Associate Degree Nursing, said the study is flawed because it considered nurses with master's degrees and other higher degrees together with those who obtained bachelor's degrees (AP/Philadelphia Inquirer, 9/24).