Nurses' Education Tied to Patient Safety

Study: Higher Nursing Education Levels Means Better Patient Care

Sept. 23, 2003 -- A nurse's judgment can literally make a life or death difference for patients. For that reason, a higher level of nursing education is critically important for hospital nurses.

A study appearing in this week's Journal of the American Medical Association (JAMA) reports on the impact of nurses' education levels and surgical patients outcomes from Pennsylvania hospitals during a one-year period.

Registered nurses in the U.S. generally get their basic education through a three-year diploma program in a hospital, an associate degree nursing education program in a community college, or at an undergraduate nursing education program in a college or university.

In 2001, about one-third -- 36% -- of new RNs graduated from baccalaureate nursing education programs, 61% were from associate degree programs, and 3% graduated from hospital diploma programs, reports researcher Linda H. Aiden, PhD, RN, of the University of Pennsylvania Center for Health Outcomes and Policy Research.

However, "surprisingly little is known about the benefits, if any, of the substantial growth in the numbers of nurses with bachelor's degrees," she writes. "The conventional wisdom is that nurses' experience is more important than their [nursing] educational levels."

Also, few studies have looked whether nursing education affects their patient care, Aiden explains. Yet it stands to reason that a higher college degree gives nurses better problem-solving and other skills that are important to patient safety, she writes.

Better Education = Better Problem-Solving Skills

In their study, Aiden and colleagues analyzed data on 232,342 surgical patients discharged from 168 Pennsylvania hospitals.

They also sent questionnaires to 10, 000 nurses working at those hospitals, asking about their highest credential in nursing, patient load during a shift, and years of nursing experience.

After a complex data analysis -- one that also took into account the hospital's size and technology level -- researchers found:

  • Nurses had an average of 14 years of experience
  • They cared for an average of six patients per shift
  • In 20% of hospitals, less than 20% of nurses had Bachelor of Science in Nursing or higher nursing education degrees
  • In 11% of hospitals, 50% or more nurses had BSN or higher degrees

Larger, high-tech hospitals had more BSN- or MSN-prepared nurses; they also had postgraduate medical training programs. Nurses there were slightly less experienced, but had significantly fewer patients under their care.

Patient deaths were 19% lower in those hospitals, she adds. There was a significant association between the proportion of nurses in a hospital with either a bachelor or master degree and the risks of death within 30 days of admission to a hospital.

For each 10% increase in the proportion of nurses with a higher degree, the risks of death decreased by 5%.

Nurses' years of experience did not significantly impact patient deaths. The surgeon's board certification made a difference there -- and those surgeons were usually found at larger hospitals, Aiden notes.

"Our findings provide sobering evidence that this imbalance may be harming patients," Aiden writes. Greater emphasis should be placed on obtaining nursing education at the BSN level, she says.

SOURCE: Aiken, L. TheJournal of the American Medical Association, Sept. 24, 2003; vol 390: pp 1617-1623.