Patient Safety Tied to Nurses' Education

The more schooling, the better, a study finds

TUESDAY, Sept. 23, 2003 (HealthDayNews) -- Doctors proudly display their diplomas in their offices, but next time you're up for surgery know this: Patients treated by better educated nurses have a greater chance of surviving their operations.

That's the conclusion of a new study, which found patients do better at hospitals where the nursing staff has more years of schooling under their scrubs. The impact of education on patient survival was as strong as the effect of the patient-nurse ratio, a well-established predictor of a successful hospital stay.

"A growing caseload and education are equally important" predictors of survival after surgery, says study leader Linda Aiken, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania's School of Nursing.

Raising a hospital's share of bedside nurses with bachelor's degrees from 20 percent to 60 percent and keeping the patient-nurse ratio at 4-1, would save four lives per 1,000 surgery patients, the researchers say. "The greater proportion of nurses with baccalaureate degrees, the better the outcome for the patient." Aiken's study appears in the Sept. 24 issue of the Journal of the American Medical Association.

Three roads lead to becoming a registered nurses (RN) in this country: attend a three-year hospital course, go to community college for two years or complete a four-year baccalaureate degree program (BSN) at a college or university.

The first route, once quite popular, is now all but extinct, producing just 3 percent of America's nurses, Aiken says. Community colleges have taken up the slack, and now train roughly 60 percent of nurses. Four-year institutions make up the rest.

Initially, community college graduates and four-year students can expect to earn about the same coming out of school, Aiken says, making the appeal of these programs strong. "Nursing is a very good return on a two-year investment in education," she says. The two tracks start to diverge later in the career.

In previous work, Aiken and her colleagues showed that nurse staffing levels were directly linked to patient survival. This time, they sought to learn if early training was similarly important.

The researchers looked at medical records from more than 232,000 surgery patients in Pennsylvania between 1998 and 1999, covering 168 hospitals in the state. The proportion of BSNs on staff ranged from zero to 77 percent.

After considering total staffing levels, whether a person's surgeon was board-certified and several other factors, Aiken's group found that every 10 percent increase in the proportion of BSNs at a hospital led to a 5 percent reduction in a person's risk of dying within 30 days of being admitted. The education effect was the same on the inability of the hospital to save a patient from serious complications, known as "failure to rescue."

All RNs must take a national licensing exam to become certified, so there's a minimum standard in place to protect patients. However, Aiken says, nurses with more education are better trained to identify problems at the bedside and rally hospital resources.

The United States is now facing a severe nursing shortage. The federal government estimates that after 2010, when the "Baby Boomer" generation begins retiring in earnest, the nation will need 400,000 more nurses to meet its hospital needs.

The looming gap has spawned a movement to churn out nurses as quickly as possible, but Aiken says the new findings point to the downside of that approach.

Geraldine Bednash, executive director of the American Association of Colleges of Nursing, a Washington, D.C. trade group, says the study proves "what ought to be obvious."

"We're pleased to see -- although we find it hard to understand why research is necessary -- that there is a direct link between education level" and patient care, says Bednash.

The RN license is the "bare minimum" of what nurses need to know, says Bednash, whose group supports adding other licensing exams to reflect the more intensive education of nurses with bachelors' degrees.

More information

For more on nursing issues, visit the American Nurses Association, the American Academy of Critical-Care Nurses or the Association of periOperative Registered Nurses.

SOURCES: Linda Aiken, Ph.D., R.N., professor, nursing and sociology, and director, Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia; Geraldine Bednash, Ph.D., R.N., executive director, American Association of Colleges of Nursing, Washington, D.C.; Sept. 24, 2003, Journal of the American Medical Association
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