How Does Your Nursing Degree Affect Patient Mortality Rates?

This past spring, renowned nurse researcher Linda Aiken co-authored a study that contributes to a growing body of evidence suggesting that a more educated nursing workforce translates into better patient outcomes. This particular study, published in The Lancet, links higher ratios of BSN-prepared nurses with lower patient mortality rates after common surgical procedures.

Among the conclusions made by the authors was this:

These associations imply that patients in hospitals in which 60% of nurses had bachelor’s degrees and nurses cared for an average of six patients would have almost 30% lower mortality than patients in hospitals in which only 30% of nurses had bachelor’s degrees and nurses cared for an average of eight patients.

A previous study co-authored Aiken and published in Health Affairs in March 2013, drew similar conclusions.

Yet there has been some criticism that studies like these are divisive within the industry and perhaps raise more questions than they answer. Do they demonstrate a causal relationship, or random correlation? Are there other confounding variables to consider? Is it fair to ask mid- or late-career nurses to return to school, based on these assumptions?

It’s true that nurses with an associate’s degree (ADN) do the same job as those holding a BSN. They pass the same NCLEX exam, hold the same license, and often start at the same entry level salary as a BSN-holding nurse. So what’s all the fuss? What you should you, as a working nurse, make of all these studies and reports calling for nurses to acquire more education?

First of all, it’s important to realize that no one is saying that BSNs are “better” nurses in general, in every instance, across the board. When industry forces (the Institute of Medicine, Carnegie Foundation, Robert Wood Johnson Foundation, and Magnet Recognition Program) call for higher ratios of BSN-prepared nurses, they are not directing criticism at nurses like you. Rather, they are responding to a health care system in a state of rapid change, due to new legislative reforms and the increasing complexity of care delivery. So no one is saying that ADN-prepared nurses are “bad nurses” – just that they may not have been adequately prepared for the kind of nursing leadership roles that will be needed in the 21st century.

This is also true of the research showing that hospitals with a more educated nursing workforce have lower mortality rates and better patient outcomes. No one is saying that you, as an ADN-prepared nurse, are causing harm to your patients.

Here are the facts: medication errors, hospital-acquired infections (HAIs), and other issues that lead to poor outcomes are largely due to system and process problems. This systems approach does not seek to pin blame on an individual – rather, it takes the view that minor human errors are inevitable, but become magnified in the context of poorly designed systems. And instead of focusing on punishment, the systems approach seeks to identify situations or factors that are likely to result in medical errors, and change the underlying workflows or systems of care, to reduce the impact on patients.

To help correct systems errors, health care needs more nurses that are prepared to implement solutions – and the BSN curriculum emphasizes leadership and evidence-based practice in a way that the much shorter ADN program can not.

The changes taking place in health care will eventually affect the way you practice nursing – that much is certain. Therefore, it may be wise for you to examine your thoughts and feelings about going back to school for an online RN-to-BSN degree.

Many RNs who return to school to fulfill an employer’s requirement do not believe, at first, that their new BSN degree will change the way they practice nursing. Yet several studies show that these nurses quickly found that education had unexpected benefits. The National Student Nurses Association (NSNA) recapped these studies in an article online, finding that RNs in a BSN program noticed subtle changes in their skills, reasoning abilities, and perspectives on nursing practice. American Sentinel has also reported on many real-life “success stories” about nurses who reached a goal, transformed their life, or made a dream come true through more education.

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