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Source: American Nurses Association
Date: September 23, 2003

JAMA Article Links Level of Nurse Education
and Patient Mortality

Washington, DC – A study published today in the Journal of the American Medical Association (JAMA) found that the educational level of Registered Nurses (RNs) working in hospitals has a significant impact on whether patients survive common surgeries. Research findings published last year showed a relationship between lower nurse-to-patient ratios and improved patient outcomes. This new study from the University of Pennsylvania probes the impact not only of the numbers of RNs providing bedside care, but how the educational preparation of RNs impacts patient mortality. According to the researchers, raising the percentage of RNs with bachelor’s degrees from 20 percent to 60 percent would save four lives for every 1,000 patients undergoing common surgical procedures.

“This study is significant because it quantifies how increased educational preparation manifests itself in practice and ultimately in the improved health and welfare of patients,” said Barbara A. Blakeney, MS, APRN,BC, ANP, president of the American Nurses Association (ANA).

“Nursing is a knowledge-based profession,” explained Blakeney. “ANA has always maintained that nurses have a responsibility for lifelong learning and ANA works to make higher education accessible to both new students and practicing nurses. This study underscores the need for employers and academic institutions to work cooperatively to find creative, flexible approaches that support nurses continuing their education at the bachelor’s level and beyond. In addition, funding for nursing education, both in terms of scholarships and loans for students and to enable institutions to increase their capacity, must be increased.”

Currently, there are three educational pathways available for RN preparation: the two-year associate’s degree, the three-year diploma (programs associated with hospitals) and the four-year baccalaureate degree. According to the 2000 National Sample Survey of Nurses, 40 percent of nurses completed their basic education at the associate-degree level, 30 percent at the diploma level and 30 percent at the baccalaureate level. This reflects a significant change in the past twenty years; in 1980 the breakdown was 19 percent associate’s degree, 63 percent diploma and 17 percent baccalaureate degree.

Reports of an escalating shortage of nurses have prompted lawmakers and other policymakers to focus on how to increase the supply of nurses. In July 2002, the Department of Health and Human Services (HHS) released data confirming that a nursing shortage already exists in the United States and that it is expected to grow. According to the HHS study, in 2000, there was a shortage of 110,000 registered nurses (6 percent). Without changes in the system, the HHS study predicts that shortage will grow to 12 percent by the year 2010, 20 percent by 2015, and 29 percent by 2020.

“There is a danger during a nursing shortage, like the one we are currently experiencing, to think that producing nurses faster is the answer,” said Blakeney. “This study suggests that may not be the best approach.”

Since 1965, ANA has advocated that the baccalaureate degree be recognized as the minimal educational preparation for RN entry into practice.

“Every nurse recognizes the need for lifelong learning regardless of which academic route was used to enter the profession. ANA strongly supports accessible, creative programs that support nurses at all levels to advance their education,” explained Blakeney.

ANA, along with other nursing and health care organizations, is lobbying for adequate funding for nursing workforce development. On Sept. 10, the U.S. Senate unanimously agreed to accept an amendment for nursing education funding submitted by Sens. Barbara Mikulski (D-MD) and Susan Collins (R-ME). The amendment increases funding for federal nursing workforce development programs, including the Nurse Reinvestment Act, by $50 million, which represents a 55 percent rise from fiscal year 2003 funding.

“We call on Congress to pass -- and the president to sign -- appropriations legislation to fully fund the Nurse Reinvestment Act. This funding will strengthen nursing education and provide meaningful financial support to new students seeking a nursing education and to nurses wishing to advance their education,” said Blakeney.

Also, ANA is advocating for passage of federal legislation, the Registered Nurse Safe Staffing Act of 2003, which aims to ensure that patients receive safe, quality nursing care in hospitals and other health care institutions. The legislation mandates the development of staffing systems that require the input of direct-care registered nurses (RNs) and provides whistle-blower protections for RNs who speak out about patient care issues. The bill, S. 991, was introduced by Sen. Daniel Inouye (D-HI) on May 5.

The RN Safe Staffing Act incorporates ANA’s Principles of Nurse Staffing. Rather than recommending specific numeric ratios, ANA developed the principles in 1999 as a tool for nurses to implement appropriate staffing. The principles not only take into account the number of patients, but they also address other important staffing considerations, such as the education and experience level of nurses on the unit, the severity of patients’ conditions and the availability of support services and resources.

“Educational Levels of Hospital Nurses and Surgical Patient Mortality,” by Linda H. Aiken, et. al, appears in the September 23/30, 2003 issue of JAMA. The study, funded by the National Institute of Nursing Research, the Agency for Healthcare Research and Quality and the Robert Wood Johnson Foundation, surveyed 10,184 nurses in 168 Pennsylvania hospitals caring for 232,342 patients who underwent general surgical, orthopedic, or vascular procedures from April 1, 1998, to Nov. 30, 1999.


 

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