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Journal ArticleDOI

Baccalaureate Education in Nursing and Patient Outcomes

01 Feb 2013-Journal of Nursing Administration (J Nurs Adm)-Vol. 43, Iss: 2, pp 89-94
TL;DR: Hospitals with a higher percentage of RNs with baccalaureate or higher degrees had lower congestive heart failure mortality, decubitus ulcers, failure to rescue, and postoperative deep vein thrombosis or pulmonary embolism and shorter length of stay.
Abstract: Objectives The aim of this study was to examine the effects of registered nurse (RN) education by determining whether nurse-sensitive patient outcomes were better in hospitals with a higher proportion of RNs with baccalaureate degrees. Background The Future of Nursing report recommends increasing the percentage of RNs with baccalaureate degrees from 50% to 80% by 2020. Research has linked RN education levels to hospital mortality rates but not with other nurse-sensitive outcomes. Methods This was a cross-sectional study that, with the use of data from 21 University HealthSystem Consortium hospitals, analyzed the association between RN education and patient outcomes (risk-adjusted patient safety and quality of care indicators), controlling for nurse staffing and hospital characteristics. Results Hospitals with a higher percentage of RNs with baccalaureate or higher degrees had lower congestive heart failure mortality, decubitus ulcers, failure to rescue, and postoperative deep vein thrombosis or pulmonary embolism and shorter length of stay. Conclusion The recommendation of the Future of Nursing report to increase RN education levels is supported by these findings.
Citations
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Journal ArticleDOI
TL;DR: Differences in patient to nurse ratios and nurses' educational qualifications in nine of the 12 RN4CAST countries with similar patient discharge data were associated with variation in hospital mortality after common surgical procedures, implying an increased emphasis on bachelor's education for nurses could reduce preventable hospital deaths.

1,630 citations

22 Feb 2016
TL;DR: Three recommendations for transforming nursing education are offered: create new nursing education systems which use existing resources in community colleges and universities and which provide for common prerequisites and a shared competency-based nursing curriculum and instructional materials, and invest in a national initiative to develop and evaluate new approaches to pre-licensing clinical education.
Abstract: Evidence is accumulating that nurses completing pre-licensure programs are not equipped with the essential knowledge and skills for today’s nursing practice, nor prepared to continue learning for tomorrow’s nursing. Citing the need to improve quality and increase capacity, this paper offers three recommendations for transforming nursing education: (1) Create new nursing education systems which use existing resources in community colleges and universities and which provide for common prerequisites and a shared competency-based nursing curriculum and instructional materials. (2) Convene one or more expert panels to develop model pre-licensure curricula which: (a) can be used as a framework by faculty in community college-university partnerships for development of their local curriculum; (b) are based on emerging health care needs and widely accepted nursing competencies as interpreted for new care delivery models; (c) incorporate best practices in teaching and learning. (3) Invest in a national initiative to develop and evaluate new approaches to pre-licensure clinical education, including a required post-graduate residency under a restricted license. The author notes that these changes will require significant investment in the reforms, as well as in nursing education research and faculty development. The return on investment would be improved educational capacity and a better prepared nursing workforce, responsive to emerging health care needs and rapidly changing health care delivery systems. TRANSFORMING PRE-LICENSURE NURSING EDUCATION: PREPARING THE NEW NURSE TO MEET EMERGING HEALTH CARE NEEDS The Carnegie Foundation for the Advancement of Teaching joins a chorus of calls for transformation of pre-licensure nursing education (Benner et al., 2009b). Citing the shift of significant responsibility to nurses for managing complex medical regimens, as well as increasing complexity of community based practices, Benner and colleagues concluded that nurses entering the field are not equipped with the essential knowledge and skills for today’s practice nor prepared to continue learning for tomorrow’s nursing (p. 31). They found (1) weak curricula in natural sciences, technology, social sciences and humanities, and in developing cultural competency; (2) weak classroom instruction and limited integration between classroom and clinical experiences; (3) limited strategies in helping The Future of Nursing: Leading Change, Advancing Health Copyright National Academy of Sciences. All rights reserved.

336 citations


Cites background from "Baccalaureate Education in Nursing ..."

  • ...Since the report’s publication, however, the body of evidence on this association has strengthened (Aiken et al., 2011, 2014; Blegen et al., 2013; Cho et al., 2015; Kutney-Lee et al., 2013; Naylor et al., 2015; Yakusheva et al., 2014a,b; You et al., 2013)....

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Journal ArticleDOI
TL;DR: Nursing staffing, nurse work environments, and percentages of nurses having Bachelor of Science in Nursing Degree in South Korea are associated with patient mortality, and improving hospital nurse staffing and work environments and increasing the percentages of Nurses having PhDs in nursing Degree would help reduce the number of preventable in-hospital deaths.

232 citations


Cites background or result from "Baccalaureate Education in Nursing ..."

  • ...The level of nurse education in this study also showed a significant association with patient mortality, which is consistent with results found in other countries, including the United States (Aiken et al., 2011a; Blegen et al., 2013; Kutney-Lee et al., 2013), Canada (Estabrooks et al....

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  • ...Many recent studies have reported that, when the proportion of nurses with a Bachelor’s or higher degree is high, patient mortality is low (Aiken et al., 2011a, 2014; Blegen et al., 2013; Kutney-Lee et al., 2013; Van den Heede et al., 2009)....

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BookDOI
01 Jan 2015
TL;DR: The Future of Nursing: Leading Change, Advancing Health as mentioned in this paper, which made a series of recommendations pertaining to roles for nurses in the new health care landscape, assesses progress made by the Robert Wood Johnson Foundation/AARP Future Of Nursing: Campaign for Action and others in implementing the recommendations from the 2010 report and identifies areas that should be emphasized over the next 5 years to make further progress toward these goals.
Abstract: Nurses make up the largest segment of the health care profession, with 3 million registered nurses in the United States. Nurses work in a wide variety of settings, including hospitals, public health centers, schools, and homes, and provide a continuum of services, including direct patient care, health promotion, patient education, and coordination of care. They serve in leadership roles, are researchers, and work to improve health care policy. As the health care system undergoes transformation due in part to the Affordable Care Act (ACA), the nursing profession is making a wide-reaching impact by providing and affecting quality, patient-centered, accessible, and affordable care.In 2010, the Institute of Medicine (IOM) released the report The Future of Nursing: Leading Change, Advancing Health, which made a series of recommendations pertaining to roles for nurses in the new health care landscape. This current report assesses progress made by the Robert Wood Johnson Foundation/AARP Future of Nursing: Campaign for Action and others in implementing the recommendations from the 2010 report and identifies areas that should be emphasized over the next 5 years to make further progress toward these goals.

185 citations


Cites background from "Baccalaureate Education in Nursing ..."

  • ...Since the report’s publication, however, the body of evidence on this association has strengthened (Aiken et al., 2011, 2014; Blegen et al., 2013; Cho et al., 2015; Kutney-Lee et al., 2013; Naylor et al., 2015; Yakusheva et al., 2014a,b; You et al., 2013)....

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References
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Journal ArticleDOI
TL;DR: Data from 1997 for 799 hospitals in 11 states was used to examine the relation between the amount of care provided by nurses at the hospital and patients' outcomes, and a higher proportion of hours of care per day provided by registered nurses was found among medical patients.
Abstract: Background It is uncertain whether lower levels of staffing by nurses at hospitals are associated with an increased risk that patients will have complications or die. Methods We used administrative data from 1997 for 799 hospitals in 11 states (covering 5,075,969 discharges of medical patients and 1,104,659 discharges of surgical patients) to examine the relation between the amount of care provided by nurses at the hospital and patients' outcomes. We conducted regression analyses in which we controlled for patients' risk of adverse outcomes, differences in the nursing care needed for each hospital's patients, and other variables. Results The mean number of hours of nursing care per patient-day was 11.4, of which 7.8 hours were provided by registered nurses, 1.2 hours by licensed practical nurses, and 2.4 hours by nurses' aides. Among medical patients, a higher proportion of hours of care per day provided by registered nurses and a greater absolute number of hours of care per day provided by registered nur...

2,069 citations

Journal ArticleDOI
24 Sep 2003-JAMA
TL;DR: In hospitals with higher proportions of nurses educated at the baccalaureate level or higher, surgical patients experienced lower mortality and failure-to-rescue rates.
Abstract: ContextGrowing evidence suggests that nurse staffing affects the quality of care in hospitals, but little is known about whether the educational composition of registered nurses (RNs) in hospitals is related to patient outcomes.ObjectiveTo examine whether the proportion of hospital RNs educated at the baccalaureate level or higher is associated with risk-adjusted mortality and failure to rescue (deaths in surgical patients with serious complications).Design, Setting, and PopulationCross-sectional analyses of outcomes data for 232 342 general, orthopedic, and vascular surgery patients discharged from 168 nonfederal adult general Pennsylvania hospitals between April 1, 1998, and November 30, 1999, linked to administrative and survey data providing information on educational composition, staffing, and other characteristics.Main Outcome MeasuresRisk-adjusted patient mortality and failure to rescue within 30 days of admission associated with nurse educational level.ResultsThe proportion of hospital RNs holding a bachelor's degree or higher ranged from 0% to 77% across the hospitals. After adjusting for patient characteristics and hospital structural characteristics (size, teaching status, level of technology), as well as for nurse staffing, nurse experience, and whether the patient's surgeon was board certified, a 10% increase in the proportion of nurses holding a bachelor's degree was associated with a 5% decrease in both the likelihood of patients dying within 30 days of admission and the odds of failure to rescue (odds ratio, 0.95; 95% confidence interval, 0.91-0.99 in both cases).ConclusionIn hospitals with higher proportions of nurses educated at the baccalaureate level or higher, surgical patients experienced lower mortality and failure-to-rescue rates.

1,694 citations


"Baccalaureate Education in Nursing ..." refers background in this paper

  • ...Furthermore, these academic hospitals had a higher level of RN education (62% with BS) than average in the United States.(6,12,31,32) The fact that the analyses found an effect for nurse education even when the average and even the range for the overall sample was high adds confidence to the findings....

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  • ...Beginning in 2002, studies linked the percentage of RNs in a hospital with baccalaureate degrees to decreased patient mortality (in-hospital and 30-day mortality, failure to rescue).(5-10) However, other studies have not found significant relationships between mortality and nursing education....

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  • ...Hospitals with a higher proportion of RNs with BS degrees have been shown to have lower inpatient and 30-day mortality, lower failure to rescue, and lower cardiac deaths.(5-10) The finding that hospitals with a higher proportion of BS-prepared RNs had lower rates of HAPUs is unique to this study....

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  • ...These large teaching hospitals represent highcomplexity hospitals with higher nurse staffing levels than average,20 and they likely had sicker patients and more advanced technology than other hospitals in the United States....

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  • ...Furthermore, these academic hospitals had a higher level of RN education (62% with BS) than average in the United States.6,12,31,32 The fact that the analyses found an effect for nurse education even when the average and even the range for the overall sample was high adds confidence to the findings....

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Journal ArticleDOI
TL;DR: Although the positive effect of increasing percentages of Bachelors of Science in Nursing Degree nurses is consistent across all hospitals, lowering the patient-to-nurse ratios markedly improves patient outcomes in hospitals with good work environments, slightly improves them in hospital with average environments, and has no effect in hospitalsWith poor environments.
Abstract: Context Better hospital nurse staffing, more educated nurses, and improved nurse work environments have been shown to be associated with lower hospital mortality. Little is known about whether and under what conditions each type of investment works better to improve outcomes. Objective To determine the conditions under which the impact of hospital nurse staffing, nurse education, and work environment are associated with patient outcomes. Design, setting, and participants Outcomes of 665 hospitals in 4 large states were studied through linked data from hospital discharge abstracts for 1,262,120 general, orthopedic, and vascular surgery patients, a random sample of 39,038 hospital staff nurses, and American Hospital Association data. Main outcome measures A 30-day inpatient mortality and failure-to-rescue. Results The effect of decreasing workloads by 1 patient/nurse on deaths and failure-to-rescue is virtually nil in hospitals with poor work environments, but decreases the odds on both deaths and failures in hospitals with average environments by 4%, and in hospitals with the best environments by 9% and 10%, respectively. The effect of 10% more Bachelors of Science in Nursing Degree nurses decreases the odds on both outcomes in all hospitals, regardless of their work environment, by roughly 4%. Conclusions Although the positive effect of increasing percentages of Bachelors of Science in Nursing Degree nurses is consistent across all hospitals, lowering the patient-to-nurse ratios markedly improves patient outcomes in hospitals with good work environments, slightly improves them in hospitals with average environments, and has no effect in hospitals with poor environments.

501 citations


"Baccalaureate Education in Nursing ..." refers background in this paper

  • ...Hospitals with a higher proportion of RNs with BS degrees have been shown to have lower inpatient and 30-day mortality, lower failure to rescue, and lower cardiac deaths.(5-10) The finding that hospitals with a higher proportion of BS-prepared RNs had lower rates of HAPUs is unique to this study....

    [...]

  • ...Beginning in 2002, studies linked the percentage of RNs in a hospital with baccalaureate degrees to decreased patient mortality (in-hospital and 30-day mortality, failure to rescue).(5-10) However, other studies have not found significant relationships between mortality and nursing education....

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Journal ArticleDOI
TL;DR: It was determined that the log-odds for 30-day mortality varied significantly across hospitals (variance = .044, p < .001) and the institutional and hospital nursing characteristics explained an additional 36.9%.
Abstract: Background: Evidence indicates that hospital nursing characteristics such as staffing contribute to patient outcomes. Less attention has been given to other hospital nursing characteristics central to optimal professionalpractice, namely nurse education and skill mix, continuity of care, and quality of the work environment. Objective: To assess the relative effects and importance of nurse education and skill mix, continuity of care, and quality of work environment in predicting 30-day mortality after adjusting for institutional factors and individual patients characteristics. Method: A cross-sectional analysis of outcome data for 18,142 patients discharged from 49 acute care hospitals in Alberta, Canada, for diagnoses of acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease, pneumonia, or stroke between April 1, 1998, and March 31, 1999, was done. Mortality data were linked to patient demographic and comorbidity factors, institutional characteristics, and hospital nursing characteristics derived from a survey of all registered nurses working in acute care hospitals. Results: Using multilevel analysis, it was determined that the log-odds for 30-day mortality varied significantly across hospitals (variance = .044, p <.001). Patient comorbidities and age explained 44.2% of the variance in 30-day mortality. After adjustment for patient comorbidities and demographic factors, and the size, teaching, and urban status of the study hospitals in a fixed-effects model, the odds ratios (95% confidence interval) of the significant hospital nursing characteristics that predict 30-day mortality were as follows: 0.81 (0.68-0.96) for higher nurse education level, 0.83 (0.73-0.96) for richer nurse skill mix, 1.26 (1.09-1.47) for higher proportion of casual or temporary positions, and 0.74 (0.60-0.91) for greater nurse-physician relationships. The institutional and hospital nursing characteristics explained an additional 36.9%. Discussion: Hospital nursing characteristics are an important consideration in efforts to reduce the risk of 30-day mortality of patients.

465 citations