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Aiken places another major study in JAMA, linking bachelor's-prepared nurses with lower patient mortality; much of elite media yawns

September 26, 2003 -- Two days ago, University of Pennsylvania professor Linda Aiken, RN, PhD, and several colleagues published a study in the Journal of the American Medical Association linking rates of surgical patient mortality to whether nurses had bachelor's degrees, leading to a widely-carried AP story by Lindsey Tanner but virtually no other original articles, no in-depth stories, and no coverage at all in most of the leading newspapers.

As the AP story explained, Aiken and her co-authors found that for surgical patients at 168 Pennsylvania hospitals, death rates were nearly twice as high at hospitals where less than 10% of nurses had bachelor's degrees as they were at hospitals where over 70% did. The study said "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." The researchers concluded that recruiting nurses from bachelor's degree programs, rather than the two-year associate's degree programs that continue to produce the majority of nurses in the United States, could lead to substantial improvements in care. Aiken argued that nurses with more formal education tend to be better at critical thinking, a key part of nursing.

Tanner's story rightly included objections to the study from the National Association for Associate Degree Nursing, whose president Sharon Bernier, RN, PhD, questioned the study's methodology and conclusions. Bernier argued that there was no difference between the associate's- and bachelor's-prepared nurses, and asserted that the study wrongly included nurses with graduate degrees along with those who had only bachelor's degrees.

The study also led to a Wall Street Journal story but it received no apparent coverage at all in The New York Times, The Washington Post, The Los Angeles Times or The Chicago Tribune. The great majority of mainstream news organs that did cover the study appear to have run Tanner's AP story. One newspaper that did run an original piece was the Pittsburgh Post-Gazette, which may have taken particular interest because of the Pennsylvania connection. Christopher Snowbeck's September 24 piece was substantial, and it also provided some opportunity for advocates of associate's degree and hospital-based programs to respond.

We note that, whatever the merits of this study, nurses can use it as evidence to support critical efforts to convince governments and the health care industry to provide greater support, such as tuition reimbursement programs, for all nurses seeking to increase their level of education. And whatever the effects of further nursing education on patient care, in this society those who have a higher level of formal education as a class are generally in a better position to argue for increases in compensation and improved working conditions.

Many have pointed to the lack of a baccalaureate standard as a major factor in the difficulty nursing has had in gaining resources and empowerment relative to the other major professions, which generally require 3-6 more years of formal university education. In particular, many believe that if there were a smaller educational gap between nurses and physicians, it would enhance nurses' ability to advocate successfully for their patients--and their profession.

See Linda H. Aiken, PhD, RN; Sean P. Clarke, PhD, RN; Robyn B. Cheung, PhD, RN; Douglas M. Sloane, PhD; Jeffrey H. Silber, MD, PhD, Educational Levels of Hospital Nurses and Surgical Patient Mortality in the Journal of the American Medical Association, 2003; 290 (12),1617-1623.

Also see Linda Aiken's study published in JAMA in October 2002 which found that when hospital nurses have 8 patients instead of 4, their patients are 31% more likely to die within a month and hospitals that place nurses in these short-staffed settings are twice as likely to cause nursing burnout (and subsequent exodus from the profession).





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