The 'De-Skilling' Of Nursing - page 24

What should be our greatest concern for the future of nursing? We must fear the day if (or when) registered nurses (RNs) and licensed practical nurses (LPNs) will be less needed in healthcare due to systematic de-skilling of the... Read More

  1. 2
    Quote from RN34TX
    There is no endless or ever growing pile of studies on BSN nurses and patient mortality. There has been only one study by Linda Aiken so it's far from being a basic fact of life. It's another example where if something gets repeated enough times, it starts to become accepted as the truth.
    No. There are at least three studies and I know of at least one study that is a meta analysis of other studies.

    From: American Association of Colleges of Nursing | Creating a More Highly Qualified Nursing Workforce


    • In the January 2007 Journal of Advanced Nursing, a study of 46,993 patients conducted by researchers at the University Toronto found that hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. The findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients.
    • In a study published in the March/April 2005 Nursing Research, Dr. Carole Estabrooks and her colleagues at the University of Alberta found that baccalaureate prepared nurses have a positive impact on mortality rates following an examination of more than 18,000 patient outcomes at 49 Canadian hospitals. This study, The Impact of Hospital Nursing Characteristics on 30-Day Mortality, confirmed the findings from Dr. Aiken’s landmark study from 2003.
    • In a study published in the September 24, 2003 Journal of the American Medical Association, Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level. A 10% increase in the proportion of nurses holding BSN degrees decreased the risk of patient death and failure to rescue by 5%.

    For more information on the link between nursing education and patient outcomes, see www.aacn.nche.edu/media-relations/fact-sheets/impact-of-education.
    SoldierNurse22 and tnmarie like this.

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  2. 0
    Quote from TheCommuter
    Perhaps facilities and units staffed with a greater proportion of BSN-educated nurses result in better outcomes because RNs with BSN degrees are typically less likely to end up in settings with horrid nurse/patient ratios (LTC, acute rehab, prisons) and more likely to work in settings with lower nurse/patient ratios (acute care hospitals).
    I don't think so because the studies compared units in acute care facilities, not nurses at different types of hospitals.
  3. 0
    Perhaps one could get their sources from an unbiased observer?
  4. 1
    Quote from nursel56
    Perhaps one could get their sources from an unbiased observer?
    Nursing journals, JAMA and IOM have all reviewed the issue. There are tens of thousands of patients in at least two countries. At this point, it's about believing what you want to believe, not about questioning the work itself.
    SoldierNurse22 likes this.
  5. 1
    Quote from VICEDRN
    Nursing journals, JAMA and IOM have all reviewed the issue. There are tens of thousands of patients in at least two countries. At this point, it's about believing what you want to believe, not about questioning the work itself.
    Not really. The IOM is joined at the hip with the AACN, and JAMA doesn't vouch for everything it publishes. Here is an excerpt of what a panel of researchers hired by the AACC found as the major flaws in the study.

    Associate Degree Nurses Vital to the Nationís Health Flawed Study Unduly Alarms Public
    Last edit by nursel56 on Nov 8, '12 : Reason: removed formatting horror
    tnmarie likes this.
  6. 2
    Quote from nursel56
    Not really. The IOM is joined at the hip with the AACN, and JAMA doesn't vouch for everything it publishes. Here is an excerpt of what a panel of researchers hired by the AACC found as the major flaws in the study.

    1. Dismissing the study’s own major finding:
    2. Simple logical fallacy:
    3. Experience matters: T
    4. Self-Selected Respondents Skew Data:
    5. Loading the Deck:

    7. True Representation?
    :
    Really. You are responding to the one study that was completed in PA. There are more studies, including the one done in Canada. I think we can imagine that in Canada, resources are divided a little more evenly since they have a universal coverage system.

    You also neglect the fact that the sheer volume of participants in these studies actually decreases the likelihood that the outcome is not correlated with the findings. Also, since I work at a large institution, the logic that more patients die at smaller institutions makes no sense to me. Smaller institutions do not take the high acuity trauma patients and medical patients that we do and if they do, they ship them to us so they can die in our ICU. They simply aren't equipped to do anything but intubate these folks and ship them to the big city.

    The only thing we agree on is that the studies are a smoking gun and do not provide us with a reason why the baccalaureate prepared nurses tended to have better outcomes as a group.
    Last edit by VICEDRN on Nov 8, '12 : Reason: typo
    SoldierNurse22 and tnmarie like this.
  7. 1
    Quote from VICEDRN
    The only thing we agree on is that the studies are a smoking gun and do not provide us with a reason why the baccalaureate prepared nurses tended to have better outcomes as a group.
    No argument there! The PA study is the study that is consistently pointed out as "proof" you are more likely to die if an ADN nurse takes care of you after your surgery. Thanks for turning that tome into a short list, though!
    tnmarie likes this.
  8. 0
    Quote from nursel56

    No argument there! The PA study is the study that is consistently pointed out as "proof" you are more likely to die if an ADN nurse takes care of you after your surgery. Thanks for turning that tome into a short list, though!
    I think the logical leap is that you are more likely to die if your nurse is an adn but this, in fact, has not been studied and no matter where I am, I won't claim that as the findings.
  9. 0
    I admit that I haven't read any of these studies (yet!) but there are so many variables in patient care settings (and in nurses, regardless of their education) that I don't see how they can make the claim that the BSN has such an influence on pt outcomes. I don't see how the kind of controlled study that it would take to make such a claim would be remotely possible. I may be "just" an LPN but even I know that correlation =/= causation. I'm really interested in seeing the studies though. Thanks for posting info on them! And thanks for the interesting debate about them.

    I also agree with the previous poster about bias. The BSN prepared RN's study finds that units with more BSN prepared nurses have lower mortality rates, hmmm. You can't discount a study just for that but it should at least give you pause and cause you to do more research before rushing out to get your BSN or causing you to dismiss your ASN nurse the next time you find yourself in a hospital.
  10. 3
    Why do we even bother going to nursing school at all? All that counts is experience. Education is useless. Let's just license high school graduates. Heck, why bother with that? If you're old enough to work after 10pm, come on in.


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