New Study Shows Nurse Education Level, Caseload Affect Patient Mortality - pg.3 | allnurses

New Study Shows Nurse Education Level, Caseload Affect Patient Mortality - page 3

"Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational studySummaryBackgroundAusterity measures and health-system redesign to minimise hospital... Read More

  1. Visit  MunoRN profile page
    2
    Quote from TiffyRN
    Lots of people on this board like to pick those studies apart as it's impossible to control for all factors in many of those studies.

    What I know is that my practice radically improved after completing my BSN; even after 20 years of practice. That emphasizes my belief in the growing evidence.


    Sent from my iPhone using allnurses
    So it sounds plausible to you that, for instance, to use the range the authors claim this data is reliable for, if the current composition of BSN nurses at your hospital is 30% and you care for 6 patients, you could care for 9 patients just as safely as 6 so long as the composition of BSN grads at your facility increased to 60%?
    Susie2310 and Esme12 like this.
  2. Visit  TiffyRN profile page
    1
    Quote from MunoRN
    So you agree that with your BSN, and if your coworkers all got BSN's, you could care for more, potentially many more, patients just as safely? For instance, to use the range the authors claim this data is reliable for, if the current composition of BSN grads at your hospital is 30% and you care for 6 patients, you could care for 9 patients just as safely as 6 so long as the composition of BSN grads at your facility increased to 60%?
    I know enough to know that I don't have the statistical proficiency to evaluate if that is a valid conclusion. I am uncomfortable with this study's measurement of two variables; it may have been overly ambitious. The body of evidence though on the topic has been pretty consistent through the years.


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  3. Visit  wtbcrna profile page
    0
    I don't think the study suggests that BSNs can take care of more patients safely compared ADNs, but that given equal number of patients the BSN educated nurses will have lower rates of mortality/complications. That may sound like same thing, but it isn't.
  4. Visit  MunoRN profile page
    1
    Quote from wtbcrna
    I don't think the study suggests that BSNs can take care of more patients safely compared ADNs, but that given equal number of patients the BSN educated nurses will have lower rates of mortality/complications. That may sound like same thing, but it isn't.
    That's actually what it says. If you're arguing that this conclusion can't necessarily be drawn from the data then I agree, that's my point.

    It doesn't directly tie BSNs with lower mortality, but rather composition of BSN nurses, which still allows for the possibility that patients cared for by ADN nurses may also have reduced mortality risk if the percentage of the ADNs' coworkers who hold a BSN increases, although it would seem that the likely explanation would be that BSN nurses are raising the overall average.

    You are correct that in the BSN composition portion of the findings the number of patients is a constant; given the same patient load, a patient cared for by a nursing staff that is predominately BSN will have lower mortality than one cared for by a nursing staff that is predominately ADN. This is quantified as every 10% increase in BSN nurses produces a 7% decrease in mortality.

    As a separate finding, the authors report a 7% increase in mortality for each additional surgical patient a nurse cares for.

    Combine the two findings, which is what the authors do, and you have a formula that says higher proportion BSN staffs can safely take care of more patients; Increasing a nursing workload by one patient increases the risk of mortality by 7%, increasing the number of BSN nurses by 10% can decrease the risk of mortality by the same amount, which means that by increasing the number of BSN nurses one can increase patient loads without altering mortality.

    I don't think the data can actually be used in that way, it's too dependent on the initial patient load and doesn't change linearly once you hit workload saturation, among other problems, but the example provided in the study certainly suggest the data can actually be used in that way.
    Last edit by MunoRN on Mar 13, '14
    Susie2310 likes this.
  5. Visit  BostonFNP profile page
    2
    Quote from MunoRN
    That's actually what it says. If you're arguing that this conclusion can't necessarily be drawn from the data then I agree, that's my point. It doesn't directly tie BSNs with lower mortality, but rather composition of BSN nurses, which still allows for the possibility that patients cared for by ADN nurses may also have reduced mortality risk if the percentage of the ADNs' coworkers who hold a BSN increases, although it would seem that the likely explanation would be that BSN nurses are raising the overall average. You are correct that in the BSN composition portion of the findings the number of patients is a constant; given the same patient load, a patient cared for by a nursing staff that is predominately BSN will have lower mortality than one cared for by a nursing staff that is predominately ADN. This is quantified as every 10% increase in BSN nurses produces a 7% decrease in mortality. As a separate finding, the authors report a 7% increase in mortality for each additional surgical patient a nurse cares for. Combine the two findings, which is what the authors do, and you have a formula that says higher proportion BSN staffs can safely take care of more patients; Increasing a nursing workload by one patient increases the risk of mortality by 7%, increasing the number of BSN nurses by 10% can decrease the risk of mortality by the same amount, which means that by increasing the number of BSN nurses one can increase patient loads without altering mortality. I don't think the data can actually be used in that way, it's too dependent on the initial patient load and doesn't change linearly once you hit workload saturation, among other problems, but the example provided in the study certainly suggest the data can actually be used in that way.
    In my opinion the data isn't there to make the assumption that the observed outcome is fully linear; this would be limited by the range of staffing ratio and range of %BSN observed in the study, which we don't have the information on. The authors only suggest the reduction in combination, which is interesting because they don't presume to balance one with another. Common sense would tell us that at the extreme ends there would be saturation.
    LadyFree28 and wtbcrna like this.
  6. Visit  MunoRN profile page
    0
    Quote from BostonFNP
    In my opinion the data isn't there to make the assumption that the observed outcome is fully linear; this would be limited by the range of staffing ratio and range of %BSN observed in the study, which we don't have the information on.
    Maybe we're misunderstanding each other, but that's part of the point I've been arguing.

    Quote from BostonFNP
    The authors only suggest the reduction in combination, which is interesting because they don't presume to balance one with another.
    They absolutely due presume to balance one with the other, odds ratios are ratios, by definition they work in both directions. Without any sort of stated limitations to their use, the same odds ratios that they use to claim mortality risk could be reduced by both increasing BSN staff and decreasing work loads, using the inverse of either would have a "balancing" effect (one would cancel out all or part of the other).

    Quote from BostonFNP
    Common sense would tell us that at the extreme ends there would be saturation.
    Yes, it would, common sense doesn't mesh well with the author's claims.


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