Does this article prove that BSN nurses are safer than ASN?

[Roland]

What would be some of your criticism of the author's methodology? I am doing a review of this article for a statistics class and am looking for some fresh perspectives.

Educational Levels of Hospital Nurses and Surgical Patient Mortality

Linda H. Aiken, PhD, RN; Sean P. Clarke, PhD, RN; Robyn B. Cheung, PhD, RN; Douglas M. Sloane, PhD; Jeffrey H. Silber, MD, PhD

JAMA. 2003;290:1617-1623.

Context Growing 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.

Objective To 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 Population Cross-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 Measures Risk-adjusted patient mortality and failure to rescue within 30 days of admission associated with nurse educational level.

Results The 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).

Conclusion In hospitals with higher proportions of nurses educated at the baccalaureate level or higher, surgical patients experienced lower mortality and failure-to-rescue rates.

Author Affiliations: Center for Health Outcomes and Policy Research, School of Nursing (Drs Aiken, Clarke, Cheung, and Sloane), Leonard Davis Institute of Health Economics (Drs Aiken, Clarke, and Silber), Department of Sociology (Dr Aiken), Population Studies Center (Drs Aiken, Clarke, and Sloane), and Departments of Pediatrics and Anesthesia, School of Medicine (Dr Silber), University of Pennsylvania, Philadelphia; and Center for Outcomes Research, Children's Hospital of Philadelphia (Dr Silber).

[313RN, BSN, RN]

a generic bsn grad is an entry level practitioner no more or no less than a diploma or adn grad.

i have a bsn and frankly i couldn't agree more. when i've talked to adn nurses and we discuss school they're often a little self-deprecating, saying something like "i only have an adn". i always ask "does your license say rn?" when they say it does i reply "so does mine".

whichever of us is the better nurse depends on a lot of things, not just the degrees i have. i suspect who had the most sleep the night before will have a larger impact on the quality of care than a degree does, everything else being equal.

here is what i think the benefit of the bsn is (and while this might sound like i'm kidding, i'm not):

let's say we're going to get the whole team together to discuss pt 313rn. we're all fairly new to the unit and don't know much about one another's particular strengths or weakness. we really know faces and titles. around the table we have:

dr. able, md, (dr. a is a specialist, he did a 5 year residency and is now an attending)

xx baker, physical therapy (xx because you have a 50/50 shot at masters or doctorate here)

dr. charlie, pharmd

mr. dogge, ot (masters degree)

ms. east, msw

ms. foxx, speech therapy (masters degree)

nurse pat, adn

nurse pat is going to have to fight against a bias that is created because his/her level of education lags behind the rest of the people at that table. it may not be overt, it may not even be intentional, but it's really likely to be true.

now the really crappy thing is that nurse pat, rn bsn is still lagging behind in this scenario.

nurse pat, rn msn might stand a fighting chance.

most specialties have gone to a minimum master level in order to be licensed in their fields. nursing lags behind, and i can see no good reason for it.

nursing as a profession needs to be better respected. we're not getting it done well enough with our adn or our bsn. maybe we really ought to make the entry level rn a minimum msn. there's a reason all the other specialties have done it.

as an rn, especially a new rn, how would you like to have your pay be comparable to an ot or speech therapist? it's completely possible.

as far as i can tell, the only things holding us back are some kind of massive professional inferiority complex, a death grip on tradition, a system of community colleges that, for good, sound business reasons doesn't want to give up a highly profitable revenue stream, and hospitals who like being able to hire talent as cheaply as possible.

education probably has fairly little to do with outcomes when you take out all the variable other than adn versus bsn. we need to give over this argument and start thinking about doing what's best for our profession and our families. more education certainly won't harm a patient, and it will make a substantial difference in how nursing professionals are perceived, both by other specialists and by the public.

but that's just one man's opinion.