Published
Now, I am all for further education, but I think this study is skewed. I truly don't see how they have come to the conclusion that taking more courses in the humanities and other such non-nursing related courses is going to produce a more competent bedside nurse. The core nursing cirriculum for most ADN and BSN programs is quite similar in my experience. I can see where the BSN nurse may have it over the ADN in managerial type roles, but as a bedside nurse? I think lots more studies need to be done before this quick conclusion is drawn. One factor that may affect nursing in this negative way is the poor economy. Maybe it is that some people are going into nursing just because it will almost guarantee them employment and don't really want to be in nursing and therefore are not as dedicated as nurses? These people may not want to go for the BSN. I don't know...that is just something I am throwing out there because this makes no sense to me. I don't want to start the old BSN vs. ADN war, but this is news and I was wondering, what do you all think?
http://www.upi.com/view.cfm?StoryID=20030923-050052-9024r
WASHINGTON, Sept. 23 (UPI) -- The ongoing nursing shortage in the United States has forced some hospitals to rely on nurses with less than a college education as they scramble to fill vacancies but new research suggests the practice can yield deadly consequences for patients.
The study, the first of its kind, reveals patients undergoing surgeries at hospitals where a greater proportion of nurses have obtained a bachelor's or higher degree experienced a lower rate of death than patients at hospitals where most nurses had only associate degrees.
Such findings have implications not only for patients but also for how nursing schools, hospitals and even the U.S. Congress should address the nursing shortage, Linda Aiken, a nurse and lead investigator of the study, told United Press International.
These institutions have made efforts to address the nursing shortage by facilitating the rapid training of nurses via associate degree programs, but the study indicates in the long-run the strategy might be worse for both patients and hospitals, said Aiken, who is director of the center for health outcomes and policy research at the University of Pennsylvania's School of Nursing in Philadelphia.
It underscores the need to find ways to increase the numbers of nurses graduating from bachelor degree programs, she said, noting some hospitals studied did not employ a single nurse with a bachelor's or higher degree.
In the study, which is published in the Sept. 24 issue of the Journal of the American Medical Association, Aiken's team examined patient data from 168 Pennsylvania hospitals over a 19-month period beginning in 1998. They found, all other factors being equal, hospitals where 60 percent of the nurses held a bachelor's degree or higher had a 19-percent lower rate of surgical patients dying within 30 days of admission or dying from complications than hospitals where only 20 percent of nurses had higher degrees.
The authors estimate if all the hospitals in the study could meet the 60-percent, bachelor's-degree-or-higher threshold, 725 patient deaths could have been prevented over the study period.
The differences in patient mortality rates "are stunning and should make people very concerned," Geraldine Bednash, a registered nurse and executive director of the American Association of Colleges of Nursing, told UPI. "One of the first questions (patients) ought to ask people in a hospital is what is the proportion of their nurses with bachelor's degrees, and if it's not 60 percent or higher, I'd be very concerned about going into that hospital," Bednash said.
The higher rate of patient deaths associated with lower education level is compounded by the fact that "all of the federal government's projections about the nursing shortage over the past decade have not only projected a shortage of nurses but a severe shortage of baccalaureate degreed nurses," Aiken said. At present, less than half of all hospital staff nurses across the nation hold bachelor's degrees or higher.
"Policymakers seem to think we just need to get nurses out fast," but that is not good for hospitals or patients, Bednash said, suggesting legislators should focus on developing ways to produce more nurses with bachelor degrees because "it makes a difference in people's care and whether or not they live or die."
President George W. Bush signed the Nurse Reinvestment Act into law in 2002 in an effort to remedy the nursing shortage and Congress will likely authorize no more than $163 million for fiscal year 2004. But this falls far short of the $250 million the American Association of Colleges of Nursing estimated would be needed to address the problem.
"To date, we've had mostly a symbolic response from Congress," Aiken said, noting the money the legislative body has appropriated is "not a sufficient amount to close the nursing shortage."
Hospitals also have a role to play in addressing the problem, however, Aiken continued. They should "subsidize continued education to the nurses because there is a return to the hospital in terms of greater productivity and better patient outcomes," she said. But many hospitals do not seem to recognize the value of more education in their nurse because many have discontinued tuition reimbursement programs to help their nurses obtain bachelor's or advanced degrees, she said.
Aiken also noted the study found nursing experience was not associated with lower mortality rates of patients. "It's the educational level that's important and experience alone cannot achieve the same level of benefit for the patient as education plus experience," she said.
Joan Hrubetz, dean of the school of nursing at Saint Louis University, said as medical treatments become even more sophisticated, hospitals "will need nurses with advanced education to be able to deal with the kinds of treatments and diagnostics" that likely would be developed in the era of genetics and molecular-based medicine. "I don't think there's any question we need better trained nurses," Hrubetz told UPI.
Nevertheless, hospitals appear to be reluctant to make any changes based on this single study.
"Hospitals are very interested in studies such as this ... but it really needs to have further studies done because this really only represents one state," Rita Turley, president of the American Organization of Nurse Executives -- a subsidiary of the American Hospital Association -- told UPI.
The good news is although enrollment rates in baccalaureate nursing programs had been down over the past decade, they now appear to be on the rise. In addition, many schools are offering rapid training programs, in which holders of bachelor degrees in other fields can obtain a bachelor's degree in nursing in approximately one year, which may help increase the number of people joining the nursing profession.
Originally posted by Hellllllo NurseThis is along the lines of what I was thinking- maybe a hospital that staffs with mostly BSNs has many other differences as well, which contribute towards nurses being able to give their best care.
If this were true, then the study would be even more flawed than some of us say it is. It's inflammatory and it's inaccurate. Period. It's an attempt by 4 year universities to self-promote; that is bad enough. I won't listen to such studies based on such shameless self-promoition and inaccuracy. It's a pack of lies, pure and simple. That anyone buys this is disturbing, to say the least. It's as good as saying 60% of care rendered by RN's (not even addressing LPN care) is inferior. WHO BUYS THIS????? REALLY? COME ON! The only ones I see "biting" are BSN nurses who already believe they give better care by virtue of their "unique" educations. It's amazing, the ego of some. And sad. I agree with whoever said "enough divide and conquer"; it's time we stand together, not let such things break us apart.
I just have one more comment about nursing and education..putting the BSN/ADN/Diploma stuff aside..Education is not only about degrees, esp in nursing. Nursing is a field that you will always have to seek more education in order to remain competent and valuable. There are certifications, continuing ed, inservices etc etc..this type of education, although not necessarily formal, is what makes a good nurse great...learning your field, keeping up on advancements and personal growth classes are essential to staying on top of the game. I honestly can not remember a time since becoming an RN that I wasn't taking a class or a certification or reading literature which was applicable to whatever specialty I was currently practicing. I have come to the conclusion I am a life long learner as are my friends that are nurses that really excel in their specialty. I do feel that success lies in having knowledge however, I do not feel the ONLY way to get there is formal education.
I have entertained the thought of getting the BSN but honestly after reviewing the curriculum and speaking to the advisor..I don't see any point. I have taken 2 semesters towards my BS in health promotion and will probably finish that one day...after I am done with my yr long certification I am currently doing and then my CCM which will take probably another 6-9 months worth of studying..then again, I don't know....Maybe I will go in a different direction altogether...
Thread like this are so aggravating....Think I will bow out now :)
I have been a bedside nurse for many years. I know many compassionate, knowledgeable ADN's (many of whom have taught me a great deal). Having been educated at a Big Ten University, I think one of the differences between some of the BSN schools and some ADN schools is the quality of the course development and the professorship of the instructors. It can work both ways, but I think RN's should be given credit for what they know if they want to get their BSN (and from what I've seen over the years, they have come along way). I would even suggest to you that many of the positions currently held by BSNs should require an MSN education.
The world is becoming more complex, not less so. We are becoming more high tech, not less so. When you think about how much you really have to know to be an RN it is quite astounding. For those of us who are worried about getting a higher level of education, don't worry. It is not in the hospital's (financial) best interest to higher only BSN's. They have made sure (for years) that this will not happen. Why pay more if you don't have to?
I have worked for several ADN nurse managers who I felt were more taken advantage of than I was. I was also in a room one time when an ADN nurse (my 'team leader') was asked by a patient what the difference was between an ADN RN and a BSN. Her reply: " The state of Iowa does not recognize a difference--we are the same." Why would anyone pursue a higher level of education with that attitude, a title and more pay than some of us lowly BSN's?
I didn't go into this profession to be in a constant war over BSN's vs. ADN's. I know I have something to offer. I believe I am well educated and my education has proven out over the years. But I stay educated, certified and pursue higher ventures.
If you are an ADN and believe you are a good if not great RN why would you believe that you would not benefit from a BSN or MSN? Could you not improve your skills? I know I can always leave room for improvement.
Having a BSN does not automatically mean you are a better RN than an ADN. It may mean you are better prepared for situations in nursing or in life in general.
That's my 2 cents and I'm sticking to it!
Blessings.
Here's the abstract: I would like to know how they adjusted for experience and nurse staffing. I would not assume this is the end of this debate. Certainly we need to look at this more but I think the studies are looking at staffing more these days.
Vol. 290 No. 12, September 24, 2003 Featured Link
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).
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JAMA. 2003;290:1549.
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Hey, Erin. No offense intended. I think everyone should be happy with their career choices. What worked for me may not work for someone else. I was simply sharing my experience and my thoughts. I am very pleased with my education and therefore will not take any comment made on this board personal. I have had a very positive experience in my BSN program. I will continue to recommend the BSN route to anyone looking to advance their career in the Science and "Art" of Nursing. Regardless of the level of nursing degree you have, what really counts is your personal satisfaction with your goals. Yes. I do Believe that my educational experience is "unique". :kiss
flenoy
We all have unique educational experiences, personal goals etc etc..As far as the BSN entry level, I would agree with another poster (Deb?)that if it would make our profession more cohesive, I am all for it. I do not however agree that BSNs give better pt care...if someone could show me an impartial study where they took identical floors with identical pts and staffed only with brand new ADNs and on the other new BSNs and it showed that the pts did better with the BSNs I might rethink it...
The part of your post that I was offended by was the stmt you made that "your instructor said it best about the monkeys"...I am assuming that ADN nurses are the monkeys in this scenario? I guess I am unsure as to why you thought that wouldn't offend when you posted it? In any case..peace..this is a topic that will never go away and I find it fruitless to even discuss. :) Erin
I assume, flenoy (and those of your ilk), that you had only BSN's or nurses with even higher degrees provide all of your precepting as a new grad.
Surely, you wouldn't lower yourself to be precepted by a lowly "monkey" such as myself (diploma grad 19y ago).
It would be very interesting to see how many of the BSN's in this study were diploma/ADN's first. Wonder why that info. was left out of the study. Hmmm...
You won't get an argument from me that education is vital; I don't think any of us are saying that it isn't. If BSN's truly believed in their superiority, they wouldn't need to dump all over those of us who do not have a degree...when you're secure in yourself you don't need to try to make yourself look better by denigrating others.
I took my first class adn to bsn and said stop..........
the first class immediately degraded the adn nurses, and said everything was going to bsn................. and soon adn nurses wouldn't have a job ........bs
I just graduated adn, and love nursing, i am perfectly fine being a staff nurse, and if i go and get my CEN then i get the same raise as i would get going for my BSN
As a newly graduated ASN RN, I can see the point to this story. I am personally working on my BSN, while working part-time at a local hospital. I am seeing first hand the difference that experience and education can do for a nurse and his/her patients. I am constantly working along side other ASN graduates as well as BSN graduates and nurses who have been working in the field longer than I have been alive. However, I must say that to some degree I agree with the article. BSN nurses seem to have more knowledge in prevention then most ASN nurses. What I mean to say is that they can see a problem coming before it is right in front of them. ASN nurses can act when the problem presents itself, but shouldn't we as healthcare providers look at the whole picture and do what we can to prevent anything unforseen from happening. Don't missunderstand me, we are not MIRACLE workers but we did take an oath to protect and keep our patients safe and that should be our main and ultimate goal. One last thing that I would like to add, I noticed the article discussed the idea that many people applied for the ASN program because it is quick and that they need a reliable job. I completely agree with this statement, many of my fellow students joined the program because they had lost their primary jobs and thanks to the govt funded scholarships they applied for a two year degree program. This personally upsets me because I have known that I have always wanted to be nurse, it is not something that I had to take just to make money. I have nothing against these people, they took the same program that I did, I just hope that they are giving GENUINE care to all of their patients and are not just doing it for the money.
Hellllllo Nurse, BSN, RN
2 Articles; 3,563 Posts
This is along the lines of what I was thinking- maybe a hospital that staffs with mostly BSNs has many other differences as well, which contribute towards nurses being able to give their best care.