I was curious what everyone thinks about the debate over the law being proposed in New York which seeks to require all registered professional nurses to attain a baccalaureate degree in nursing within ten years of their initial licensure?
The New York bill A01977 wouldn't apply to registered professional nurses who are already licensed in the state of New York. Also those currently in school to become registered professional nurses in the state of New York would also be grandfathered in and exempt from the new legislation.
I have looked into research regarding this topic and the research I have seen seems to support the fact that nurses educated at the baccalaureate degree have lower mortality rates for patients. One study indicates that increasing nurse's educational level decreases the risk of patient death and failure to rescue by four percent (Aiken et al., 2008). Also hospitals with a higher proportion of baccalaureate-prepared nurses have a lower mortality rate (Friese et al., 2008). In fact the Institute of Medicine has issued a call for 80% of registered nurses to possess a baccalaureate degree or higher by 2020 (Institute of Medicine, 2011). Other research I found supports the fact that BSN nurses are associated with lower mortality rates. I have included this research below:
Estabrooks, C. A., Midodzi, W. K., Cummings, G. G., Ricker, K. L., & Giovannetti, P. (2005). The impact of hospital nursing characteristics on 30-day mortality. Nursing Research, 54(2), 74-84.
Tourangeau, A. E., Doran, D. M., Hall, L. M., Pallas, L. O. B., Pringle, D., Tu, K. V., et al. (2006). Impact of hospital nursing care on 30-day mortality for acute medical patients. Journal of Advanced Nursing, 57(1), 32-44.
To be fair I tried locating research that would cast doubt on the research above or that would come to a different conclusion. I was however unsuccessful in locating any such research. If anyone has any additional research that would repudiate the fact that nurses prepared at the bachelor's level seem to have a lower rate of mortality for their patients could you please post it? I would love to see such a study and would be very interested in reading it.
References
Aiken, L.H., Clarke, S.P., Sloane, D.M., Lake, E.T. & Cheney, T. (2008). Effects of hospital care environment on patient mortality and nurse outcomes. Journal of Nursing Administration, 38(5), 223-229.
Friese, C.R, Lake, E.T., Aiken, L.H., Silber, J.H. & Sochalski, J. (2008). Hospital nurse practice environments and outcomes for surgical oncology patients. Health Services Research, 43(4), 1145-1163.
Institute of Medicine. (2011). The Future of Nursing: Leading Change,Advancing Health. Washington, DC: The National Academies Press.
By admitting there is a correlation you are admitting that there is a relationship between lower mortality rates and a baccalaureate degree in nursing. However you appear to be arguing that because the studies don’t show causation they are irrelevant. That is not the case.
I brought up the smoking argument because it was relevant to this discussion. We didn’t prove causation when it came to the fact that smoking caused cancer. Instead we proved that smoking caused cancer by endlessly repeating findings showing an association between smoking an cancer.
Therefore I believe you are in err regarding the argument that we cannot state that training in BSN programs helps reduce patient mortality. By endlessly repeating findings that show an association between lower mortality rates and a baccalaureate degree in nursing we can prove it and state it.
As for the questions on the variables I was just asking you what variables you think could lead to a correlation but not causation.
I am glad you like your boss, but some of my 'old time bosses' couldn't be grandfathered out fast enough for me (and one in particular still isn't out).
Specializes in Peds/outpatient FP,derm,allergy/private duty.
Therefore I believe you are in err regarding the argument that we cannot state that training in BSN programs helps reduce patient mortality. By endlessly repeating findings that show an association between lower mortality rates and a baccalaureate degree in nursing we can prove it and state it.
As for the questions on the variables I was just asking you what variables you think could lead to a correlation but not causation.
I added a link (with plenty of points to explain) to my other post. Repeating a fallacy over and over does not make it truthier. Also, the idea that you look for a certain result until you finally find one is bad science.
I don't know enough specifics about the tobacco industry to comment on that. There may well be studies that are conclusive there. I doubt it was quite as simplistic as you present it, though.
Why do you think the Insitute of Medicine didn't claim proof in 2010? There were certainly enough "associations" by that time.
My commEnt is mistakes and med errors probably have less to do with the education and more to do with the nurse patient ratio... I believe if the floors are equipped with enough nurses people have the time to be diligent...when any person is running overworked expected to do
the job of two people then the patient lives are in danger.... Im all for commonsense solutions... Many people seem to over look the most practical reasonable solutions... Nurse helpers
I am 100% on board with this. It is absolutely the truth. Although I do think experience does play a role I think staffing plays a bigger one.
Are you taking a post RN-BSN program? It seems like you have read the BSN as entry to practice literature and I assume you are writing a paper on the topic. If this is correct, then I think you will find it easier to drink the koolaide that your university program wants you to drink and regurgitate the information that shows the patient outcomes are linked to BSN education (just keep in mind the university benefits from nurses believing in these studies). On the other hand, if you are personally interested in what really happened when BSN became entry to practice in Ontario, I can tell you that where all RN staffing existed, there is now a mix of RN/RPN staffing and the decision to change to mixed staffing was based on research and guidelines Development and Evaluation of an RN/RPN Utilization Toolkit :: Longwoods.com The staffing changes were not published by the employers, they have been tracked by the ontario nursing union. Most nurses in Ontario have seen this happen in their workplaces and if they are being honest, they will admit that it has not resulted in worse patient outcomes.
That same Institute of Medicine you referred to said this in 2010: "The causal relationship between the academic degree obtained by RNs and patient outcomes is not conclusive in the research literature." Why do you think the Insitute of Medicine didn't claim proof in 2010? There were certainly enough "associations" by that time.
Nursel56 I think the Institute of Medicines report calling for 80% of all nurses to have their BSN by 2020 was pretty definitive. However I will include excerpts of the report below that further demonstrate the reports support for BSN education.
"A growing body of research documents that hospitals with a larger proportion of bedside care nurses with BSNs or higher qualifications is associated with lower risk of patient mortality."
"Advances in medical science and technology, the changing practice boundaries between medicine and nursing, and the increase in the share of the population with multiple chronic health conditions create a level of complexity in health care that requires a more educated health care workforce. Nursing is the least well educated health profession by far but the one experiencing the greatest expansion in scope of practice and responsibilities."
I'm going to post a link to the Institute of Medicines report below so everyone can read it for themselves and come to their own conclusions. By the way nursel56 do you know the page in the report where you got your quote from? I looked for it but was unable to find it. My quotes are from page 485 of the report.
Repeating a fallacy over and over does not make it truthier. Also, the idea that you look for a certain result until you finally find one is bad science.
Nursel56 you can look for a certain result in science, it's called a hypothesis. However what you cannot do is disregard data that doesn't support your hypothesis. Researchers propose hypotheses as explanations of phenomena, and design studies to test these hypotheses.
I added a link (with plenty of points to explain) to my other post.
Nursel56,
Nursel56 I took a look at your link. As a very intelligent individual you know that the American Association of Community Colleges (AACC) would be very biased regarding this matter. Also since the AACC first sent out this message back in 2003 it has had plenty of time to do its own research to dispute these studies but has not done so. In addition since the AACC's 2003 statement there have been numerous different studies that researchers have done regarding the relationship between lower patient mortality rates and BSN nurses. These studies have come to the exact same conclusions as the 2003 study that the AACC attacked.
Here is another excerpt from the Institute of Medicines report which I think helps illustrate this concept:
"Aiken and colleagues (2003) in a paper published in the Journal of the American Medical Association (JAMA) showed that in 1999, each 10 percent increase in the proportion of a hospital's bedside nurse workforce with BSN qualification was associated with a 5 percent decline in mortality following common surgical procedures. A similar finding was published by Friese and associates for cancer surgical outcomes (Friese et al., 2008). Aiken's team has replicated this finding in a larger study of hospitals in 2006. Similar results have been published for medical as well as surgical patients in at least three large studies in Canada and Belgium (Estabrooks et al., 2005; Tourangeau et al., 2007; Van den Heede et al., 2009)."
Are you taking a post RN-BSN program? It seems like you have read the BSN as entry to practice literature and I assume you are writing a paper on the topic. If this is correct, then I think you will find it easier to drink the koolaide that your university program wants you to drink and regurgitate the information that shows the patient outcomes are linked to BSN education (just keep in mind the university benefits from nurses believing in these studies). On the other hand, if you are personally interested in what really happened when BSN became entry to practice in Ontario, I can tell you that where all RN staffing existed, there is now a mix of RN/RPN staffing and the decision to change to mixed staffing was based on research and guidelines Development and Evaluation of an RN/RPN Utilization Toolkit :: Longwoods.com The staffing changes were not published by the employers, they have been tracked by the ontario nursing union. Most nurses in Ontario have seen this happen in their workplaces and if they are being honest, they will admit that it has not resulted in worse patient outcomes.
Dishes,
I am an ADN nurse who is currently in school getting my BSN. I am also heavily into science and research and am always willing to keep an open mind regarding these matters. However there are currently numerous studies stating that there is a relationship between lower mortality rates and a baccalaureate degree in nursing. Combined these studies examined hundreds of hospitals, tens of thousands of nurses and hundreds of thousands of patients. These studies as you can imagine are very compelling.
I also read your link about research that you posted. From what I gathered the study of an RN/RPN toolkit focused on designing a guide that would determine appropriate RN/RPN staffing ratios based on patients level of acuity. What I didn't see in this study was a comparison between an all RN work force and a RN/RPN workforce. Again this study seemed to be focused primarily on staffing. This study seems to be designed for setting appropriate staffing mix ratios of an RN/RPN workforce. This study was pretty hard to follow though and it's getting late so I'm pretty tired. So if you think I made a mistake regarding this research please let me know and I will review it again after I have gotten some more sleep.
I'm an MSN-prepared APN and though I obviously am in favor of education, this is an age old argument that has been around at least 30 years.
When I was in school for my LPN (1990), it was "there will be no more LPNs".
When I was originally in school for my ADN (1977) it was "there will only be a BSN prepared entry level soon."
Now, as an APN, I hear "in 2015" all APNs will need their DNP.
Hogwash! I'll believe it when I see it.
I don't know about the LPN and APN thing, but, as for BSNs, it probably won't be legislated. However, employers are making the change. I'm always browsing the job postings, and more and more are requiring BSNs, especially university-affiliated and magnet hospitals in my urban area.
You are in central Illinois, right? The job listings for Carle show ADN required, BSN preferred. Considering that Champaign-Urbana is surrounded by cornfields, Carle and other well-respected rural healthcare systems may not be able to make the change to BSN required as quickly as Chicago-area hospitals.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Its foolishness. My Director has been forced out of her position b/c she had to have a masters by 2012. Now some spring chicken 6 years out of nursing school with an MSN is up for the job! I feel my Director should have been grandfathered in 20 plus years speak volumes as opposed to a few letters. Its a sad transition I'd like to see end but as hospitals move toward "Magnet" status, this is becoming the norm. But should it be a law, ABSOLUTELY NOT. and that research sounds great, but other factors should be considered.
Many nurses have ANd but got BSN online was that accounted for? I doubt it. This research is focusing on the wrong variables if you ask me.
Signed,
I'll miss my boss
Honey, They forced your boss to get her out of the facility because she made too much money and benifits in favor of that young MSN willing to be paid pennies and less benefits. Plus us old bats have opinions and we aren't afraid to use them.......young hungry, indebt newbies don't speak up....they say yes, alot.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
Chronis,
I am very familiar with the Institute of Medicine report. I've referred to that document many times here on allnurses. I plan to deconstruct that into plain English one day soon. There's quite a bit of humor in the way they shovel bucketloads of arcane jargon out to simply state that they believe ADN nurses are too dumb to figure out fancy medical machinery or figure out if they need a referral to an audiologist and/or if it is covered by their insurance plan.
Why do they do that? Because they realize what you don't seem to realize.
Yes, you will find lots of information that contains claims of links to, associated with, etc. The central fact still remains that there is no way to exclude the possibility that another factor or factors are in whole or in part the cause of those changes in outcome. You don't seem to understand the difference. Until you do there really is no point in pursuing this further.
I expected you might dismiss the AACC paper as biased. I would suggest you do some independent research into the connections between the AACN, the ANA, and the IOM. Ask yourself "was there a chance in hell that the IOM would call for ADN nurses not to be relegated to a sub-caste of "technical" RNs?
I've read countless numbers of what passes for "studies", real studies, position papers, press releases, pseudo-scholarly pontifications and outright ********. A really effective advocate or even an apologist will learn to persuasively argue his or her opponent's point of view as well as their own. If you look at it in that light the AACC list can't be anything but helpful to you going forward. They raise some intriguing issues.
Your posts are starting to sound a bit condescending, which is irritating even when someone does have the facts at hand. So I'll bow out of this thread now. The entrenched oligarchy certainly has a friend in you, though. While they will couch their statements with qualifiers, you do not. Good luck to you!
There are likely tons (literally) of "studies" out there that are made into statistics.
We all know what is (accurately) said about statistics.
The problem (again) is that somebody, somewhere said, "there ought to be a law..." and there are always more than enough politicians eager to pounce on yet another way to garner more votes.
Chronis
35 Posts
By admitting there is a correlation you are admitting that there is a relationship between lower mortality rates and a baccalaureate degree in nursing. However you appear to be arguing that because the studies don’t show causation they are irrelevant. That is not the case.
I brought up the smoking argument because it was relevant to this discussion. We didn’t prove causation when it came to the fact that smoking caused cancer. Instead we proved that smoking caused cancer by endlessly repeating findings showing an association between smoking an cancer.
Therefore I believe you are in err regarding the argument that we cannot state that training in BSN programs helps reduce patient mortality. By endlessly repeating findings that show an association between lower mortality rates and a baccalaureate degree in nursing we can prove it and state it.
As for the questions on the variables I was just asking you what variables you think could lead to a correlation but not causation.