Nurses w/ advanced education & patient outcomes

MunoRN, RN · Mar 22, 2011

If you're referring to BSN vs ADN you can find many threads that address the research.

Response #5 in this thread is pretty thorough:

https://allnurses.com/registered-nurses-diploma/does-article-prove-132809.html

As a BSN I certainly wouldn't mind definitive proof that my money was well spent, although it doesn't appear that is necessarily the case. My state recently rescinded it's plan for "BSN in 10" citing a lack of evidence to support the costs of the mandate (Hospitals were concerned with the higher initial training costs associated with BSN's as well as tuition assistance). In the past, any disparity between 2 year and 4 year graduates in terms of bedside practice was thought to be largely due to the educational background and learning potential of the students rather than the programs themselves, which is less significant now that ADN program entry requirements are very similar to that of BSN programs given the heavy demand. The local ADN program in my area has had a minimum prerequisite GPA requirement of 3.8 since they started 5 years ago, and starting next year they will be requiring a previous Bachelors degree for entree, preferably a BS.

netglow, ASN, RN · Mar 22, 2011

Like what's going on in your state. Better if the Bachelors requirement also required a GPA to be considered for entrance. Just sayin, 'cause I KA for both my degrees. I always hated it to hear educators say a "C" is passing with a big :). Seriously? A "C" has always meant FAIL to my personal book.

NPinWCH · Mar 23, 2011

C was a fail in my BSN program, even a C in a prereq disqualified you from the program. It wasn't easy to get into the program and it wasn't easy to stay in the program.

A study in JAMA, http://jama.ama-assn.org/content/290/12/1617.short , found that:

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).

Other studies have shown that BSN wasn't as important as experience, but all the studies admit that there are limitations to their methodology. I've worked with excellent RNs with all degrees from a diploma to a masters and I've worked with some not so great RNs with the same degrees.

classicdame, MSN, EdD · Mar 23, 2011

depends on what you call "advanced". Linda Aikens has plenty of published articles on the relationship of BSN nurses to lower mortality rates.

nursn4u11 · Mar 23, 2011

So many things im reading is saying a bsn degree equals lower mortality rates because the bsn programs go in dept more about cultural and social aspects. So what's the reasoning...im still trying to figure out. I feel as if us nurses learn more on the floor and being around doctors than sitting In a classroom. Im looking into going back to get my bsn myself but tell me how classes like english literature, history or art classes we have to take help better patients? And like when I was a student in school...are your patients going to ask you what kind of grades you received in school? No they care about how you care for them, your presentation and manner towards them. Any other thoughts about this topic? Too, Another nurse with a higher education than i can care for the same patient but im sure it boils down to how confident they feel about their nurses confidence.

MunoRN, RN · Mar 24, 2011

A study in JAMA, http://jama.ama-assn.org/content/290/12/1617.short , found that:
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).

depends on what you call "advanced". Linda Aikens has plenty of published articles on the relationship of BSN nurses to lower mortality rates.

Both of these references, as well as the one I referenced in the first response, are all the same study. There seems to be an impression out there that this a wealth of studies on the subject, when really there are only 3, 2 of them by Aikens. The main one is Aiken's more recent which was basically a re-do of her initial study.

What she found was that a combination of factors; care environment, staffing ratios, and RN level of education as a group could predict mortality and failure to rescue rates. Her conclusion was that a more favorable care environment, a ratio of 4:1, and a staff that consisted of 60% BSN's significantly improved outcomes compared to a less favorable care environment, a ratio of 8:1 and only 20% BSN's. We don't really know how much of that difference was due to the number of BSN's specifically, although one would think that a 4:1 ratio compared to an 8:1 ratio would be a significant impairment to mortality and failure to rescue rates, potentially accounting for the majority of the difference, especially when you look at Aiken's better known work on patient ratios that was the main foundation for California's staffing law.

That doesn't mean there is no evidence that correlates characteristics specific to BSN nurses and better outcomes. BSN nurses have been shown to be less timid as a whole when communicating with Doctors. We know that inadequate communication is a huge, probably the largest, threat to patient safety. One possibility for this is that for the most part BSN's are educated in teaching hospitals, while the majority of ADN's are not. The intern/resident/attending MD environment is much different from that of a non-teaching hospital. Experienced nurses tend to fit in on the teaching hospital food chain at least above the interns and often even above the residents, allowing BSN's students to spend their formative years learning that nurses closer to an equal to MD's, than what occurs in non-teaching hospitals. I don't think it is a huge contributor, but when trying to determine why ADN's are more timid, it can't help that they hear they are inferior all the time, whether it be from Linda Aiken, the ANA, or pretty much every thread on the subject on this site.

elkpark · Mar 24, 2011

Both of these references, as well as the one I referenced in the first response, are all the same study. There seems to be an impression out there that this a wealth of studies on the subject, when really there are only 3, 2 of them by Aikens. The main one is Aiken's more recent which was basically a re-do of her initial study.

Yes -- thank you for pointing this out (I was wondering if I should). A lot of people, either those who are intentionally pushing an agenda or those who are just not well-informed about the literature and simply repeating what they've heard from others, like to make it sound like there's a sizeable body of evidence now that support the idea that BSN-prepared nurses are clearly "better" than ADN- or diploma-prepared RNs in the clinical setting. In fact, it's just the same few studies getting mentioned and referenced over and over, and they are simply interesting preliminary findings, certainly nothing definitive.