Quote from rebeccainlv
My VA doesn't hire LPNs or ADNs anymore either. The trend is totally going towards BSN and higher. The VA takes safety very seriously and that's why their hospitals have the highest safety ratings in the US. They go along with the research that more BSNs on a floor equals lower morbidity rates.
Ah, you must be referring to the "famous" (or rather should I say infamous
) Aiken study, a prime example of why one needs to critically appraise
all research studies and not just accept carte blanche the results as "gospel truth."
Study: Nurses' Education Affects Death Rates
Researcher: Nurses With More Education Better At Critical Thinking
University of Pennsylvania researchers studied data on more than 230,000 patients from 168 Pennsylvania hospitals. They also surveyed more than 10,000 nurses throughout the state.
The researchers found that death rates were nearly twice as high when the percentage of nurses with bachelor's degrees was low. They said care could improve a lot if hospitals recruit nurses with bachelor's degrees rather than two- or three- year programs. The percentages of more highly educated nurses ranged from zero to 77 percent at the Pennsylvania hospitals studied.
This report is a bone of contention among ADN educators. It is so fatally flawed that it has absolutely no redemptive value other than showing it is wise to have surgery in hospitals in which there are board-certified surgeons! Unfortunately, this one unreplicated research report has been promulgated as gospel (by those with radically pro-BSN agendas), and has been a very damaging piece of propaganda indeed.
Here is an analysis I did of this study for my nursing research class:
Probably one of the most controversial research reports of all times in the great BSN versus ADN entry level debate among nursing academia has been the Aiken study. This one research study was the major catalyst for the Institute of Medicine (IOM) calling for a ratio of 60% BSN and 40% ADN/ diploma in the North Carolina nursing workforce.
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).
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.
"Our findings indicate that surgical patients cared for in hospitals in which higher proportions of direct-care RNs held bachelor's degrees experienced a substantial survival advantage over those treated in hospitals in which fewer staff nurses had BSN or higher degrees. Similarly, surgical patients experiencing serious complications during hospitalization were significantly more likely to survive in hospitals with a higher proportion of nurses with baccalaureate education."
"Nursing education policy reports published in the past decade concluded that the United States has an imbalance in the educational preparation of its nurse workforce with too few RNs with BSN and higher degrees. Our findings provide sobering evidence that this imbalance may be harming patients."
Possible confounding variables and biases:
Selection bias: BSN, MSN, and nurses with doctorates all grouped together; ADN's and diploma nurses grouped together (Pennsylvania has one of the highest populations of diploma nurses in the US).
This factor alone seriously compromises the study's generalizability to a target population of just ADNs and BSNs and produces flawed study conclusions.
Aiken 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.
In reference to this quotation, the researchers need to do a better job of factoring out the experience variable.
It was not known how many nurses in the sample were originally ADN nurses who went back to get their BSN's (the BSN sample likely had nurses with more education and experience than the ADN's). This is flawed sampling methodology, also, because many BSN nurses were originally ADN nurses who went back to get their BSN's. The opposite is not true- BSN's don't go back to get their ADN.
For an accurate comparison, the researcher needs to compare strictly new ADN graduates with BSN graduates and patient outcomes.
Another possible confounding variable:
Patients admitted to a high tech and/or teaching hospital by virtue of the type of hospital have a better chance of survival. These hospitals often employ higher percentages of BSN and higher degree nurses than smaller outlying hospitals.
Nurse patient ratios:
BSN/ MSN nurses tended to work in the high tech/ teaching hospitals and to have lower ratios of nurse to patient 4:1 as compared with the ADN at 8:1.
Are the researchers adequately controlling for patient acuity level?
The article noted control of acuity level, but no explanation was given for how this was done.
Other points of concern:
Mortality rates increases with age. The study states that the average patient age in the hospitals with more ADNs is 61.9 years, while the average patient age in the hospitals with more BSNs is 57.3 years.
The researchers admit, but do not speak to the control of, that the ratio of Board Certified surgeons in a given hospital has a much greater impact on mortality than does the education level of the nurse.
My comment: The example of the Aiken report highlights the danger of institutions making practice recommendations on the basis of the findings of one, unreplicated study, especially if the study involved has serious biases and flaws in methodology.
Unfortunately, much damage has already been done by the Aiken Report--the average person does not see these flaws and takes the findings to heart as being unquestionably true.
AACN: (2003, October). Media/ News Watch. Retrieved October 21, 2004, from http://www.aacn.nche.edu/Media/NewsWatch/Oct03.htm
Aiken, L.H., Clarke, S.P., Cheung, R.B., Sloane, D.M., & Silber, J.H. (2003). Educational levels of hospital nurses and surgical patient mortality. Journal of the American Medical Association (JAMA), 12, 1617-1623.
Bernier, S. (2003). N-OADN update: JAMA Article "Educational Levels of Hospital Nurses and Surgical Patient Mortality."
North Carolina Institute of Medicine (IOM). (2004, March). Executive summary: Final report of the Task Force on the North Carolina Nursing Workforce.