Hiring nurses with four-year degrees decreases patient deaths, new research report says

When hospitals hire more nurses with four-year degrees, patient deaths following common surgeries decrease, according to new research by the University of Pennsylvania School of Nursing's Center for Health Outcomes and Policy Research as reported in the March issue of the prestigious policy journal Health Affairs. Less than half the nation's nurses (45%) have baccalaureate degrees, according to the most recent data available (2008).

If all 134 Pennsylvania hospitals involved in the study had increased the percentage of their nurses with four-year degrees by 10 percentage points, the lives of about 500 patients who had undergone general, vascular, or orthopedic surgery might have been saved, the researchers found.

Specifically, a ten percentage point increase, say from 30 to 40 percent, in the overall percentage of BSN-prepared nurses in the hospitals studied between 1999 to 2006 saved about 2 lives for each 1,000 patients treated on average, according to lead author Penn Nursing professor Ann Kutney-Lee, PhD, RN, who is also a senior fellow at the Leonard Davis Institute of Health Economics. The researchers surveyed 42,000 registered nurses (RN) in Pennsylvania in 1999 and 25,000 in 20006.

Currently, RNs have obtained a four-year (baccalaureate degree), a two-year (associate's) degree, or graduated from a hospital-based diploma school. Licensed practical nurses (LPN) also practice at the bedside with a one-year degree.

"This adds to the importance of public policies to help direct a substantial shift toward the production of nurses with baccalaureates in nursing," said Kutney-Lee, noting that a recent report from the Institute of Medicine recommends that 80 percent of nurses hold at least a baccalaureate degree by 2020. "Nursing is both high-touch and high-tech requiring honed critical thinking skills in our complicated healthcare system."

While the study did not pinpoint why more patients survive surgeries, previous work in the Center found that better-prepared nurses offer higher levels of surveillance of patients, noticing subtle shifts in their patients' conditions that can lead to death from complications while there was still time to intervene.

"As part of their practice, nurses are responsible for the continual assessment and monitoring of a patient's condition, identifying changes that could indicate clinical deterioration, and initiating interventions when necessary," noted Kutney-Lee.