Nurses with higher education decrease patient deaths

When hospitals hire more nurses with four-year degrees, patient deaths following common surgeries decrease, according to new research by the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing in Philadelphia.

Reported in the policy journal Health Affairs, the study says 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 said in their article.

Consider the example of a 10-percentage point increase, from 30% to 40%, in the overall percentage of BSN-prepared nurses in the hospitals studied between 1999 to 2006. Statistically, that increase would have saved about two 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 in Pennsylvania in 1999 and 25,000 in 20006.

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 (LPNs) 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. She noted that a recent report from the Institute of Medicine recommends that 80% 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,” Kutney-Lee said.

While the authors of the study did not pinpoint why more patients survive surgeries, previous work at the center found that better-prepared nurses offer higher levels of surveillance of patients. The better-prepared nurses notice 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 in the journal article. “The findings provide support for efforts to increase the production and employment of baccalaureate nurses.”

(Note from the editor: An abstract of the journal article is available online at The full text of the study requires a membership or one-time purchase of $12.95.)