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Quality Quickie: Better educated nurses make the hospital safer?

Linda Aitken has been the leading academic looking at nursing professionals in the US for several years. (Ed O’Neill has been her opposite number on the physician side).  Aitken’s latest research is going to put the cat amongst the pigeons and maybe have a major impact. Both the abstract and some more detailed press reports (like this one that interviews Aitken) suggest that hospitals that have a greater proportion of better educated nurses have better mortality rates.  And the differences are significant both statisitically and in real life; up to 5% improvement in 30 day mortality for a 10% increase in the number of nurses with bachelor degrees.  All other features of the hospitals were corrected for, so the only difference was whether the nurse had a 2 year degree or a 4+ year degree. While representatives of 2 year nursing courses criticized the methodology, Aitken is no dummy and JAMA is no throwaway mag, so it carries the burden of proof.

So if a shift from a ratio of 50-50 to 55-45 in nursing mix (based on education) leads to a 5% decrease in mortality, how long before the lawyers/quality advocates start coming after hospitals that employ a large proportion of nurses holding only Associates degrees? You know that if a drug came out that improved mortality in the inpatient setting by 5% over a competitor, it would be adopted like a shot. The proof is in the uptake of TPA over Streptokinase 10 years ago when TPA decreased mortality only 0.2% better (see this post).  And if such a  move is made, who will end up paying for it given that we have a nursing shortage already?

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