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. 2021 Oct;44(5):787-795.
doi: 10.1002/nur.22163. Epub 2021 Jun 14.

Changes in proportion of bachelor's nurses associated with improvements in patient outcomes

Karen B Lasater  1   2 , Douglas M Sloane  1 , Matthew D McHugh  1   2 , Joshua Porat-Dahlerbruch  1   2 , Linda H Aiken  1   2
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Changes in proportion of bachelor's nurses associated with improvements in patient outcomes

Karen B Lasater et al. Res Nurs Health. 2021 Oct.

Abstract

This study uses data from two cross-sections in time (2006, 2016) to determine whether changes over time in hospital employment of bachelor's of science in nursing (BSN) nurses is associated with changes in patient outcomes. Data sources include nurse survey data, American Hospital Association Annual Survey data, and patient administrative claims data from state agencies in California, Florida, New Jersey, and Pennsylvania. The study sample included general surgical patients aged 18-99 years admitted to one of the 519 study hospitals. Multilevel logistic regression and truncated negative binomial models were used to estimate the cross-sectional and longitudinal effects of the proportion of hospital BSN nurses on patient outcomes (i.e., in-hospital mortality, 7- and 30-day readmissions, length of stay). Between 2006 and 2016, the average proportion of BSN nurses in hospitals increased from 41% to 56%. Patients in hospitals that increased their proportion of BSN nurses over time had significantly reduced odds of risk-adjusted mortality (odds ratio [OR]: 0.95, 95% confidence interval [CI]: 0.92-0.98), 7-day readmission (OR: 0.96, 95% CI: 0.94-0.99) and 30-day readmission (OR: 0.98, 95% CI: 0.95-1.00), and shorter lengths of stay (incident rate ratio [IRR]: 0.98, 95% CI: 0.97-0.99). Longitudinal findings of an association between increased proportions of BSN nurses and improvements in patient outcomes corroborate previous cross-sectional research, suggesting that a better educated nurse workforce may add value to hospitals and patients.

Keywords: education; health service research; nursing; outcomes research.

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Conflict of interest statement

CONFLICT OF INTERESTS

The authors declare that there are no conflict of interests. The content is solely the authors' responsibility. This paper is our original, unpublished work and it has not been submitted to any other journal for review.

Figures

FIGURE 1
FIGURE 1
Study data sources. Patient data are obtained from state administrative claims data representing all inpatient hospital discharges within each study state (California, Florida, New Jersey, Pennsylvania). Nurse data are from the RN4CAST survey of nurses. Hospital data are from the American Hospital Association Annual Survey
FIGURE 2
FIGURE 2
Percentage of hospitals with (A) varying percentages of BSN nurses in 2006 and 2016, and (B) varying decreases and increases in the percentage of BSNs over the period. BSN, bachelor's of science in nursing
See this image and copyright information in PMC

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