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

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.

The Association between Nursing Skill Mix and Patient Outcomes in a Mental Health Setting: Protocol for an Observational Feasibility Study

“…Most previous studies have determined skill mix (e.g., the nurse-to-patient ratio) using a self-report questionnaire, e.g., [ 8 ] that asks nurses to estimate the number of nurses and patients present during their last shift. The validity of this measure of skill mix has not been established and is likely subject to multiple sources of bias (social desirability, non-response).…”

“…The association between nursing education and patient outcomes (mortality, medication errors) in medical and surgical settings has been extensively studied [ 5 , 6 , 7 , 8 ]. Most authors report that a more highly qualified nursing workforce is associated with lower odds of mortality.…”

“…Most authors report that a more highly qualified nursing workforce is associated with lower odds of mortality. For example, Lasater et al [ 8 ] conducted an observational study using data from two cross-sections in time (2006, 2016) to examine if changes in hospital employment of nurses with bachelor’s degrees over time were associated with differences in patient outcomes in surgical wards of 519 hospitals. The authors used a nurse survey, American Hospital Association Annual Survey, and patient administrative claims to collect data.…”

“…The authors used a nurse survey, American Hospital Association Annual Survey, and patient administrative claims to collect data. Patients in hospitals with a higher proportion of nurses with bachelor’s degrees had lower risk-adjusted mortality, 7-day and 30-day readmission rates, and shorter hospital stays [ 8 ].…”

The association between hospital nursing resource profiles and nurse and patient outcomes

“…Although the cost of improving one's nursing resource profile may deter nurse managers from taking action, research finds that care in hospitals with better resource profiles has equivalent or less costs (Lasater, Sloane, et al, 2021).…”