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Study: Patient Mortality Risks Decrease with the Presence of Professional Nurses

It’s easy to determine the financial value in earning a Master of Science in Nursing, but the practical knowledge and experience gained from the degree are no less valuable, particularly in a critical industry like health care.

This notion has been underscored lately in studies that have shown the difference a degree-level nurse can make in a health-care setting. Many nurses pursue a graduate degree not just for the financial gain, but for the ability to further improve quality of care. Here, we’ll examine the impact and importance of professional nurses in care delivery.

Study finds mortality rates increase when nursing skill levels decrease

Does the staff composition of a hospital have an affect on patient outcomes? This was one of the key questions set to be answered by a research group based in Western Europe, with the study published in BMJ Quality and Safety.

The subsequent study looked at more than 243 hospitals in Belgium, Finland, Ireland, Spain and Switzerland, polling more than 13,000 nurses and nearly 19,000 patients. The nurses surveyed are considered “professional nurses” by European standards, which mean they have at least 10 years of general secondary education in addition to at least three years of nursing-specific education, as detailed in the study.

The goal was to examine the relationship between nursing skill mix and care outcomes, along with other provider indicators. The group noted that there are current overarching economic trends which have led to the dilution of nursing skill mixes. As a result, nursing professionals are being replaced with nursing assistants, who may not have completed the same level of education as their professional counterparts.

The study found that on average there were six nurse caregivers for every 25 patients, with four being nursing professionals. Research demonstrated that substituting just one nurse professional with a nurse assistant led to a 21 percent increase in the odds of patient mortality. Conversely, after adjusting for the data, substituting one nursing assistant with a professional nurse per every 25 patients rendered a decrease in the odds of mortality by 18 percent.

Despite this, the proportion of professional nurses ranged widely across the surveyed hospitals. The average skills mix comprised 66 percent of professional nurses, but reached as low as 41 percent in some hospitals and as high as 87 percent in others.
The increased chance of patient survival, while an integral benefit of a strong proportion of nursing professionals, was not the only positive effect tied to the skill level. Other noted benefits included reduced odds of:

  • Being scored low in patient satisfaction surveys
  • Reported instances of poor care quality
  • Below-average safety scores
  • Other poor outcomes (pressure ulcers, falls, UTIs)

The impacts of decreasing skill mixes are felt throughout the spectrum of care. Across some 19,000 patients and 182 hospitals, 54 percent of patients gave low marks for quality of care. Meanwhile, 30 percent of nurses were identified by the study as highly likely to burnout, and a similar percentage said they were dissatisfied with the job.

As noted by the researchers, the results in Europe (the study was the first to address such trends present on the continent) were reflective of those from U.S.-focused studies that examined the effect of nursing professionals.

One such study, published in the journal Health Affairs, used Pennsylvania data to quantify the effect of professional nurses on postsurgery care outcomes. Researchers found that for every 10 percent increase in the staff proportion of baccalaureate-prepared nurses, 2.12 deaths per 1,000 patients could have been avoided. This significance was most pronounced in patients with complications, a subset for which a 10 percentage point bump in professional nurses led to a decrease in 7.47 deaths per 1,000 patients.

Nurse speaking with patient.

How more education can lead to increased positive care outcomes for nurses

What becomes clear as more studies like these are released is that nurses with a degree make a qualitative difference in care outcomes. When tied to the increased financial prospects of an MSN, the clinical benefits make the degree particularly attractive to nurses who want to impact quality and initiate positive change.

But the question remains: Why are nurses with professional degrees more equipped to improve care in health-care settings? While the answer may be as simple as the fact that earning such degrees takes more time and practice, that’s not the whole story.

However, to start, the years and clinical hours spent in baccalaureate and graduate degree programs may play a central role in preparing professional nurses to address care outcomes and patient satisfaction with ever-increasing levels of skill.

Education is a massive factor to Patricia Benner’s widely publicized nursing theory of levels of expertise. The ascending tiers of expertise—novice, advanced beginner, competent, proficient and expert—are not exclusive to certain degrees, but overwhelming evidence consistently shows a relationship between a nurse’s highest level of education and its direct correlation to his or her job aptitude.

In a 2010 study of nursing clinical expertise from researchers at the University of Pennsylvania:

  • Nearly 60 percent of MSN-level nurses were classified as experts
  • 35 percent were proficient

Comparatively, “expert” proportions for other levels of nurses were:

  • 17 percent for diploma
  • 11 percent for associate degree
  • 16 percent for bachelor’s

Further, a study from researchers in Spain, and published in the American Journal of Nursing Research, found each extra year of education contributed to a 15 percent greater probability of advancing in expertise level.

There are more factors than just highest completed degree level to be considered a nursing expert. For example, in the same study from the University of Pennsylvania, 76 percent of expert-level nurses said other nurses came to them for their opinion in a clinical matter frequently; 45 percent of proficient nurses said they were consulted frequently. Additionally, 30 percent of expert nurses said they’d been frequently selected to be a preceptor—a hybrid clinical and educational mentor for less-experienced nurses; 16 percent of proficient nurses said the same.

It’s clear, then, that not only can professional nurses influence care quality personally, but they can also lift outcomes through their interactions with and advice to other nurses. The mere presence of an MSN-level nurse may be enough to avoid mistakes that could have otherwise been made, demonstrating the value in professional nurses beyond education level.

Beyond that, MSN-holding nurses are also more likely to be satisfied with their job, an attitude that can certainly manifest in efforts to improve quality of care. A 2016 survey from Nursing.org found:

  • 35 percent of nurses with a master’s were satisfied every day of their job; overall more than three-quarters were satisfied at least often.
  • Comparably, 28 percent of baccalaureate holders were satisfied every day.

Nurse with ICU patient.

How can earning an MSN help nurses further improve care quality?

While enrolling in the Master of Science in Nursing online program from the University of Arizona may be a start, there’s more to an education besides new skills that can help aspiring nurses improve quality of care.

A key draw to the MSN for nurses seeking continued education is the ability to translate the degree—and everything learned and experienced during the program—into the know-how to create, advocate and initiate strategies designed to improve care. This goes beyond the basic day to day of administering and coordinating care and further empowers a nurse to address care issues as he or she sees them in a health-care setting—another extension of a nurse’s capability to positively impact, among other things, mortality and poor outcome rates.

Indeed, in the American Association of Colleges of Nursing’s 2011 revised edition of “The Essentials of Master’s Education in Nursing,” quality improvement and safety is one of the nine core competencies of an MSN education:

“A master’s-prepared nurse must be articulate in the methods, tools, performance measures, culture of safety principles, and standards related to quality, as well as prepared to apply quality principles within an organization to be an effective leader and change agent.”

Achieving an MSN is also a step on the path to becoming an Advanced Practice Registered Nurse, or earning a Doctor of Nursing Practice. Becoming an APRN or completing the DNP not only helps expand a nurse’s expertise level, but prepares them for high-level positions in clinical structures where they can dictate change and improve care as a recognized leader, and maybe even an executive.

This all matters when it comes to patient outcomes. As evidenced, professional nurses—and their years of experience and expertise—are indispensable in a health-care setting, and continued education can reinforce each aspect of a nurse’s capacity to affect care quality for the better.

One master’s-level nurse put it best to Nursing.org: “I feel a 4-year degree better prepares people for the seriousness of having people’s lives in your hands. It’s not just a job.”

Sources

http://www.medicalnewstoday.com/releases/314167.php

http://qualitysafety.bmj.com/content/early/2016/11/03/bmjqs-2016-005567

http://docplayer.net/36684151-Nursing-skill-mix-in-european-hospitals-cross-sectional-study-of-the-association-with-mortality-patient-ratings-and-quality-of-care.html

http://content.healthaffairs.org/content/32/3/579.abstract?sid=32bce161-cc20-4fd2-837b-577d651033f0

http://www.health.nsw.gov.au/nursing/projects/Documents/novice-expert-benner.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2998339/

http://pubs.sciepub.com/ajnr/2/3/4/index.html

http://www.nursing.org/wp-content/uploads/2015/10/Nursing.org_.State-of-Nursing_2016.pdf

http://www.aacn.nche.edu/education-resources/MastersEssentials11.pdf

https://www.healthcareers.nhs.uk/I-am/considering-or-university/studying-nursing

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