The landmark Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health, includes a recommendation to increase the proportion of nurses holding BSN degrees or higher to 80 percent by 2020. While the IOM advocates hitting this target across the board, until now there has been no economic analysis of what achieving such a threshold would do for costs and revenues in hospitals, the largest employers of nurses.
A new interdisciplinary study, published in the current issue of Medical Care and funded by the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative (INQRI), finds that increasing the proportion of BSN-prepared nurses in a hospital to 80 percent or more, and having those nurses interact most with patients, improves outcomes on several measures and reduces costs. The research team found that patients who received 80 percent or more of their care from BSN-prepared nurses had 18.7 percent lower odds of readmission, and 1.9 percent shorter lengths of stay. Researchers also found that a 10 percent increase in the proportion of BSN-educated care was associated with a 10 percent reduction in the odds of mortality.
The savings realized by having more BSN-educated nurses outweighed the cost of paying those nurses a higher salary. The team estimated that increasing the proportion of BSN-prepared nurses caring for each patient to 80 percent or more would reduce annual readmissions by roughly 248 days, reducing costs by $5,653,022.97 annually. The cost associated with salaries for a larger group of BSN-prepared nurses was estimated to be $1,843,266.46 for the nurses included in the study.
“The real contribution of this study is that when we looked at patients in the same hospital, who were hospitalized on the same unit with the same diagnosis, patients who received more than 80 percent of nursing care from BSN-educated nurses tended to do better—despite often being sicker at the time of admission,” said Olga Yakusheva, PhD, associate professor of nursing at the University of Michigan School of Nursing and one of the lead researchers. “These patients tended to spend less time in the hospital, fewer of them had to go back to the hospital after discharge, and fewer of them died. This makes you think, really, how can we give all of our patients an equal opportunity to receive high-quality care they deserve? The answer is, or at least seems to be, by investing in nurse education. And our study shows that these investments can also have real cost-saving effects in the long term.”
The research team also included Richard Lindrooth, PhD, associate professor in the Department of Health Systems, Management and Policy in the Colorado School of Public Health, University of Colorado Anschutz Medical Campus; and Marianne Weiss, DNSc, RN, associate professor and Wheaton-Franciscan Healthcare/Sister Rosalie Klein professor of women’s health at Marquette University College of Nursing.
The study included analysis of electronic data on 8,526 patients who received care from 1,477 nurses in an academic medical center from June 1 to December 31, 2011. One fifth of the patients received 80 percent or more of their care from BSN-prepared nurses. The research team also conducted regression modeling.
The Interdisciplinary Nursing Quality Research Initiative is funded by the Robert Wood Johnson Foundation.