Evidence for a BSN Workforce

Aiken, L.H., Clarke, S., Cheung, R., Sloane, D. and Silber, J. (2003) Educational Levels of Hospital Nurses and Surgical Patient Mortality. Journal of the American Medical Association, 290(12), 1617-1623.

  • Major Findings: This landmark study found that acute care facilities with a 10 percent increase in the proportion of RNs holding a BS in nursing degree decreased the risk of patient death and failure to rescue by 5 percent. 

Aiken, L.H., Clarke, S.P., Sloane, D.M., Lake, E.T. & Cheney, T. (2008, May). Effects of hospital care environment on patient mortality and nurse outcomes. Journal of Nursing Administration, 38(5), 223-229.

  • Major Findings: This study verified the results of Aiken, et al, 2003 study.  Every 10% increase in the proportion of BS in nursing-prepared RN in hospital staff was associated with a 4% decrease in the risk of death. 

Aiken, L.H., Sloane, D., Bruyneel, L., Van den Heede, K., Griffiths,P., Busse,R., Diomidous,M.,  Kinnunen,J., Kózka,M., Lesaffre, E., McHugh, M., Moreno-Casbas, M.T., Rafferty, A.M., Schwendimann, R. Scott, P.A., Tishelman, C., van Achterberg,T., & Sermeus,W. (February 26, 2014) Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. Lancet.


  • Major Findings: A large-scale study conducted in nine European countries (Belgium, England, Finland, Ireland, the Netherlands, Norway, Spain, Sweden, and Switzerland) found that an increase in a nurse’s workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7% and every 10% increase in BS prepared nurses was associated with a decrease in this likelihood by 7%.

Blegen, M., Goode, C., Park, S., Vaughn, T. and Spetz, J. (2013) Baccalaureate Education in Nursing and Patient Outcomes. JONA, 43(2), 89-94.

  • Major Findings: Acute care facilities with higher percentage of RNs with BS or higher degrees had lower congestive heart failure mortality, decubitus ulcers, failure to rescue, postoperative deep vein thrombosis or pulmonary embolism, and shorter length of stays.

Estabrooks, C.A., Midodzi, W.K., Cummings, G.C., Ricker, K.L. & Giovanetti, P. (2005, March/April). The impact of hospital nursing characteristics on 30-day mortality. Nursing Research, 54(2), 72-84.

  • Major Findings: This large-scale Canadian study found that BS-prepared RNs have a positive impact on mortality rates.

Friese, C.R, Lake, E.T., Aiken, L.H., Silber, J.H. & Sochalski, J. (2008, August). Hospital nurse practice environments and outcomes for surgical oncology patients. Health Services Research, 43(4), 1145-1163.

  • Major Findings: BS prepared RNs were linked with lower mortality and failure-to-rescue rates in acute care facilities. The authors state that, “…moving to a nurse workforce in which a higher proportion of staff nurses have at least a baccalaureate-level education would result in substantially fewer adverse outcomes for patients.”

Kane, R., Shamliyan,T., Mueller, K., Duval,S. and Wilt, T. (2007) Nurse Staffing & Quality of Patient Care. Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services,  AHRQ Publication No. 07-E005

  • Major Findings: This meta-analysis of observational studies found that higher RN nurse staffing was associated with less hospital-related mortality, failure to rescue, cardiac arrest, hospital acquired pneumonia, and other adverse events.  This was especially evident in intensive care units and for surgical patients. Some evidences indicates that higher proportion of BS-prepared RN staff was associated with lower mortality and failure to rescue.

Kendall-Gallagher, D., Aiken, L., Sloane, D., and Cimiotti,J. (2011) Nurse Specialty Certification, Inpatient Mortality, and Failure to Rescue. Journal of Nursing Scholarship,  43(2),188–194.

  • Major Findings: Although specialty certification was associated with better patient outcomes, such outcomes were associated only when care was provided by nurses with baccalaureate level education. The authors concluded that “…no effect of specialization was seen in the absence of baccalaureate education.”

Kutney-Lee, A., Sloane, D., and Aiken, L. (2013). An Increase In The Number Of Nurses With Baccalaureate Degrees Is Linked To Lower Rates Of Postsurgery Mortality. Health Affairs, 32(3), 579-586.

  • Major Findings: A 10-point increase in the percentage of nurses holding a BSN within a hospital was associated with an average reduction of 2.12 deaths for every 1,000 patients—and for a subset of patients with complications, a10-point increase in the percentage of nurses holding a BSN was associated with an average reduction of 7.47 deaths per 1,000 patients.

McHugh, M.D., Kelly, L.A., Smith, H.L., ES,w., Vanak, J.M., & Aiken, L.H. (2013, May) Lower mortality in magnet hospitals. Medical Care, 51(5):382-8.

  • Major Findings: Patients treated in Magnet hospitals had 14% lower odds of mortality and 12% lower odds of failure-to-rescue while controlling for nursing factors as well as patient and hospital variation. The researchers indicated that while Magnet hospitals have better work environments with higher percentage of BS-prepared RNs with specialty certification there is a mortality advantage above and beyond what they could measure.  

Ridley, R. (2008) The Relationship Between Nurse Education Level and Patient Safety: An Integrative Review. Journal of Nursing Education,  47(4), 149-156.

  • Major Findings: A review of literature encompassing twenty years and examining evidence linking the percentage of BS-prepared RNs and patient outcomes.

Tourangeau, A.E., Doran, D.M., McGillis Hall, L., Obrien Pallas, L., Pringle, D., Tu, J.V. & Cranley, L.A. (2007). Impact of hospital nursing care on 30-day mortality for acute medical patients. Journal of Advanced Nursing, 57(1), 32-41.

  • Major Findings: This large-scale Canadian study found that acute care facilities with higher proportions of BS-prepared RNs tended to have lower 30-day mortality rates. They conclude that, “Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."