What you need to know about the forces reshaping our industry.


July 17, 2019

Do patients fare better when nurses have 4-year degrees?

Daily Briefing

    A patient's chances of being discharged with good neurologic function after an in-hospital cardiac arrest increases when hospitals have a higher share of nurses with a bachelor of science in nursing (BSN) degree, according to a study published recently in Health Affairs this month.

    Nurses: Access 7 tools to improve the patient experience—and patient outcomes

    Study details

    In 2010, the National Academy of Medicine—then called the Institute of Medicine—recommended that at least 80% of nurses in the workforce should have a BSN or higher by 2020 based on existing evidence that hospital patient outcomes improved when a larger percentage of nurses had at least a BSN.

    The researchers sought to put the recommendation to the test, examining the correlation between a nurse's educational qualification and cardiac arrest outcomes.

    For the cross-sectional study, researchers examined data on 11,123 patients across 36 hospitals in California, Florida, New Jersey, and Pennsylvania from the:

    • 2015 and 2016 RN4CAST-US hospital nurse survey;
    • American Heart Association's Get With the Guidelines-Resuscitation (GWTG-R) registry for 2013 to 2018; and
    • American Hospital Association's 2015 Annual Survey.


    The researchers found the share of nurses with a BSN at each hospital ranged from 33% to 86%—with an average of 61%—and the patient-to-nurse ratios on the hospital's general floors ranged from 2.8 to 6.6 patients per nurse—with an average of 4.7, according to Medscape.

    The researchers found each 10 percentage-point increase in the share of nurses with a BSN was associated with 24% greater odds of patients surviving to discharge with good neurologic functions after an in-hospital cardiac arrest—even when adjusting for event, hospital, and patient characteristics.

    However, the researchers found no significant association between a nurse's educational level and survival to discharge when they did not take into account neurologic function.

    Overall, the researchers found:

    • 81.7% of patients did not survive to discharge;
    • 11.2% of patients survived cardiac arrest to discharge with good cerebral performance; and
    • 7.1% of patients survived discharge with neurologic disability.

    In addition, the researchers found the odds of survival to discharge with good neurologic function fell by 17% for each additional patient per nurse. The odds of survival regardless of neurologic status fell by 16% per each additional patient per nurse.


    Jordan Harrison, the study's lead author and a health services researcher from the Leonard Davis Institute of Health Economics at the University of Pennsylvania, said better-trained nurses "may allow for more opportunity to recognize patient deterioration before cardiac arrest, along with effective response once an arrest has happened, minimizing the potential for neurological injury."

    When it comes to meeting the National Academy of Medicine's goal, Harrison said, "I don't think we'll get to 80% by 2020." Harrison estimated that about 55% of U.S. nurses have a BSN.

    "This is partly a regional issue, in that in more rural areas, there is a lower supply of bachelor-prepared nurses," Harrison said, adding, "But there has been a large increase in the proportion of nurses who have a BSN because many hospitals are preferentially hiring bachelor-prepared nurses"

    To meet the goal, Harrison said, "Investing in human capital, including nursing resources, is part of organizational transformation to reduce harm and improve patient outcomes, particularly in emergency situations like cardiac arrest."

    Eileen Handberg, who directs the cardiovascular clinical trials program at the University of Florida College of Medicine in Gainesville, said, "There really aren't enough BSN programs currently to accommodate everyone who wants to get one, so I think the call from this research is not just a call to the hospital system to increase the number of BSNs they hire, it's also a call to colleges and state legislatures that provide funding that we need seats available in colleges of nursing BSN programs"  (Beck, Medscape, 7/9; Harrison et al., Health Affairs, July 2019; Maradiaga,, accessed 7/15).

    Have a Question?


    Ask our experts a question on any topic in health care by visiting our member portal, AskAdvisory.