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Investing in Nursing: Good for Patients, Good for Business,
And Good for the Bottom Line

Donna M. Nickitas, PhD, RN, NEA-BC, CNE, FAAN


T IS NOT OFTEN that I am distracted from the "task at
hand" to go onhne and read a
study. However, as an editor, I
am always on the "outsight" looking for trends and research that invests in nursing and nursing resources. Thus, I came upon a recent study in The Lancet led by
Linda H. Aiken, professor of nursing and sociology, and director of
the Center for Health Outcomes and
Policy Research at the University
of Pennsylvania, and a team of researchers from Catholic University
of Leuven in Belgium (Aiken et al.,
2014). The researchers reported on
the results of a study in nine
European countries documenting
that hospital nurse staffing and the
proportion of nurses with a bachelor's education were
associated with significantly fewer deaths after common surgery.
These findings revealed what nurse leaders
worldwide have known for a very long time: patient
safety depends on low ratios for nurse staffing, and
nurses' education. The evidence is clear that adequate and appropriate nurse staffing levels reduce
preventable hospital deaths and re-admissions. In
fact, Aiken and coauthors noted the assumption that
reducing hospital nurse staffing to save money without adversely affecting patient outcomes may be foolish at best, and fatal at worst. Investing in ntirse
staffing is beyond just good business sense, it actually saves lives. When hospitals cut or reduce nursing
levels and/or positions because of budgetary constraints, there are real and dangerous consequences
for patients. For example, "...every one patient
increase in patient to nurse ratios was associated
with a 7% increase in deaths, while having a better
educated nurse workforce is associated with fewer
deaths. Every 10% increase in bachelor's degree nurses is associated with a 7% decline in mortality"
(Aiken et al, 2014, p. 4).

When Is Enough Scientific
Evidence Enough?
There is a growing body of
research clearly linking baccalaureate-prepared nurses to lower mortality and better patient outcome.
Aiken and colleagues (2014) evaluated close to a half million surgical
patients in 300 hospitals. In those
hospitals where 60% of nurses had
bachelor's degrees and cared for an
average of six patients, the risk of
death after inpatient surgical procedures was nearly one-third lower
than hospitals where half as many
nurses had bachelor's degrees and
cared for an average of eight
patients each. Why are governmental agencies, regulatory bodies, and
professional nursing organizations
not aligning to invest in nursing? The evidence is
clear, comprehensive, and compelling. The Institute
of Medicine's (2011) Future o/JVursing report recommended a national workforce this is 80% bachelor's
educated by 2020. The New York State Legislature is
considering a bill to amend the Education Law to
require new registered professional nurses to attain a
baccalaureate of science degree in nursing within 10
years of the first initial licensure.
The conversations within the halls of academe,
hospital boardrooms, and consumer groups must be
singularly focused on real measures and methods to
invest in bachelor's nursing education and support
sufficient nurse staffing levels. Nursing Economics
will continue to monitor and report on research that
sheds light on inadequate staffing. It is no longer moral
or ethical to place hospitalized patients at risk of dying
when the evidence reveals otherwise. When hospitals
provide inadequate staffing, patient safety is compromised. Many states in the United States have already
begun studying and enacting regulation and/or legislation around hospital staffing levels. Many health care
organizations, Magnet® institutions in particular, are
now only hiring baccalaureate-prepared nurses.
continued on page 69


NURSING ECONOMIC$/March-April 2014/Vol. 32/No. 2

evolving power and influence.
Hopefully, my work has raised the
consciousness of mentoring for
nursing students, clinicians, educators, researchers, and professional nurses in all specialties and
at all levels. The best thing for me
is that nurses now know and use
the word mentor! I believe promulgating mentorship has set the
stage for ongoing research; the initiation of formal programs in
schools, associations, and workplaces; and the development of
power mentor networks among all
of us. We know there is an enormous demand for nursing leaders
who are prepared and committed
to transforming our profession,
and who can lead change and
advance health.
My study of the "nurse influentials" demonstrated nurses are
able to make a major mark in the
profession and influence societal
change through the legacy of being
mentored and mentoring others.
As I indicated earlier, we've come
a long way since the late '70s
when "mentor" was never uttered;
and if it was done, it was "underground" and labeled something
else. Now, leaders are increasingly
aware they have an obligation to
find good mentors and to mentor
others. And, hopefully, we are
socializing the next generation of

nurses to expect mentor relationships, to seek, and to cultivate
these connections. Thus, mentoring will increasingly become part
of our professional ethos and our
professional behavior.
DN: Thank you. Dr. Vance, for
your insights and beliefs on mentorship in nursing. This interview
emphasized the importance of
mentoring within the nursing profession. I am grateful for your contemporary definitions and descriptions of mentoring. I could not
agree more that we must adapt the
necessary professional ethos and
behaviors to ensure the next generation of nursing will recognize
and cultivate these mentoring
connections. $
American Nurses Association. (2010).
Nursing: Scope and standards of
practice (2nd ed.). Silver Spring, MD:
Institute of Medicine. (2010). The future of
nursing: Leading change, advancing
health. Washington, DC: National
Academies Press.
Vance, C, & Olson, R.K. (1998). The mentor connection in nursing. New York,
NY: Springer Puhlishing Company.

Vance, C. (2011). Fast facts for career success in nursing: Making the most of
mentoring in a nutshell. New York,
NY: Springer Publishing Company.

continued from page 54

Best Value for the Nursing Workforce Is Investment
After careful reflection and thoughtful analysis on the results reported
by Aiken and her team, it is obvious nursing resources are important predictors of patient satisfaction and in the nurse assessments of quality and
safety of care. Therefore, it is the responsibility of all citizens to demand
public and private responses to improve nurse staffing and nurses education. This is a rally to action that cannot be ignored. Investing in nursing
makes good business sense. Now, we must use this evidence to inform and
educate others about how nurse staffing and education make all the difference to patients, the business of caring, and even to the bottom line. $

Aiken, L.H., Sloane, D.M., Bruyneel, L., Van den Heede, K., Criffiths, P., Busse, R., ...
Sermeus, W. (2014, February). Nurse staffing and education and hospital mortality
in nine European countries: A retrospective observational study. The Lancet. [Epub
ahead of print.] doi:10.1016/S0140-6736(13)62631-8
Institute of Medicine. (2011). The future of nursing: Leading change, advancing health.
Washington, DC: The National Academies Press.

NURSING ECONOMIC$/March-April 2014A/ol. 32/No. 2

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continued from page 63
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