Analyzing the Relationship Between Nursing Education and Patient Outcomes

Hospital-based research links higher proportions of nurses with baccalaureate of science in nursing (BSN) degrees to lower patient mortality rates, but it does not explain the mechanism. This study explored mechanisms related to individuals and work groups that could explain the association between nurses' education and patient outcomes. Using survey and administrative data from 45 units across nine hospitals, we analyzed hierarchical models of the relationships between a BSN education and empowerment, communication, work environment, and patient outcomes. Results revealed that, although at the individual and work group levels no significant association existed between BSN education and empowerment or communication, on units with higher proportions of BSNs, care providers reported work environments more supportive of their work and patient care.The percentage of BSNs had no significant direct effect on care quality or safety, although work environment, equally weighted for each occupational group, had a significant, positive relationship with interactions with nurses, care quality, and safety. Our findings suggest the need for a broadened regulatory focus that considers not only nurses' education but also the contribution of the work environment and interdisciplinary teams to the coproduction of high-quality safe care.