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Editorial
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 th at I am dis-
tracte d from the task at
han d to go onh ne and read a
study. However, as an editor, I
am always on the outsight look-
ing for trends and research that in-
vests in nursing and nursing re-
sources. Thus, I came upon a re-
cent study in The Lancet led by
Linda H. Aiken, professor of nurs-
ing and sociology, and director of
the Center for Health Outcomes and
Policy Research at the University
of Pennsylvania, and a team of re-
searchers 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 com-
mon 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 ade-
quate 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 with-
out adversely affecting patient outcomes may be fool-
ish at best, and fatal at worst. Investing in ntirse
staffing is beyond just good business sense, it actual-
ly saves lives. When hospitals cut or reduce nursing
levels and/or positions because of budgetary con-
straints, there are real and dangerous consequences
for patien ts. For exam ple, ...every one patien t
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 nurs-
es is associated with a 7% decline in mortality
(Aiken et a l, 2014, p. 4).
When Is Enough Scientific
Evidence Enough
There is a growing body of
research clearly linking baccalaure-
ate-prepared nurses to lower mor-
tality and better patient outcome.
Aiken and colleagues (2014) evaluat-
ed 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 proce-
dures 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 governmen-
tal 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
recom-
mended 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 n urses 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 an d 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 ina dequ ate staffing. It is no longer m oral
or ethical to place h ospitalized patients at risk of dying
whe n the evidence reveals otherwise. When hospitals
provide inadequate staffing, patient safety is compro-
mised. Many states in the United States have already
begun studying and enacting regulation an d/or
legisla-
tion around hospital staffing levels. Many health care
organizations, Magnet® institutions in particular, are
now only hiring baccalaureate-prepared n urses.
continued on page 9
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evolving power and influence.
Hopefully, my work has raised the
consciousness of mentoring for
nursing students, clinicians, edu-
cators, researchers, and profes-
sional 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 prom-
ulgating mentorship has set the
stage for ongoing research; the ini-
tiation of formal programs in
schools, associations, and work-
places; and the development of
power mentor networks among all
of us. We know there is an enor-
mous 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 nurs e influ-
entials dem onstrated nurses are
able to make a major mark in the
profession and influence societal
change thr ough the legacy of being
mentored and mentoring others.
As I indicated earlier, we've come
a long way since the late '70s
wh en me ntor was never uttered;
and if it was done , it was unde r-
ground 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 relation-
ships,
to seek, and to cultivate
these connections. Thus, mentor-
ing will increasingly become part
of our professional ethos and our
professional behavior.
DN: Thank you. Dr. Vance, for
your insights and beliefs on men-
torship in nursing. This interview
emphasized the importance of
mentoring within the nursing pro-
fession. I am grateful for your con-
temporary definitions and des-
criptions of
mentoring.
I could not
agree more that we must ad apt the
necessary professional ethos and
behaviors to ensure the next gen-
eration of nursing will recognize
and cultivate these mentoring
connections. $
REFERENCES
American Nurses Association. (2010).
Nursing: Scope and standards of
practice
(2nd ed.). Silver Spring, MD:
Author.
Institute of Medicine. (2010).
The future of
nursing: Leading change, advancing
health.
Washington, DC: National
Academies Press.
Vance, C ,
Olson, R.K. (1998).
The men-
tor connection in nursing.
New York,
NY: Springer Puhlishing Company.
ADDITIONAL READING
Vance, C. (2011).
Fast facts for career suc-
cess in nursing: Making the most of
mentoring in a nutshell. New York,
NY: Springer Publishing Company.
Editorial
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 pre-
dictors 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 educa-
tion. This is a rally to action that cannot be ignored.
Investing in nursing
makes good business sense. Now, we m ust use this evidence to
inform and
educate others about ho w nurse staffing and education
make all the differ-
ence to patients, th e business of caring, and even to
the bottom line. $
R F R N S
Aiken, L.H., Sloane, D.M., Bruyneel, L., Van den
Heede, K., Criffiths, P., Busse, R., ...
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education an d hospital mortality
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Institute of Medicine. (2011).
The future of nursing: Leading change, advancing
health.
Washington, DC: The National Academies Press.
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Improvement
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