Economic evaluation of the 80% baccalaureate nurse workforce recommendation: a patient-level analysis

• Published in: Medical care Vol. 52; no. 10; p. 864
• Main Authors: Yakusheva, Olga, Lindrooth, Richard, Weiss, Marianne
• Format: Journal Article
• Language: English
• Published: United States 01.10.2014
• Subjects: Academic Medical Centers; Adult; Aged; Cost-Benefit Analysis; Education, Nursing, Baccalaureate - economics; Education, Nursing, Baccalaureate - statistics & numerical data; Female; Hospital Mortality - trends; Humans; Length of Stay - statistics & numerical data; Male; Middle Aged; Nursing Staff, Hospital - economics; Nursing Staff, Hospital - statistics & numerical data; Patient Readmission - statistics & numerical data; Personnel Staffing and Scheduling - statistics & numerical data; Quality of Health Care - economics; Quality of Health Care - statistics & numerical data; Retrospective Studies; Treatment Outcome; United States; United States
• ISSN: 1537-1948
• DOI: 10.1097/MLR.0000000000000189

Higher proportions of BSN-educated nurses were associated with improved outcomes in hospital-level studies. A recent Institute of Medicine report calls for increasing the proportion of BSN-educated nurses to 80% by 2020. Patient-level evidence of cost and quality implications of the 80% BSN threshold is needed for a business case to support these efforts. To conduct the economic analysis of meeting the 80% BSN threshold on patient outcomes and costs, using linked patient-nurse data. Retrospective observational patient-level analysis of electronic data. Linear and logistic regression modeling with patient controls and diagnosis and unit fixed effects. A total of 8526 adult medical-surgical patients matched with 1477 direct care nurses from an Eastern US academic medical center, during June 1, 2011-December 31, 2011. Outcomes include hospital mortality, all-cause same-facility 30-day readmission, length-of-stay, and total hospitalization cost. BSN proportion is a continuous measure for the proportion of nurse assessment inputs into the patient's electronic medical record made by BSN-educated nurses; a dichotomous indicator for BSN proportion is 0.8-1.0. Continuous BSN proportion was associated with lower mortality (OR=0.891, P<0.01). Compared with patients with <80% BSN care, patients receiving ≥ 80% of care from BSN nurses had lower odds of readmission (OR=0.813, P=0.04) and 1.9% shorter length-of-stay (P=0.03). Economic simulations support a strong business case for increasing the proportion of BSN-educated nurses to 80%. A combined approach of increasing the hospital-level BSN proportion to 80% and assuring a high BSN dose through individual patient-level staffing assignments is needed to achieve projected quality and costs benefits.