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About the American Association of Colleges of Nursing
The American Association of Colleges of Nursing (AACN) is the national voice for academic nursing representing more than 850 schools of nursing nationwide. AACN establishes quality standards for nursing education, influences the nursing profession to improve health care, and promotes public support of baccalaureate and graduate nursing education, research, and practice. 



AACN Applauds New Lancet Study Linking Nursing Education and Patient Outcomes

Published February 25, 2014

AACN Applauds New International Study that Confirms Strong Link 
Between Nursing Education and Patient Outcomes

Breaking research shows that patient mortality rates are lower in hospitals 
with a higher percentage of baccalaureate-prepared nurses

WASHINGTON, D.C., February 25, 2014 – The American Association of Colleges of Nursing (AACN) applauds new research published today in The Lancet, which shows that patients experiencing complications after surgery are more likely to live if treated in hospitals with adequate nurse staffing levels and higher numbers of nurses prepared at the baccalaureate degree level. Following a review of more than 420,000 patient records in 300 hospitals spanning nine European countries, the study authors found that a 10% increase in the proportion of nurses holding a bachelor’s degree in an acute care setting is associated with a 7% decrease in the risk of death in discharged patients following common surgeries, such as knee replacements, appendectomies, and vascular procedures.

“These findings significantly augment the growing body of research, which shows that quality patient care hinges on having a well-educated nursing workforce,” said AACN President Jane Kirschling. “The study results add a new level of urgency to calls from the Institute of Medicine, the American Organization of Nurse Executives, AACN, and other authorities for increasing the number of baccalaureate-prepared nurses available to enhance patient safety and healthcare quality.”

Led by Dr. Linda Aiken from the University of Pennsylvania School of Nursing, this study is titled Nurse Staffing and Education and Hospital Mortality in Nine European Countries: A Retrospective Observational Study. The research findings published in today’s Lancet mirror those from similar studies conducted by Dr. Aiken and others in U.S. hospitals. For more details about this important research effort, see

Nursing Education and Patient Outcomes

AACN strongly believes that registered nurses (RNs) with baccalaureate degrees are better equipped to meet the demands for contemporary nursing practice. Chief nurse executives, federal agencies, the military, leading nursing organizations, healthcare foundations, magnet hospitals, and minority nurse advocacy groups all recognize the unique value that baccalaureate-prepared nurses bring to the practice setting.

Dr. Aiken published her first article on the connection between baccalaureate-prepared nurses and patient outcomes in the September 2003 issue of the Journal of the American Medical Association (JAMA). Findings from this landmark study show that patients experienced significantly lower mortality and failure to rescue rates in hospitals with higher proportions of baccalaureate-prepared nurses. In her analysis, Dr. Aiken stated that the study’s results “suggest that employers’ efforts to recruit and retain baccalaureate-prepared nurses in bedside care and their investments in further education for nurses may lead to substantial improvements in the quality of care.”

Since the release of this groundbreaking research, almost a dozen additional studies have been published, which validate these conclusions and confirm that nursing education is a factor in saving lives. Some of these studies include:

  • In an article published in the March 2013 Health Affairs, nurse researcher Ann Kutney-Lee and colleagues found that a 10% increase in the number of nurses educated at the baccalaureate level in hospitals was associated with an average reduction of 2.12 deaths for every 1,000 patients—and for a subset of patients with complications, an average reduction of 7.47 deaths per 1,000 patients.
  • In the February 2013 Journal of Nursing Administration, Dr. Mary Blegen and colleagues found that patients in hospitals with a higher percentage of RNs with baccalaureate degrees had lower incidents of congestive heart failure mortality, decubitus ulcers, failures to rescue, and shorter lengths of stay.
  • In a 2008 study, University of Michigan professor Dr. Christopher Friese and colleagues examined the impact of nursing education level and the practice environment on outcomes for cancer patients undergoing surgery. Nurses prepared at the baccalaureate level were linked with lower mortality and failure-to-rescue rates.
  • Researchers at the University of Toronto found that hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. The findings indicated that a 10% increase in the proportion of baccalaureate-prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients.

For more research linking patient outcomes to nursing education and support for baccalaureate level education, see the following AACN resources:

Exploring Academic Progression in Nursing

Support for academic progression in nursing – a key recommendation in the Institute of Medicine’s (IOM) 2010 report on the Future of Nursing: Leading Change, Advancing Health – is now widely embraced by most U.S. organizations, employers, and opinion leaders interested in moving the nursing profession forward. The evidence-based findings in the IOM report present a clear argument for supporting national, state, and local efforts to advance the formal education of today’s registered nurse. Reaching the IOM report’s goal of preparing at least 80% of the nation’s RN workforce at the baccalaureate or higher degree level by 2020 will require innovative solutions and collective action among all parties engaged in the development of future generations of nurses.

“AACN is committed to working collaboratively with partners across the educational continuum to raise the education level of the RN workforce with the goal of enhancing both clinical competency and care delivery,” added Dr. Kirschling. “Encouraging all nurses to continue their education serves the best interests of our patients.”
To read more about the growing support for academic progression, see: