Adults with Alzheimer's disease or related dementia (ADRD) are at high risk for adverse outcomes after surgery, and good nursing care is particularly important in these patients. The quality of nursing care has been shown to be positively associated with nurses' level of education, which leads to the question of whether nurses' educational level would also have a positive impact on the care of patients with ADRD. To assess this association, researchers undertook a study to determine whether surgical care in a hospital with more nurses with a bachelor of science in nursing (BSN) or higher degree was associated with better outcomes in all patients and also to compare the effects of nursing education in surgical patients with and without ADRD.

Cross-sectional data from Medicare claims from hospitals in four states were linked to data from a national survey of nurses. The patient population included more than 350,000 Medicare beneficiaries (65 years of age or older), with or without ADRD, who underwent general, orthopedic, or vascular surgery. The primary outcomes were death within 30 days of hospital admission and failure to rescue (death after a complication).

Patients with ADRD were found to be more sensitive to differences in nursing education than other patients. Controlling for hospital, procedural, and individual characteristics, the investigators found that each 10% increase in the proportion of nurses with BSNs was associated with 6% lower odds of death and failure to rescue in all patients. The odds of death and failure to rescue in patients without ADRD were 4% and 5% lower, respectively, with each 10% increase in the proportion of nurses with BSNs, but the odds of both were 10% lower in patients with ADRD.

The authors note that because patients with ADRD are particularly vulnerable and have complex medical needs, they require care from nurses who are able to think critically, synthesize large amounts of information, solve problems, and coordinate multiple aspects of care. Increasing the number of nurses with BSNs in hospitals could improve surgical outcomes in this population and lead to a significant reduction in health care costs.

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