I disagree with the conclusions drawn by the study summarized in NewsCAPS ("Patients seem to fare better when more RNs hold bachelor's or master's degrees," November 2003). The cause of the improved outcomes was most likely the result of nurse-to-patient ratios, not the level of education of the nurses. The group of nurses who were more highly educated cared for an average of four patients-half the number cared for by the other group, in which fewer than 20% of nurses held bachelor's or master's degrees.

How can the study be meaningful if all of the nurses were not working under the same conditions? No amount of academic education can compensate for an overload of patients.

Editor's note:

The NewsCAPS article summarized the results of a study by Linda H. Aiken, PhD, RN, and colleagues entitled "Educational Levels of Hospital Nurses and Surgical Patient Mortality," which was published in the Journal of the American Medical Association (2003; 290[12]:1617-23). In response to this reader's comments, Aiken says, "We reported that every 10% increase in the proportion of hospital staff nurses with bachelor's degrees is associated with a 5% decline in mortality after taking into account the impact of differences in nurse staffing ratios and several other factors. The impact of nurses' education on patient mortality is independent of and in addition to the effect of staffing."

Virgina Dykhuis, RN