Evidence has increasingly linked better outcomes in hospitalized patients with a greater proportion of nurses who have a bachelor of science in nursing (BSN) degree. Notably, in the 2010 Future of Nursing report, the Institute of Medicine recommended that 80% of the nursing workforce have a BSN or more advanced degree by 2020 in order to improve the quality of patient care. Researchers sought to determine whether patients treated in hospitals with higher proportions of nurses with BSNs and lower patient-to-nurse ratios would have better odds of surviving with good cerebral performance after cardiac arrest.

They used patient data from an American Heart Association registry, a hospital nurse survey, and an American Hospital Association survey. The study population comprised adults who experienced cardiac arrest in an inpatient unit. The proportion of nurses with a BSN ranged from 33% to 86%. The staffing ratio on general units ranged from 2.8 to 6.6 patients per nurse. Overall, 11.2% of patients survived cardiac arrest to discharge with good cerebral performance.

After controlling for other variables, the researchers found that each 10 percentage-point increase in the hospital share of nurses with a BSN was significantly associated with a greater chance of surviving to discharge with good cerebral performance. On general units, but not ICUs, each additional patient per nurse was associated with 17% lower odds of surviving to discharge with good cerebral performance. Hospital characteristics other than nurse education and staffing weren't significantly associated with patient outcomes.

The authors point out that cost savings as a result of a reduced number of adverse events, hospital stays, and readmissions may offset the costs of increased nurse staffing. Innovative higher education policies, practices, and financing are needed to facilitate greater access to baccalaureate-level education for all nursing students, the researchers conclude.