I'd like to comment on the statement that "mortality rates were as much as 34% lower when a greater proportion of a hospital's nursing staff had a baccalaureate." Professional journals should exercise caution when publishing statistics. The study showed a correlation but not causation. In other words, a multitude of other factors not addressed by this metaanalysis likely influenced patient outcomes at these hospitals. For example, are nurses with baccalaureates more attracted to larger, better-equipped hospitals with more experienced physicians? Are schools that offer these degrees more likely to be located in urban areas with a higher concentration of good hospitals? Publishing statistics without qualifying them insults those of us who chose a different route to obtain our nursing licenses. I have an associate's degree in nursing, a bachelor's degree in psychology, and a vocational teaching credential. I am also a former firefighter and emergency medical technician and commercial diver medic. There are many more nurses who are better educated and qualified than I am who chose to enter nursing with an associate's degree. Please stop implying that the care we provide is inferior to that provided by our colleagues with baccalaureates. I'm sure that my coworkers and my patients and their families would tell you differently.

Eric Hexdall, RN

Raleigh, NC