NURSE MANAGER EDUCATION LEVELPilot Study Proposal

Jerusalem Walker, BA, RN, BSN

Chorus of calls for advanced nursing education• American Association of

the Colleges of Nursing• The American Nurses

Credentialing Center• The American Nurses

Association• State Nursing

Associations• Institute of Medicine • The White House• Health care agencies

The Evidence• Aiken et al. (2003)

• Hospital-level data from late 1990’s

• Voluntary, mailed survey instrument

• Cited 893 times!

• Sales et al (2008)• Unit-level data from

Veterans Health Administration hospitals

• Collected within the hospital• Cited only 36 times

Aiken et al. (2003)

• Hospitals stratified by size, teaching status, and technology usage

• Problem: endogeneity bias or missing variables• Serious threat to validity• Example: University of Pennsylvania and Temple

University Hospitals

Sales et al. (2008)• No association between level of

RN education and patient outcomes

• RN education aggregated to the hospital level

• VHA hospitals already provide “seamless academic progression” advocated by IOM’s “Future of Nursing”

Magnet Status• 100% of nurse managers must

have at least a BSN by January 2013

• Anecdotal evidence that ADN and diploma RN managers are losing their jobs because of this requirement

The Evidence• There are no studies linking manager education level to

unit-level outcomes• There is evidence that nursing education has been

commoditized:“Nursing continuing education is required in some nursing jobs, but is also beneficial to your career. For example, a graduate degree or certificate in a specific area of continuing education may help you get a raise or a promotion to a higher position. Your new knowledge will not only impress your managers, but it will also improve your resume and potentially increase your salary.”

http://www.allnursingschools.com/nursing-careers/nursing-continuing-education/nursing-continuing-education

Study Proposal• Nurse manager

experience and educational levels

• Unit-level outcome data• Nursing skill mix and

hours per patient day

POPULATION CHARACTERISTICS

AND ENABLING FACTORS

• Demographic characteristics

• Years of Nursing Experience

• Years of management experience

• Years on current unit• Years in current

position• Education level and

type

MODIFYING FACTORS

• Nursing hours per patient day

• Skill mix

OUTCOME VARIABLES

• Falls prevalence

• Restraint prevalence

• Voluntary turnover

DETERMINANTS OF NURSING CARE OUTCOMES

References• Aiken, L.H., Cimiotti, J. P., Sloane, D. M., Smith, H. L., Flynn, L., & Neff, D. F. (2011). Effects of Nurse Staffing and Nurse Education on

Patient Deaths in Hospitals With Different Nurse Work Environments. Medical Care, 49(12), 1047.• Aiken, L.H., Clarke, S. P., Cheung, R. B., Sloane, D. M., & Silber, J. H. (2003). Educational levels of hospital nurses and surgical patient

mortality. JAMA: the journal of the American Medical Association, 290(12), 1617–1623.• Aiken, L.H., Clarke, S. P., Sloane, D. M., Lake, E. T., & Cheney, T. (2008). Effects of hospital care environment on patient mortality and nurse

outcomes. The Journal of nursing administration, 38(5), 223.• Aiken, L.H., Sloane, D. M., Clarke, S., Poghosyan, L., Cho, E., You, L., Finlayson, M., et al. (2011). Importance of work environments on

hospital outcomes in nine countries. International Journal for Quality in Health Care, 23(4), 357–364.• Aiken, Linda H, Clarke, S. P., Cheung, R. B., Sloane, D. M., & Silber, J. H. (2003). Educational levels of hospital nurses and surgical patient

mortality. JAMA: The Journal of the American Medical Association, 290(12), 1617–1623. doi:10.1001/jama.290.12.1617• ANCC Magnet Recognition Program. (n.d.). Retrieved February 15, 2012, from http://www.nursecredentialing.org/Magnet.aspx• Andrews, D. R., & Dziegielewski, S. F. (2005). The nurse manager: job satisfaction, the nursing shortage and retention. Journal of Nursing

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