• Olga Yakusheva, Richard Lindrooth, and Marianne Weiss.
• *Division of Systems Leadership and Effectiveness Science, School of Nursing, Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI †Department of Health Systems, Management and Policy, School of Public Health, University of Colorado, Aurora, CO ‡College of Nursing, Marquette University, Milwaukee, WI.
• Med Care. 2014 Oct 1; 52 (10): 864-9.

BackgroundHigher proportions of BSN-educated nurses were associated with improved outcomes in hospital-level studies. A recent Institute of Medicine report calls for increasing the proportion of BSN-educated nurses to 80% by 2020. Patient-level evidence of cost and quality implications of the 80% BSN threshold is needed for a business case to support these efforts.ObjectivesTo conduct the economic analysis of meeting the 80% BSN threshold on patient outcomes and costs, using linked patient-nurse data.Research DesignRetrospective observational patient-level analysis of electronic data. Linear and logistic regression modeling with patient controls and diagnosis and unit fixed effects.SubjectsA total of 8526 adult medical-surgical patients matched with 1477 direct care nurses from an Eastern US academic medical center, during June 1, 2011-December 31, 2011.MeasuresOutcomes include hospital mortality, all-cause same-facility 30-day readmission, length-of-stay, and total hospitalization cost. BSN proportion is a continuous measure for the proportion of nurse assessment inputs into the patient's electronic medical record made by BSN-educated nurses; a dichotomous indicator for BSN proportion is 0.8-1.0.ResultsContinuous BSN proportion was associated with lower mortality (OR=0.891, P<0.01). Compared with patients with <80% BSN care, patients receiving ≥ 80% of care from BSN nurses had lower odds of readmission (OR=0.813, P=0.04) and 1.9% shorter length-of-stay (P=0.03). Economic simulations support a strong business case for increasing the proportion of BSN-educated nurses to 80%.ConclusionsA combined approach of increasing the hospital-level BSN proportion to 80% and assuring a high BSN dose through individual patient-level staffing assignments is needed to achieve projected quality and costs benefits.

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