Are Variations In Baccalaureate Nursing Education Pathways Associated With Patient Outcomes?

Joshua Porat-Dahlerbruch, University of Pennsylvania


In 2010, the IOM's Future of Nursing report recommended an increase in the proportion of nurses with bachelor’s degrees in nursing (BSNs) comprising the workforce to 80% by 2020. This goal was largely based on evidence linking hospitals with higher proportions of BSN nurses to improved patient outcomes. Professional nursing organization support for meeting the 80% IOM goal and preferential hiring for BSN nurses has bolstered multiple educational pathways for registered nurses to obtain a BSN. Nurses completing BSN programs (transitional BSN nurses) comprise 48% of all new BSN nurses—both transitional BSN nurses and nurses initially obtaining a BSN as their pre-licensure qualification (initial BSN nurses). Widespread support of multiple educational pathways for achieving a BSN qualification, nevertheless, is based on the presumption that there is no difference in patient outcomes between these pathways. Although, research is lacking. This study aims to determine to what extent differences in risk-adjusted surgical patient mortality is associated with hospital nurse staffs with varying proportions of transitional BSN and initial BSN nurses. Using 2015-2016 cross-sectional patient and nurse data from four states, this study determines the association between risk-adjusted odds of inpatient mortality and transitional and initial BSN nurse composition across hospitals. Results suggest that decreased odds of inpatient mortality are not dependent on specific BSN pathway comprising a hospital’s nursing staff. These findings provide empirical support for policies promoting multiple educational pathways to achieve a largely bachelor’s qualified nurse workforce in the U.S.