The landmark Institute of Medicine (IOM) report The Future of Nursing: Leading Change, Advancing Health includes a host of ambitious recommendations, including increasing the number of registered nurses with baccalaureate degrees to 80 percent by 2020. Over the past decade, the body of research supporting this increase has grown, and a new study underscores a fundamental reason for the recommendation: Having more nurses with baccalaureate degrees saves more lives.

Researchers from the University of Pennsylvania in Philadelphia studied 1999 and 2006 data from three sources—nurse surveys, administrative patient discharge records, and the American Hospital Association Annual Survey—available for 134 hospitals in the state. They found that a 10-point increase in the percentage of nurses holding a baccalaureate degree was associated with an average reduction of 2.12 deaths for every 1,000 patients, and for a subset of patients with complications, an average reduction of 7.47 deaths per 1,000 patients.

If all of the study hospitals had moved to a workforce containing 80 percent of nurses with baccalaureates, the researchers conclude, more than 2,100 lives might have been saved, equivalent to 60 percent of the observed deaths in 2006.

The study, “An Increase in the Number of Nurses with Baccalaureate Degrees Is Linked to Lower Rates of Postsurgery Mortality,” published in the March issue of Health Affairs, stems from the Future of Nursing: Campaign for Action, a collaboration between the Robert Wood Johnson Foundation (RWJF) and AARP. The study was funded by the Agency for Healthcare Research and Quality, the National Institute of Nursing Research, and RWJF.

The research team consists of three University of Pennsylvania faculty members: Ann Kutney-Lee, PhD, RN, assistant professor of nursing and senior fellow at the Leonard Davis Institute of Health Economics; Douglas M. Sloane, PhD, adjunct professor of nursing; and Linda H. Aiken, PhD, FAAN, FRCN, RN, the Claire M. Fagin Leadership Professor of Nursing and senior fellow at the Leonard Davis Institute of Health Economics.

“Our research speaks strongly to a significant mortality advantage associated with improved nurse education,” said Kutney-Lee. “Saving lives matters, and seeing the difference that baccalaureate nurses make is something that can support an important shift in public policies.”

Previous research on nurse education and patient outcomes has linked baccalaureate nurses to ongoing surveillance of patients to prevent adverse outcomes. As part of their practice, nurses are responsible for the continual assessment and monitoring of a patient’s condition, identifying changes that could indicate clinical deterioration, and initiating interventions when necessary.

While most studies of nurse education and patient outcomes have been cross-sectional, this longitudinal study, in which repeated samples of patients and nurses in the same hospitals were compared at two points in time, enhances the understanding of the relationship between nurse education and patient outcomes.

The 134 hospitals in the study represented about 80 percent of all acute care hospitals in Pennsylvania, one of the largest and most geographically diverse states in the country. Patient outcomes of interest included mortality within 30 days of admission and failure to rescue, meaning that the patient had died following the development of a condition—such as wound infection, sepsis, and shock—that could have been remedied but wasn’t.

The American Association of Colleges of Nursing estimates that the United States will need to produce more than 760,000 nurses with baccalaureates by 2020 to meet the IOM’s education recommendation. The most recent data from the Department of Education show that 75,000 baccalaureate degrees in nursing were awarded in 2010, compared with more than 82,000 associate’s degrees.

The nursing licensure exam shows a similar pattern, with nearly 60 percent of candidates passing the exam in 2011 holding an associate’s degree, compared with about 40 percent holding a baccalaureate degree. The most recent National Sample Survey of Registered Nurses revealed that in 2008, only 45 percent of U.S. nurses had earned a baccalaureate degree.