Nurses Unite!

Talking with my clinical group this week about different kinds of hospital nursing (team and primary) I picked up from my colleagues' literature review that there seemed to be no qualitative nor quantitative difference between outcomes for the two -- neither in perceived care nor worker satisfaction. I thought the findings were interesting given the proposed phase-out of LPNs/LVNs in California. The data seemed to reflect that mortality, patient outcomes, satisfaction and nursing burnout were undifferentiated, whether four-year nurses worked on their own or whether they worked with the support of LPNs and CNAs. My clinical instructor weighed it differently, quoting one Linda Aiken who reported in a 2003 study, "hospitals with higher proportion of nurses educated at the baccalaureate level or higher, surgical patients experienced lower mortality and failure-to-rescue rates." The argument was that LPNs had unfavorable outcomes based strictly on their education.

This illustrated for me another great failure of academia. Some quantified outcomes, like this one, contain numerous confounding factors that tend to flub up reported and repeated results. The Aiken study does not illustrate better rates of care by better educated nurses; it illustrates how more resources impact outcomes. Where are the LPNs/LVNs? In poor, rural hospitals. Are there surgical centers in those hospitals? No. Are the baccalaureate educated nurses better able to care for patients? Not necessarily. Do they have more resources -- education being one of those resources? Yes. And what's the relationship of education to labor? The California labor union has systematically displaced two-year educated nurses rather than provide a means to give them the additional year they need for the BSN. So, it's not about the education but the resource -- and to whom that resource is available. It's something to mull over. Especially if you want to argue it away as being strictly about education or strictly about class, as one is wont to do. It's about access and it's about care. Look around the hospital and see who's got it and who's giving it. It's certainly not just the baccalaureate or master's educated nurses that are giving.

It occurred to me in the middle of the night that we are one year educated nurses. An interesting twist.