Making a Match: Impact of RN Education, Certification, and Experience on Quality Outcomes and Safety

Registered Nurses (RN) comprise the largest health care professional group in the United States estimated at 3 million licensed RNs (AACN, 2015).  As many as 1.3 million RNs work in the acute care setting as frontline clinicians having direct influence on safe, efficacious care provided to patients. Despite the large RN workforce and pivotal position in patient care, there remains a need to quantify the RN contribution to quality care outcomes. Education, national nurse certification, and years of experience are variables that are thought to contribute to the nurse’s ability to provide quality outcomes and may help to quantify the RN impact on patient care outcomes.

Purpose: The purpose of this presentation is to examine the relationship of education, national nurse certification, and years of RN experience to nurse reported adverse events, hospital quality, and safety.

Methods: The presentation focuses on the results of a secondary analysis consisted of selected survey data from a cross- sectional survey conducted in Florida. The current study included data reported by 6515 direct care hospital nurses who rated frequency of adverse patient events, provided an overall grade on patient safety for their assigned work unit, their perceptions of quality of care, ability of patients to manage their care upon discharge, and management’s response to patient safety concerns. Spearman correlation coefficient and logistic regression provided the statistical analysis for data review.

Results: The RNs in this study averaged 44.1 years of age, were white, and female with 14.4 years of experience ranging from 1 to 50 years of experience. Certified nurses represented 25 percent of this study’s sample which is slightly higher than national average (17.1 percent). The educational level of the RN consisted of Diploma Degree (9.5 %); Associate Degree (51.8 %); Baccalaureate degree (36.1%), and Masters (2.6%). The study found a significant relationship across all levels of nurse education with the majority of outcomes. For example, Diploma nurses had higher odds for reporting use of restraints (8 hours or more and vest or limb) and health care associated urinary tract infections and were less confident that their managers would help to resolve problems around their patient’s care. Associate Degree (ADN) nurses were less confident in their management to resolve reported patient problems. Additionally, they reported that based on the actions of their management, they were not confident that patient safety was a top priority in their institution.  BSN prepared nurses reported greater frequencies of incidents in the use of physical restraints (8 hours or longer and vest or limb) and medication as restraints involving their patients.  While Master prepared nurses (MSN) were less confident in their patients’ ability to manage their care when discharged and also in their management’s ability to resolve nurse reported patient care problems. With regards to national nurse certification, this study found only one difference between certified and non-certified nurses in nurse reported outcomes. Certified nurses reported more use of restraints (8 hours or more) than non-certified nurses. In addition, certified nurses with 5 or more years of experience reported more incidents of use of restraints (8 hours or more) than non-certified nurses with the same experience.  Significant relationships were found between years of experience and nurse reported select adverse events: pressure ulcer develop, patient falls with injury, use of physical restraints (vest/limb), use of physical restraints (8 hours or more), and urinary tract infections, and central line associated blood stream infections, such that, as years of experience increased, nurse reporting of select adverse events decreased.  As years of experience increased, nurses reported increased quality of care in their work setting and an overall grade of patient safety on their unit/practice setting increased. In contrast, as years of RN experience increased, the level of confidence that the manager would act to resolve problems reported by the nurse decreased.

Conclusion: Interestingly, the nurse characteristics of years of experience, certification, and level of education affected a different perspective in care based on the nurse reported outcomes. Years of experience had an effect on reported incidents of adverse events affecting physiological outcomes (pressure ulcer development, falls with injury, urinary tract infections, and central line associated blood stream infections). Certification had an effect on nurse reported outcomes affecting patient safety (use of restraints). Lastly, level of education, specifically Diploma educated nurses, had an effect on reporting concerns for quality of nursing care and ability of patients to manage their care upon discharge. The study confirmed the need for further research to better understand how demographic characteristics may influence a nurse’s perspective in reporting, providing, and/or evaluating patient care.  The continued nurse shortage forces administrators to examine the workplace environment with respect to experience, education, and certification. This presentation meets all the Congress objectives with the focus of presenting evidence based practice and research to promote positive clinical outcomes. 

American Association of Colleges of Nursing (2015). Nursing fact sheet. Retrieved from http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-fact-sheetursingbynumbersfactsheet.