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March 17, 2004

Relationship Between Patient Mortality and Nurses' Level of Education

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291(11):1320-1323. doi:10.1001/jama.291.11.1321-b

To the Editor: In the study by Dr Aiken and colleagues,1 it is puzzling that clinical outcomes were significantly related to nurses' education and staffing but not to to their years of experience. It is possible, however, that education may be a proxy for certification, with which it could be confounded. To the extent that this is true, education and experience may be collinear, and thus the statistical analysis would be unlikely to find that both variables are significantly related to the outcome. This is particularly a problem because the unit of analysis was hospitals, not individual nurses or patients.

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