Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: Dr Aiken and colleagues1 studied hospitals, not the educational level of
individual RNs or the care delivered by individual nurses. Several nurses
may care for a patient during a hospital stay. Because of staffing variability,
it is impossible to correlate patient outcomes with any particular nurse(s)
in this study. In a hospital categorized as having a high proportion of baccalaureate-prepared
nurses, it could well have been the RN with an associate degree who took care
of the patients who survived or who were rescued. Another important consideration
is that hospitals with low numbers of baccalaureate-prepared nurses were smaller,
rural facilities with fewer financial, educational, and technological resources
than hospitals with larger numbers of baccalaureate-prepared nurses. These
are important variables that undoubtedly affect patient care and outcomes.
Comeau C, Crook M, Hirsch R. Relationship Between Patient Mortality and Nurses' Level of Education. JAMA. 2004;291(11):1320–1323. doi:10.1001/jama.291.11.1321-c