Getting everyone on a level playing field

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How educational preparation in nursing affects staff education practices

Teaching a classroom of nurses with varying backgrounds can present challenges to staff educators. But today, when those variances refer mainly to educational levels, those challenges can grow substantially within your facility.

“Looking back in the late 70s and 80s, this wasn’t a problem,” says Deborah Davis, RN, MS, RNC, clinical nurse specialist and educator for labor and delivery at the University of Colorado Hospital (UCH) in Denver. “Twenty-five years ago, there were different issues that were more clinical and hands-on. Now, I think it’s necessary to advance your education.”

Today’s pain points

A major issue facing staff educators is the differences in educational preparation and experience among nurses in the work force, says Mary Krugman, PhD, RN, FAAN, director of professional resources at UCH. Nurses with at least a bachelor’s degree have been shown to produce better patient outcomes, she says.

“There’s a growing and developing body of literature that clearly documents that patient mortality significantly decreases when the nurse is better educated,” says Krugman. “This is something that our country is going to need to face in terms of how we prepare nurses as professionals.”

A study in the Journal of the American Medical Association (JAMA) identified a clear link between higher levels of nursing education and better patient outcomes, finding that surgical patients have a “substantial survival advantage” if treated in hospitals with higher proportions of nurses with at least bachelor’s degrees.

Additionally, according to the study, a mere 10% increase in the number of nurses holding bachelor’s degrees decreased the risk of patient death and failure to rescue by 5%.

In light of the focus that many facilities are placing on the importance of incorporating evidence into daily practice and conducting nursing research, the educational level of nurses becomes an increasingly important factor, says Davis.

“It also means a staff development specialist has a challenge if an organization is going to adopt evidence-based practice,” she says. “Nurses need to be better prepared to do that.”

Making advances at your facility

In order to be teaching to a level playing field, Krugman suggests that nursing settings need “better prepared, educated nurses” to improve the current environment.

“Just hiring more nurses is not going to solve the shortage,” she says. “We’ll have fewer nurses to be faculty and actually prepare nurses.”

The authors of the JAMA study recommended that public financing of nursing education should aim at shaping a work force best prepared to meet patient needs. The authors also advocate renewed support and incentives from nurse employers to encourage RNs to pursue bachelor’s and higher degrees.

Davis adds that hospitals should be aware of measures that they can take to bring new hires up to speed smoothly if nurses come from different educational levels.

“For my staff development staff, it means -having extended orientations to oversee new grads,” says Krugman, adding that hiring new grads requires expanding preceptor resources.

Inspiring your staff members to advance their edu-cation can lead to a more positive and successful working environment, she says.

“My staff development specialists are heroes to me,” says Krugman. “They walk the boundaries of departments between staff and management and between units, working together to make safety a reality in a very challenging work environment. They have amazing skills and are up to the challenge.”


Aiken, L. (2003). “Educational Levels of Hospital Nurses and Surgical Patient Mortality,” Journal of the American Medical Association 290: 1617–1623.

Attributes of a successful nursing environment

What are the essentials for a positive nursing environment? A study from the Nursing trade publication identified the following attributes:

  • Support for education
  • Working with other nurses who are clinically competent
  • Positive nurse/physician relationships
  • Autonomous nursing practice
  • A culture that values concern for the patient
  • Control of and over nursing practice
  • Perceived adequacy of staffing
  • Nurse manager support


    Kramer, M. and Schmalenberg, C. (2004). “Essentials of a magnetic work environment,” Nursing.