UF study: Florida nurses below U.S. average for higher degrees; patient care may suffer

February 23, 2011

GAINESVILLE, Fla. — Nurses in Florida are falling behind national trends in terms of education — a direction that may affect patient safety and quality of care as well as the ability to educate the next generation of nursing professionals.

A statewide survey of registered nurses suggests Florida’s nursing work force is more diverse than those of other states, which has positive implications for patient care, according to a University of Florida study published online this week in Nursing Forum. However, the study found that the state has a significantly lower percentage of nurses with baccalaureate and graduate degrees than the nation as a whole.

Forty-one percent of Florida’s nurses had either a baccalaureate or graduate degree as their highest degree in nursing versus 50 percent nationally. Previous research has found that the odds of patient mortality were significantly reduced in hospitals with a higher proportion of nurses who had attained a baccalaureate or higher degree.

“The lower educational levels are not only worrisome because of possible effects on the quality and safety of patient care, but the pipeline for nursing faculty is greatly hampered when there are fewer nurses with graduate degrees,” said lead researcher Donna Neff, an assistant professor in the UF College of Nursing.

Neff says that the development of new R.N. to B.S.N. programs in many of Florida’s state colleges is a “positive first step because it should allow more nurses to obtain the bachelor’s degree toward improving the educational qualifications of Florida’s nurses.” The bachelor’s degree is the foundation for graduate-level education required for advanced practice and faculty roles.

Study surveys were mailed to a random sample of all registered nurses licensed and residing in Florida — the largest survey of R.N.s ever conducted in the state — resulting in 49,385 responses. Data were collected on demographics such as age, race/ethnicity and level of education, the practice environment, nurse outcomes and the perception of nurses regarding the quality of care in Florida. Responses were compared with results from a similar national survey of nurses.

“Florida is a state that is ahead of national trends in having an aging population with multiple health care needs, and thus the state’s responses to current health care challenges could inform policies nationally. Findings from this study provide an agenda for action on how Florida can attract and retain a qualified nurse work force capable of providing high quality of care to all the state’s residents,” said Linda Aiken, co-author of the study, the director of the Multi-State Nursing Care and Patient Safety Study at the University of Pennsylvania, and longtime resident of Florida.

In the U.S., registered nurses on the frontlines of care are challenged by changes in staffing, increased turnover, demands on their time and the continual need to update knowledge and training. In Florida, nurses who provide patient care in hospitals and nursing homes were among those with the highest proportion of burnout and job dissatisfaction.

“The outcomes reported by nurses employed in Florida hospital and nursing home settings are consistent with prior research conducted in the U.S.,” Neff said. “These findings can be important to policymakers in developing approaches to retain our state’s nurses and improve patient outcomes.”

A recent report from the national Institute of Medicine on the future of nursing recommended increasing the proportion of nurses with a baccalaureate degree from 50 percent to 80 percent by 2020, and doubling the number of nurses with a doctorate by 2020 to add to the cadre of nurse faculty and researchers.

Nursing schools in Florida already turn away thousands of students each year because of a lack of resources, notably a shortage of qualified faculty.

“Florida already has an existing nursing faculty shortage that is projected to grow worse in the future,” Neff said. “The lower proportion of nurses with graduate degrees will hamper the state’s ability to increase nursing school graduations to respond to the large and growing nursing shortage.”

In addition, the greater proportion of elderly residents in Florida and the future possible effects of U.S. health care reform suggest a greater need for advanced practice nurses prepared at the graduate level, Neff said.

“Overall, I think the results of the study highlight the need to address issues of predicted nurse shortage, work environment and educational level for nurses in Florida; this could ultimately lead to more satisfied nurses, higher quality care for patients, and improved patient care delivery,” Neff said.

“The study’s findings build upon the nursing work force data produced by our Florida Center for Nursing and align with the recent Institute of Medicine Future of Nursing report and recommendations,” said Andrea Gregg, president of the Florida Nurses Association, who was not involved in the research.

“These study findings enrich our knowledge about how nurses in Florida feel about their practice environments and their intent to stay employed in nursing,” said Gregg, who is also an associate professor in the UF College of Nursing. “We need to actively encourage nurses to continue their professional education, and we need to assure that our clinical environments have safe staffing levels. These two interventions would go a long way in curing some of the nursing ills here in Florida.”