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	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: Dr Aiken and colleagues¹ reported that surgical patients had lower mortality rates and lower rates of death from serious complications (failure-to-rescue rates) if they received care at hospitals with higher proportions of registered nurses (RNs) educated at the baccalaureate level or higher. On behalf of the American Federation of Government Employees, AFL-CIO (which represents RNs in Veterans Affairs medical centers throughout the United States), we do not think that the authors' methods support their conclusions.

The authors did not assess many variables that are related to the quality of individual care, such as the educational preparation of the RNs who actually provided care to the patients at any given time. They also did not account for patient acuity, the staffing mix, or the nursing care model.

We believe that these results suggest that patient deaths after surgery are highest in hospitals where RNs care for greater numbers . . . [Full Text of this Article]

Sarah Atkins, RN, MS
sarah.atkins@med.va.gov
Portland, Ore

Jane Nygaard, RN
Minneapolis, Minn
For the AFGE Professional Activists

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