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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.

The authors suggested that hospital care may be improved by limiting the number of patients assigned to each RN and also by increasing the certification level of RNs. Both forms of investment consume resources; the ideal mix of these remains uncertain. Many RNs appear to be leaving hospital care within . . . [Full Text of this Article]

Deborah Burger, RN
California Nurses Association
Oakland

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