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 AACC Says Deceptive Study Maligns Millions of Nurses 


To: Community college presidents/other interested parties

The following statement was issued by the American Association of Community Colleges (AACC) in response to a study published in the Journal of the American Medical Association. The study, which was conducted by Linda Aiken at the University of Pennsylvania, erroneously links increased mortality among surgical patients in the state of Pennsylvania to the educational level of RNs.

As the statement indicates, AACC has closely analyzed the report and found that is uses flawed methodology, is riddled with inaccuracies, and reaches unfounded conclusions. This statement is but the first effort in what will be a vigorous and sustained communications outreach campaign to refute the study's findings and to defend Associate Degree Nursing Programs and their graduates.


September 26, 2003    

Contact:  Norma Kent    
202/728-0200, ext. 209
(703)585-8556 (cell)


The study by Linda Aiken published this week by the Journal of the American Medical Association that purports to prove that hospitals with higher proportions of nurses educated at the baccalaureate level enjoy reduced mortality rates for surgical patients is riddled with inaccuracies and uses flawed methodology, according to the American Association of Community Colleges.

"More than 60% of new nurses are educated through Associate Degree Nursing (ADN) programs, most at community colleges," said AACC President George F. Boggs. "This study maligns the millions of ADN nurses who historically pass their state licensure exams with scores as good or better than their four-year counterparts, and have the same responsibilities on the job."

The flaws in this study are almost too many to list. The most important are:

  • The elephant in the room: Anyone who has ever had surgery knows the most important qualifications are those of his or her surgeon. The study itself admits that the ratio of board-certified surgeons in a given hospital has a much greater impact on patient mortality than the degree status of the nurse on duty. And the study then proceeds to dismiss this finding!   

  • Nurses matter, but individual patient outcomes are needles in haystacks. Multiple nurses typically care for hospital patients, and tracing patient outcomes to particular nurses is impossible. But there are major factors with substantial impact that this study does not address, including the fact that hospitals with low numbers of baccalaureate nurses also tend to be smaller, more rural and have fewer financial and technological resources.   

  • Logical Fallacy 101: Statisticians generally understand that when two events occur at the same time one does not necessarily cause the other. Although nursing care matters, nothing in the survey demonstrates that the ratio of ADN to baccalaureate nurses causes patient outcomes.   

  • Apples and oranges. In an attempt to make patient outcomes in hospitals with more baccalaureate nurses look more positive, the study conflates baccalaureate nurses with nurses with master’s degrees and PhDs. This is absurd, since ADN nurses and baccalaureate nurses are the categories that receive the same classroom and clinical education. Ironically, more than 150 graduate-level nursing programs, including the study author’s own university, accept Associate Degree Nurses directly into programs that award graduate degrees without a baccalaureate degree, judging them well-qualified for graduate-level work.

For more than fifty years, four-year nursing programs have attempted to discredit other educational routes to RN status. This survey, authored by a nurse associated with a four-year program and applauded by those programs with a financial stake in attracting more students, is the most egregious attempt ever to bolster declining enrollments in four-year programs.

We at America’s community colleges are making a long-term commitment to quality, affordable nurse education and to the delivery of safe health care to the American public. At a time when the nursing shortage is becoming ever more acute, attacking the majority of front-line nurses in our hospitals, and the institutions that educate them, is a selfish and short-sighted strategy by other nursing educators. We will continue to provide analysis of the shortcomings of the Aiken study, and reach out to other members of the healthcare and health education community to ensure that our well-educated graduates continue to provide much-needed care to millions of patients.

The American Association of Community Colleges (AACC) is the leading national organization representing the nation’s 1,173 accredited community, junior, and technical colleges. Community colleges are the largest sector of higher education serving almost half (44 percent) of all U.S. undergraduates.

George R. Boggs,
President and CEO
American Association of Community Colleges
One Dupont Circle, NW, Suite 410

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