No offense to the creative people at the Oregon Center for Nursing who came up with this catchy poster campaign that encourages men to apply to nursing school (see "Wanted: More Male Nurses" on page 13), but they're asking the wrong question. Instead of asking if you're man enough to be a nurse, they should have asked if you're smart enough to be a nurse. A study out last month that examined the impact of education on patient survival suggests that the only concern you should have about what's under your nurses' scrubs is more years of schooling.

In a review of data from 168 Pennsylvania hospitals, surgery patients' death rates were nearly twice as high when the percentage of nurses with bachelor's degrees was low, says the study, published in the Sept. 24 Journal of the American Medical Association. The patients studied underwent such common operations as knee replacements, appendectomies and gallbladder removal.

"Some 4 million procedures like the ones we studied are performed in U.S. hospitals every year, yielding a substantial number of preventable deaths," says lead author Linda Aiken, a University of Pennsylvania nursing and sociology professor. Ms. Aiken and her research team suggest that recruiting nurses with four-year bachelor's degrees, instead of two or three years of education, "may lead to substantial improvements in quality of care."

If you accept that surgical patient death rates are higher when nursing education levels are lower (previously published research by the same group found that patient survival rates are also directly related to nurse staffing levels), how do you quantify the difference in competence between associate- and bachelor's degree nurses? Better-educated nurses tend to be more proficient in critical thinking, was all the researchers had to say on this subject. Without naming (maiming?) the RNs who aren't BSNs on your team, that's quite an indictment and an insult.

Nationwide data from 2001 show that 61 percent of new registered nurses came from associate-degree programs, 36 percent from bachelor's degree programs and 3 percent from hospital diploma programs - which educated the bulk of U.S. nurses 50 years ago. When you consider that Ms. Aiken et al. would say that nearly two-thirds of new nursing grads ain't smart enough to care for surgical patients, the study loses at least some of its sting.