basic education from a diploma program decreased from 60 to 30 percent, while the proportion of those receiving basic education from AD or baccalaureate programs increased from 19 to 40 percent and 17 to 29 percent, respectively. However, these data do not fully characterize the educational level of the RN workforce, as many RNs pursue additional education after being licensed. In 2000, the distribution of RNs according to their highest degree was as follows: diploma preparation (23 percent), AD (34.3 percent), baccalaureate degree (32.7 percent), and master’s or doctoral degree (10 percent). The educational level of RNs varies by place of employment. RNs in nursing homes generally have a lower level of education than those in other settings. In 2000, only 27 percent of RNs employed by nursing homes were prepared at the baccalaureate level, compared with 43 percent in hospitals. Nurses with advanced-practice credentials are also less well represented in nursing homes: 7.6 percent of hospital nurses were prepared at the masters or doctorate level, compared with 4.3 percent of nursing home nurses (Spratley et al., 2000).

Research on the effect of different educational paths to RN licensure on nurse performance and patient outcomes has been inconclusive. Such research has examined the characteristics, abilities, and work assignments of nurses with and without baccalaureate degrees, but has not been as thorough in examining the quality of the care they provide (including patient safety) (Blegen et al., 2001). However, an analysis of educational preparation and years of experience in the nursing workforce from the National Sample Survey of Registered Nurses (NSSRN) suggests that baccalaureate-prepared nurses have tended to stay in the workforce longer and accrue more years of work experience than those not thus prepared (Sochalski, 2002). Further, limited data from studies of magnet hospitals (i.e., hospitals characterized by their ability to attract and retain nurses) indicate that those hospitals have higher percentages of baccalaureate-prepared nurses (50 percent) as compared with the national hospital average of 34 percent (Aiken et al., 2000a).

Education for LPNs/LVNs LPN/LVN training programs are shorter than those for RNs, taking 12 to 18 months, and emphasize technical nursing tasks such as monitoring vital signs, administering medications, and completing treatments (GAO, 2001b). In 2000, approximately 1,100 state-approved programs provided LPN/LVN education. Students attending these programs were enrolled predominantly in vocational/technical schools and community and junior colleges. A state licensing examination also must be completed successfully following the LPN/LVN training program (Bureau of Labor Statistics, 2003).

Education for NAs Training for NAs depends on their place of employment. Those working in Medicare- or Medicaid-reimbursed nursing homes



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