RN Staffing Time and Outcomes of Long-Stay Nursing Home Residents
- 1 November 2005
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in The American Journal of Nursing
- Vol. 105 (11), 58-70
- https://doi.org/10.1097/00000446-200511000-00028
Abstract
A clear link has been demonstrated between lower nurse staffing levels in hospitals and adverse patient outcomes, but the results of studies of such relationships in long-term care facilities haven't been as clear. This study explored the time nurses spent in direct care and how it affected outcomes in long-stay (two weeks or longer) nursing home residents. In a retrospective study of data collected as part of the National Pressure Ulcer Long-Term Study (NPULS), we analyzed data on 1,376 residents of 82 long-term care facilities whose lengths of stay were 14 days or longer, who were at risk of developing pressure ulcers but had none at study entry, and who had a Braden Scale score of 17 or less. Primary data came from residents' medical records during 12-week periods in 1996 and 1997. Dependent variables included development of pressure ulcer or urinary tract infection (UTI), weight loss, deterioration in the ability to perform activities of daily living (ADLs), and hospitalization. Independent variables included resident demographics, severity of illness, nutritional and incontinence interventions, medications, and nurse staffing time. More RN direct care time per resident per day (examined in 10-minute increments up to 30 to 40 minutes per resident per day) was associated with fewer pressure ulcers, hospitalizations, and UTIs; less weight loss, catheterization, and deterioration in the ability to perform ADLs; and greater use of oral standard medical nutritional supplements. More certified nursing assistant and licensed practical nurse time was associated with fewer pressure ulcers but did not improve other outcomes. The researchers controlled for important variables in long-stay nursing home residents at risk for pressure ulcers and found that more RN direct care time per resident per day was strongly associated with better outcomes. There's an urgent need for further research to confirm these findings and, if confirmed, for improving RN staffing in nursing homes to decrease avoidable adverse outcomes and suffering.Keywords
This publication has 20 references indexed in Scilit:
- Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job DissatisfactionJama-Journal Of The American Medical Association, 2002
- Who Cares For Older Adults? Workforce Implications Of An Aging SocietyHealth Affairs, 2002
- Nurse-Staffing Levels and the Quality of Care in HospitalsNew England Journal of Medicine, 2002
- Research priorities for staffing, case mix, and quality of care in U.S. nursing homes.Journal of Nursing Scholarship, 2000
- Some Impacts of Nursing on Acute Care Hospital OutcomesJONA: The Journal of Nursing Administration, 1999
- Nurse Staffing Levels and Adverse Events Following Surgery in U.S. HospitalsImage: the Journal of Nursing Scholarship, 1998
- Nurse Staffing and QUALITY OF CARE IN NURSING FACILITIESJournal of Gerontological Nursing, 1996
- Nursing Home Ownership Revisited: Market, Cost and Quality RelationshipsMedical Care, 1993
- Agents of Nursing Home Quality of Care: Ombudsmen and Staff Ratios RevisitedThe Gerontologist, 1991
- The influence of registered nurse staffing on the quality of nursing home careResearch in Nursing & Health, 1990