Staffing Ratios In Nursing Homes

“High rates of staff turnover in nursing homes is not a recent phenomenon. As far back as the mid-1970s studies have documented average turnover rates for registered nurses (RNs), licensed vocational nurses (LVNs) and certified nurse’s aides (CNAs) ranging between 55% and 75%” (Mor,V., Mukamel, D.B., & Spector,W. D. 2009, 1). Long term care facilities (LTC) have staffing issues related to the high turnover of licensed staff. The effect can have a heavy financial burden and also affect the care given to residents. Many ask the question why is it hard to attract and keep nurses at a long term facility. The International

Statistical data on hospital discharges and nurse staffing were collected between the years of 1997-1998 from the following eleven states; Arizona, California, Maryland, Massachusetts, Missouri, Nevada, New York, South Carolina, Virginia, West Virginia, and Wisconsin. The total sample included 799 hospitals. The population of patients included medical and surgical patients that were followed by basis of hospital discharge abstracts and those that were potentially sensitive by staffing of nurses. The levels of staffing of RN’s, LPN’s, and nurse’s aides were estimated in hours. To control for differences among all hospital data, in the mix of patients they used patient level logistic regression analysis to predict each patients’ probability of experiencing an adverse outcome. Patient level variables included the rate of outcome in the patient diagnosis related group, age, state of residence, sex, primary health care insurer, whether or not patient was admitted for an emergency, and presence/absence of chronic disease. Data was used to calculate length of stay, rates of adverse outcomes, hours of nursing care, and proportion of nursing hours of care for each nursing personnel. To examine whether the mix of skills of nurses or number of patient care hours were more significant, two models were used to gather results. The first model looked at mix of skills and proportion hours of care provided by RN’s, LPN’s, and nurse aides per day. The second model measured all nurse staffing of RN’s, LPN’s, and nurse aides in hours per

In the above article by Burgio and others (Burgio, et al. (2004) researchers conducted a staff assignment and work shift review analysis on June 1, 2004 in which they look at quality of care in the nursing home and their effects on staff assignments, responsibilities and work shift. This study was conducted in a nursing home with actual professionals with an employee population of 200 workers.

Staffing and resource adequacy refers to nurses perception on registered nurse/patient ratios, time allocation for patient care, and peer communication (Middleton, et al, 2008), while according to Blegen, et.al., (2011), better patient outcomes result from a high proportion of registered nurses. Following is a table with questions related to staffing and resource adequacy:

Mandated nurse-patient staffing ratios will affect nursing practice, healthcare delivery and healthcare consumers in beneficial ways. Through Bill 394, mandatory minimum staffing levels were implemented in California in 2004. There are numerous studies conducted relating to the effectiveness of this law, but The Center for Health Outcomes and Policy Research at the University of Pennsylvania’s independent scientific evaluation of California’s mandated nurse staffing requirements (Aiken, 2010) makes the most impact. The study comes from the 2006 survey data of hospital RNs in California, Pennsylvania, New Jersey, and state hospital

Formulating the proper ratio of nurses to patients remains to be a challenging topic that has been debated in healthcare policy in numerous techniques during the previous twenty years. Adequate staffing of nurses is critical due to the direct effect that it can have on the ability to provide safe, quality healthcare (American Nurses Association, 2012). In the modern era, legislators have attempted to answer the idea of nurse staffing ratios in two distinct techniques. The first technique, embraced by the state of California, is to enforce a definite numeric nurse-to-patient ratio which is required to be upheld within the entire medical insitiution. The second technique, which is recently more frequently used, is to develop a

Allen, D. (2013). Evidence shows that staff ratios can work. Nursing Standard. Retrieved 2016, from http://www.24activ.com/tickets/scp/public_attachment.php?id=25635

IntroductionIn Systematic Review of Studies of Staffing and Quality in Nursing Homes it takes about thestaffing measures, quality measures, and risk adjustments/control measures. Staffing measures willinclude the number of patients the staff has, the hours the staff works to number of patients, how manynurse or other healthcare providers are present. Quality measures would include things such as numberof patients to the number of bed, one on one time with patient, and how well the facility is cared forand how well they take care of patients. Risk adjustments/control measures would be if there are anysafety issues that could be prevented then how could they be prevented and how things stay the same.DevelopmentSome key points would be with quality

There are three staffing models, budget based in which nursing staff is allocated to nursing hours per patient day. Another method is nurse to patient ratio in which the number of nurses per number of patients. Lastly, and I think most importantly is patient acuity in which patient characteristics are used to determine a shift’s staffing needs. My organization uses a combination of methods and taking the overall staffing approach to their specific needs of the unit. There can be concerns about appropriate and safe staffing when only financial approach is taken without considering such as patient acuity, and

Mandating nurse-to-patient staffing ratios may not be the best idea because there is “little evidence that specific nurse-to-patient staffing ratios improve safety or quality” (Welton, 2007, p. 4). Legislation “points to research indicating an association between nurse workload and patient mortality and morbidity” according to a study from 2002 (Welton, 2007, p. 4). The study showed that for every “additional patient a nurse was assigned, there was a seven percent increase in the likelihood of dying got a patient under that nurse’s care” (Welton, 2007, p. 4). On the contrary, the studies that the legislation points to have “several weaknesses”; like how it was only implemented at two hospitals and was done in the 1990s, thus, it is outdated information (Welton, 2007, p. 4). The American Organization of Nurse Executives believed that mandating nurse-to-patient staffing ratios is causing more harm to the health industry because it is “reducing scheduling and staffing flexibility” (Welton, 2007, p. 5). The patient load and acuity is not the same every day; consequently, there needs to be flexibly schedules to be financially appropriate and beneficial to the patient. If you are overstaffed on nurses then the unit is losing more money, because they are paying for nurses to sit around. For example, when a unit is low acuity patients they do not need as many nurses, thus, they may send nurses home; same goes for high acuity patient

One professional organization that has been stepping up to the plate in regards to this issue is the American Nurses Association (ANA) and its Constituent & State Nurses Associations (C/SNA). The American Nurses Association (n.d.) role in this issue is to promote legislation that holds hospitals responsibility for developing and executing valid and reliable staffing plans. These plans are not to be confused with mandated ratios, which require fixed nurse to patient ratios. These plans are strictly based on each hospital’s unit unique circumstance and should evolve as the unit grows and changes.

I chose to examine research related to the nurse-to-patient ratios and the variety of effects on safety and quality of care. Nurse staffing levels are directly correlated with quality patient care, safety, and nurse satisfaction. Todays nurse has a larger workload due to higher complexity of care, reduced staffing, and increased responsibility (Hughes, 2008). Low nurse staffing levels with an increased patient load leads to a wide array of problems such as medication errors, sentinel events, nurse burnout, reduced patient dissatisfaction, and overall decreased quality of care (Hughes, 2008).

The debates about proper nurse to patient staffing issues have been going on for decades, but now with the changing healthcare environment and the tendency of patients to be sicker with more comorbidities, it is more important than ever to discuss and determine adequate nurse to patient ratios (Unruh & Fotter 2006). Research studies have been conducted to examine and study best approach with mixed findings. Studies conducted in support of patient safety have shown a decrease in mortality with an increase in nurse staffing levels. (Aiken et al) There are lots of variables that need to be considered. One thing is for sure, appropriate nurse staffing is critical to patient safety and well-being and inadequate nurse staffing levels are known to

A nurse-patient ratio is the maximum number of patients a nurse can have at any time during a shift. There are two primary models utilized, while some methods are gaining popularity as research advances. Presently there is no set methodology used to determine ratios. One model is nursing hours per patient per day and the other being mandated ratios. Either model affects patient outcomes, safety, and quality of care. There are advantages and disadvantages to both models. Besides the advantages and disadvantages, hospitals must also look at cost, patient outcomes, satisfaction of nurses and patients, and safety for both. Another model gaining momentum is one based on the acuity level of patients.

This article is about the quality of life of residents in a nursing home as it relates to the staffing. The United States has approx. 16,100 nursing homes and 1.7 million elders live in those homes (Shin 2013). The number of elderly patients to enter nursing home are going to be on the rise. The quality of life is an important factor to look with the more people entering nursing homes.