Nursing Staff Time and Care Quality in Long-Term Care Facilities: A Systematic Review

Abstract

Background and Objectives In long-term care (LTC) facilities, nursing staff are important contributors to resident care and well-being. Despite this, the relationships between nursing staff coverage, care hours, and quality of resident care in LTC facilities are not well understood and have implications for policy-makers. This systematic review summarizes current evidence on the relationship between nursing staff coverage, care hours, and quality of resident care in LTC facilities. Research Design and Methods A structured literature search was conducted using four bibliographic databases and gray literature sources. Abstracts were screened by two independent reviewers using Covidence software. Data from the included studies were summarized using a pretested extraction form. The studies were critically appraised, and their results were synthesized narratively. Results The systematic searched yielded 15,842 citations, of which 54 studies (all observational) were included for synthesis. Most studies (n = 53, 98%) investigated the effect of nursing staff time on resident care. Eleven studies addressed minimum care hours and quality of care. One study examined the association between different nursing staff coverage models and resident outcomes. Overall, the quality of the included studies was poor. Discussion and Implications Because the evidence was inconsistent and of low quality, there is uncertainty about the direction and magnitude of the association between nursing staff time and type of coverage on quality of care. More rigorously designed studies are needed to test the effects of different cutoffs of care hours and different nursing coverage models on the quality of resident care in LTC facilities.

COVID-19 in long-term care homes in Ontario and British Columbia

“…Several studies have shown inverse relations between staffing levels and care hours, and poor outcomes such as rates of infection and hospital admission among residents. [18][19][20][21] Recent studies have also shown an association between low staffing levels and COVID-19 infections within LTC homes. [22][23][24] Many LTC staff, in particular care aides or personal support workers, are underpaid and less likely to secure fulltime positions relative to their counterparts in other sectors of the health care system.…”

Citizen and stakeholder led priority setting for long-term care research: identifying research priorities within the Translating Research in Elder Care (TREC) Program

“…While we did not conduct systematic reviews to assess whether each of the identified research priorities have been addressed before, TREC researchers with extensive expertise in the content area of prioritized research questions have identified that the identified priorities indeed not only constitute a gap in using our TREC data, but also a gap in the literature. For example, the question identified as highest priority (influence of different staffing levels and staff mix on resident outcomes) has been addressed in LTC settings [35,36], but these reviews highlight that the quality of available studies is weak, findings are heterogeneous and inconclusive, and that especially the interaction between elements of care staff work environments (leadership, culture, connections within the team) and staffing levels or staff mix may better explain resident outcomes. However, this interaction has not been studied yet in LTC.…”

Increasing Registered Nurse Hours Per Resident Day for Improved Nursing Home Residents’ Outcomes Using a Longitudinal Study

“…There have been, however, no systematic reviews that investigate a minimum HPRD of RNs to attain the maximum quality of care in NHs [ 22 ]. Most studies used cross-sectional or retrospective designs [ 22 ].…”

“…There have been, however, no systematic reviews that investigate a minimum HPRD of RNs to attain the maximum quality of care in NHs [ 22 ]. Most studies used cross-sectional or retrospective designs [ 22 ]. In a systematic review (54 studies in total), 20 (37%) were retrospective studies, 16 (30%) were retrospective studies with cross-sectional analysis, and nine (17%) used cross-sectional analysis.…”

“…These factors may correlate with the explanatory variables of the study. Due to the limitations of the study design, studies of the relationship between nurse staffing and quality of care in NHs have shown inconsistent results [ 22 ].…”