The Relationship Between Nursing Staff Levels, Skill Mix, and Deficiencies in Maryland Nursing Homes

Abstract

The objective of this data analysis was to explore whether nurse staffing levels and skill mix influenced the number and severity of nursing home deficiencies in Maryland nursing homes. Nursing staff levels and skill mix in relation to quality outcomes in nursing homes have been explored with inconsistent results. Two multiple regression analyses were done to explore factors influencing deficiencies and the severity of the deficiencies found during the annual survey process. The factors influencing the number of deficiencies were the number of nursing home beds (β = .29), nursing assistant hours per patient-day (β = -.206), and the location of the nursing home (β = -.138). The only factor influencing the severity of the deficiencies was RN hours per patient-day (β = -.199). In conclusion, it was determined that RN staffing, although not associated with the number of deficiencies, is associated with deficiency severity.

Factors contributing to serious adverse events in nursing homes

“…Bowblis (2011) found a connection between increased number of RNs and fewer pressure ulcers. Lerner (2013) showed that the number of RNs in nursing homes was not associated with frequencies of shortcomings, but with their seriousness. A systematic review by Spilsbury, Hewitt, Stirk, and Bowman (2011)…”

“…Bowblis () found a connection between increased number of RNs and fewer pressure ulcers. Lerner () showed that the number of RNs in nursing homes was not associated with frequencies of shortcomings, but with their seriousness. A systematic review by Spilsbury, Hewitt, Stirk, and Bowman () showed that RN staffing in nursing homes was associated with better outcomes related to care deficiencies, nutritional supplements, urinary tract infections and satisfaction.…”

Adverse events in nursing: A retrospective study of reports of patient and relative experiences

“…Among the few studies in elderly care reporting levels of competence and adverse events, Bowblis () found an association between increased RN staffing and decreased rates of pressure ulcers. Lerner () pointed out that the RN staffing in elderly care settings was not associated with numbers of deficiencies but with the deficiency severity. In hospitals (Bobay et al.…”

Innovation to enhance health in care homes and evaluation of tools for measuring outcomes of care: rapid evidence synthesis

“…This section collates studies that had a specific focus on the comparative impact of nurses with different levels of training. One study is from the Netherlands 805 and five are from the USA 505,601,683,684,687 , all of which make use of the US MDS. Three out of the five US studies make use of reported care home deficiencies as a proxy for resident outcomes.…”

“…683 Nursing homes with higher NA staffing were noted to have lower rates of falls, but RN and LPN hours per resident per day were not predictive of falls. Routine data from 225 Maryland nursing homes 684 found that the NA hours per day influenced the number of deficiencies reported, while RN hours were associated with the severity of the deficiencies. In another study with OSCAR data (from 1999 to 2004), Lin and colleagues 687 reported that both RN and NA staffing had a small but non-statistically significant impact on quality of care, measured by reported deficiencies.…”