Appropriate Nurse Staffing Levels for U.S. Nursing Homes

Abstract

US nursing homes are required to have sufficient nursing staff with the appropriate competencies to assure resident safety and attain or maintain the highest practicable level of physical, mental, and psychosocial well-being of each resident. Minimum nurse staffing levels have been identified in research studies and recommended by experts. Beyond the minimum levels, nursing homes must take into account the resident acuity to assure they have adequate staffing levels to meet the needs of residents. This paper presents a guide for determining whether a nursing home has adequate and appropriate nurse staffing. We propose five basic steps to: (1) determine the collective resident acuity and care needs, (2) determine the actual nurse staffing levels, (3) identify appropriate nurse staffing levels to meet residents care needs, (4) examine evidence regarding the adequacy of staffing, and (5) identify gaps between the actual staffing and the appropriate nursing staffing levels based on resident acuity. Data sources and specific methodologies are analyzed, compared, and recommended. The goal is to assist nursing home nurses and administrators to ensure adequate nursing home staffing levels that protect resident health, safety, and well-being.

Nurses Working in Nursing Homes: A Mediation Model for Work Engagement Based on Job Demands-Resources Theory

“…First, because our study was conducted in Japan, the findings regarding nursing-home settings are limited to the Japanese context, which may consequently limit the generalizability of the results. Although, in many countries, the proportion of registered nurses working in nursing homes is small (e.g., [ 28 , 29 ]), the number of registered nurses, licensed practical nurses, certified nursing assistants, and care workers varies across countries. These differences are influenced by the laws and the provisions of the long-term care insurance systems present in each country where the salaries and benefits of nurses may also differ.…”

“…The percentage of registered nurses who provide direct care in nursing homes, varies across countries, but is generally small (e.g., [ 28 , 29 ]). For example, in Japan there are two types of long-term care facilities for older adults who do not require hospitalization: long-term care welfare facilities and long-term care health facilities [ 30 ].…”

Restoring trust: COVID-19 and the future of long-term care in Canada

“…A useful process proposed to establish adequate and appropriate staffing by all groups of nursing personnel is to: (a) determine the collective resident care needs, (b) determine the actual nurse staffing levels, (c) identify appropriate nurse staffing levels to meet resident's care needs, (d) examine evidence on the adequacy of staffing, and (e) identify gaps between the actual and appropriate staffing levels (Harrington et al 2020). Harrington, a recognized US leader and expert in nursing home staffing, also advises that the minimum total nursing hours to ensure care quality is about 4.1 h per resident per 24 h (Harrington et al 2016).…”

COVID-19 and long-term care facilities: Does ownership matter?

“…10 Recommendations for minimum ratios of residents to RNs and licensed practical nurses, adjusted for resident case mix, are also available and evidence informed. 11 In preparation for the next wave of COVID-19, public policy should be directed at funding, mandating and enforcing sufficient staffing levels based on the available evidence, not only to address resident care needs, but also to accommodate the added time required for safety-related tasks such as meticulous handwashing, careful donning and doffing of personal protective equipment, and consistent compliance with infection control standards. If requirements to fund adequate levels of staffing affect the bottom lines of for-profit facilities, then it might be time for this care to be turned over to public and nonprofit entities.…”