Nursing home leaders’ and nurses’ experiences of resources, staffing and competence levels and the relation to hospital readmissions – a case study

Abstract

BackgroundThirty-day hospital readmissions represent an international challenge leading to increased prevalence of adverse events, reduced quality of care and pressure on healthcare service’s resources and finances. There is a need for a broader understanding of hospital readmissions, how they manifest, and how resources in the primary healthcare service may affect hospital readmissions. The aim of the study was to examine how nurses and nursing home leaders experienced the resource situation, staffing and competence level in municipal healthcare services, and if and how they experienced these factors to influence hospital readmissions.MethodThe study was conducted as a comparative case study of two municipalities affiliated with the same hospital, chosen for historical differences in readmission rates. Nurses and leaders from four nursing homes participated in focus groups and interviews. Data were analyzed within and across cases.ResultsThe analysis resulted in four common themes, with some variation in each municipality, describing nurses’ and leaders’ experience of the nursing home resource situation, staffing level and competence and their perception of factors affecting hospital readmissions. The nursing home patients were described as becoming increasingly complex with a subsequent need for increased nurse competence. There was variation in competence and staffing between nursing homes, but capacity building was an overall focus. Economic limitations and attempts at saving through cost-cutting were present, but not perceived as affecting patient care and the availability of medical equipment. Several factors such as nurse competence and staffing, physician coverage, and adequate communication and documentation, were recognized as factors affecting hospital readmissions across the municipalities.ConclusionSeveral factors related to nurses’ and leaders’ experience of the resource situation, staffing and competence level were suggested to affect hospital readmissions and the municipalities were similar in their answers regarding these factors. Patients were perceived as more complex with higher patient mortality forcing long-term nursing homes to shift towards an acute care or palliative function, and short-term nursing homes to function as “small hospitals”, requiring higher nurse competence. Staffing, competence and physician coverage did not seem to have adjusted to the new patient group in some nursing homes.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3769-3) contains supplementary material, which is available to authorized users.

Practice-based learning and innovation in nursing homes

“…Despite these addressed challenges, research on learning and innovation in nursing homes is relatively scarce. The studies that exist-both Norwegian (Totcheva, Vedeler and Slettebø, 2019;Eines, Angelo and Vatne, 2019;Eines and Vatne, 2018;Glette et al, 2018;Øye et al, 2016) and international (Brodtkorb, Skaar and Slettebø, 2019;Bezboruah Paulson and Smith, 2014;Wegener, 2016)-highlight the importance of leadership and management engagement and capacities when innovation processes are initiated at nursing homes. Other studies approaching learning as a prerequisite for innovation point to the potential in care workers everyday work practices where problems occur, new ideas are tried out, and colleagues serve as reflection partners (Verleye and Gemmel, 2011;Fuglsang, 2010;Wegener and Tanggaard, 2013;Wegener, 2012) Some studies find that, to improve the quality of care delivered to nursing home residents, the care professionals must be educated on the evidence-based practice and proper use of guidelines derived from the theory of gerotranscendens.…”

Exploring challenges in quality and safety work in nursing homes and home care – a case study as basis for theory development

“…The Norwegian healthcare system has increasing knowledge about hospital settings but knows little about how nursing home and home care managers experience quality and safety challenges [2]. Norwegian research by Glette et al [10] shows that managers and employees experience patients as sicker and more complex in nursing homes and that patient care is also becoming more time-consuming. Specific challenges in home care are the unregulated environment, fragmentation of care, discontinuity and multiple care givers that lack overview of patient status [6,11].…”

Technology-Based Interventions for Nursing Home Residents: Implications for Nursing Home Practice Amid and Beyond the Influence of COVID-19: A Systematic Review Protocol

“…Further, nursing homes often lack adequate healthcare resources or infrastructure needed to curb the impact of COVID-19. For example, numerous studies have indicated a lack of investment in training programs for nursing home staff, in addition to high turnover rates [33,34], that management teams are often ineffective [35,36], and that the nursing home infrastructure is often too outdated [32,[37][38][39].…”