Relationship between the presence of baccalaureate-educated RNs and quality of care: a cross-sectional study in Dutch long-term care facilities

Abstract

BackgroundRecent evidence suggests that an increase in baccalaureate-educated registered nurses (BRNs) leads to better quality of care in hospitals. For geriatric long-term care facilities such as nursing homes, this relationship is less clear. Most studies assessing the relationship between nurse staffing and quality of care in long-term care facilities are US-based, and only a few have focused on the unique contribution of registered nurses. In this study, we focus on BRNs, as they are expected to serve as role models and change agents, while little is known about their unique contribution to quality of care in long-term care facilities.MethodsWe conducted a cross-sectional study among 282 wards and 6,145 residents from 95 Dutch long-term care facilities. The relationship between the presence of BRNs in wards and quality of care was assessed, controlling for background characteristics, i.e. ward size, and residents’ age, gender, length of stay, comorbidities, and care dependency status. Multilevel logistic regression analyses, using a generalized estimating equation approach, were performed.Results57% of the wards employed BRNs. In these wards, the BRNs delivered on average 4.8 min of care per resident per day. Among residents living in somatic wards that employed BRNs, the probability of experiencing a fall (odds ratio 1.44; 95% CI 1.06-1.96) and receiving antipsychotic drugs (odds ratio 2.15; 95% CI 1.66-2.78) was higher, whereas the probability of having an indwelling urinary catheter was lower (odds ratio 0.70; 95% CI 0.53-0.91). Among residents living in psychogeriatric wards that employed BRNs, the probability of experiencing a medication incident was lower (odds ratio 0.68; 95% CI 0.49-0.95). For residents from both ward types, the probability of suffering from nosocomial pressure ulcers did not significantly differ for residents in wards employing BRNs.ConclusionsIn wards that employed BRNs, their mean amount of time spent per resident was low, while quality of care on most wards was acceptable. No consistent evidence was found for a relationship between the presence of BRNs in wards and quality of care outcomes, controlling for background characteristics. Future studies should consider the mediating and moderating role of staffing-related work processes and ward environment characteristics on quality of care.

Nursing Staff Needs in Providing Palliative Care for Persons With Dementia at Home or in Nursing Homes: A Survey

“…Nonetheless, a partial-response analysis suggests that partial responders (who may share characteristics with nonresponders) were similar, although more experienced and certified or registered staff were more likely to respond fully. The representation of certified nurse assistants is consistent with the general staffing levels in Dutch long-term care (Arbeid in Zorg en Welzijn [AZW], 2016; Backhaus et al, 2017). The mean age and proportion of females in the sample are comparable to national statistics (AZW, 2016).…”

Baccalaureate‐educated Registered Nurses in nursing homes: Experiences and opinions of administrators and nursing staff

“…Second, research has yet to confirm whether nursing homes that do employ BRNs make use of their expertise, or differentiate their roles from those of other staff members such as nursing home medical specialists, speech therapists, physiotherapists and psychologists (Huls, De Rooij, Diepstraten, Koopmans, & Helmich, ). Third, a BRN who is employed in a nursing home typically works across several different wards, meaning that the time he or she spends in any one ward is often low (Backhaus et al., ). The relationship between QoC and BRN employment could be mediated by this practice of assigning BRNs to too wide a range of wards.…”

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.…”

“…A cross-sectional study in Dutch care homes analysed data on 6145 residents from the 2016 LPZ (Landelijke Prevalentiemeting Zorgkwaliteit or the International Prevalence Measurement of Care Problems in Care Homes). 805 The authors looked at the relationship between the employment of baccalaureate-educated RNs and a range of resident outcome measures across 282 wards in 95 care homes. They found no consistent association between the employment of baccalaureate-educated RNs and resident outcomes.…”

“…The probability of developing pressure ulcers was not associated with the employment of baccalaureate-educated RNs in either setting. 515,805 Five studies analysed information from the US MDSs on staff mix and resident outcomes. Data on the 230,730 people admitted to US nursing homes in 2006 were analysed in a cross-sectional study.…”