The Impact of Nursing Staffs’ Working Conditions on the Quality of Care Received by Older Adults in Long-Term Residential Care Facilities: A Systematic Review of Interventional and Observational Studies

Abstract

Background: Little documentation exists on relationships between long-term residential care facilities (LTRCFs), staff working conditions and residents’ quality of care (QoC). Supporting evidence is weak because most studies examining this employ cross-sectional designs. Methods: Systematic searches of twelve bibliographic databases sought experimental and longitudinal studies, published up to May 2021, focusing on LTRCF nursing staff’s working conditions and the QoC they provided to older adults. Results: Of the 3577 articles identified, 159 were read entirely, and 11 were retained for inclusion. Higher nursing staff hours worked per resident per day (HPRD) were associated with significant reductions in pressure sores and urinary tract infections. Overall staff qualification levels and numbers of RNs had significant positive influences on QoC. Conclusions: To the best of our knowledge, this systematic review is the first to combine cohort studies with a quasi-experimental study to explore associations between LTRCF nursing staff’s working conditions and older adult residents’ QoC. Human factors (including HPRD, staff turnover, skill mix, staff ratios) and the specific working contribution of RNs had overwhelmingly significant influences on QoC. It seems essential that LTRCF supervisory and decision-making bodies should promote optimal working conditions for nursing staff because these have such a direct impact on residents’ QoC.

Intent to stay, moral distress, and nurse practice environment among long‐term care nurses: A cross‐sectional questionnaire survey study

“…This study resulted in nurses reporting high intent to stay in their current work organization, in long-term care, and generally in nursing. This report of a favorable perception of the nurse practice environment and a high degree of intent to stay among nurses in long-term care was surprising because it contradicts the general perception of poor working conditions (Perruchoud et al, 2021) and the high rate of nurse turnover in long-term care (Gandhi et al, 2021).…”

“…This study resulted in nurses reporting high intent to stay in their current work organization, in long‐term care, and generally in nursing. This report of a favorable perception of the nurse practice environment and a high degree of intent to stay among nurses in long‐term care was surprising because it contradicts the general perception of poor working conditions (Perruchoud et al., 2021) and the high rate of nurse turnover in long‐term care (Gandhi et al., 2021). Notable nurses' characteristics in this group include a high median age (40.5 years) and extensive work experience (10 years of work experience as a nurse, 3.6 years working in their current facility, and 8.7 years working in long‐term care).…”

Resident Impact of the Single Site Order Restricting Staff Mobility across Long-Term Care Homes in British Columbia, Canada

“…The association between staffing shortages and adverse resident outcomes is very well documented in the pre-pandemic and pandemic literature. For example, a 2022 systematic review of 11 research papers found that increased nursing hours per resident per day were associated with a statistically significant reduction in adverse resident outcomes such as pressure ulcers and urinary tract infections [24].…”

Comparing Preferred and Actual Clinical Learning Environments and Perceptions of First-Year Nursing Students in Long-Term Care: A Cross-Sectional Study

“…Other authors have also assessed the impact of the CLE in LTC with other scales [15], also finding moderate positive results. It might appear paradoxical that in a clinical setting with worse nurse-patient ratios and a lack of resources [42,43] students rate the CLE as positive. The interpretation of this data might take into consideration various aspects.…”