More robust nurse staffing key to quality of care in nursing home residents

Increasing the hours per resident day (HRPD) of registered nurse (RN) staff improves quality of life among nursing home (NH) residents, according to a new Korea study.

“[T]his study provides evidence that increasing RN HPRD improved residents’ quality of care outcomes in NHs. This is because professional RNs can develop scientific care plans based on the timely assessment of residents’ health status and cooperate with physicians for better outcomes,” the researchers said.

“This suggests that professional RNs must be secured to an appropriate level to improve the quality of care for NH residents,” they added.

Seventy-four NHs participated in the study. Data on nurse staffing HPRD and 15 quality of care indicators were collected. Indicators were selected from the Korean National Health Insurance Corporation evaluation manual and were included in the current analysis if they were nursing sensitive. These included cognitive impairment, bed rest, and fall prevalence, among others.

The average RN HPRD was 10 minutes and 45.1 seconds. In comparison, the HRPDs of certified nursing assistants (CNAs) and care workers were higher at 20 minutes and 6.8 seconds, and 3 hours 32 minutes and 43.4 seconds, respectively. On average, each NH had 1.567 RNs, though some had none, while others had as many as 17. [Int J Environ Res Public Health 2021;18:e402]

Of the participating NHs, 36.49 percent were rated as superior by the Korean National Insurance. This was much higher than the national benchmark: only 13.4 percent of all NHs across Korea earned a superior grade during the most recent evaluation, while 21.1 percent were given the lowest grade.

In terms of indicators at the organizational level, cognitive impairment was the most common, reported in 67.76 percent of NHs. It was followed by urinary incontinence (42.10 percent) and the use of antidepressant sleeping pills (27.38 percent).

RN HRPD was the only variable that significantly impacted the residents’ quality of care outcomes. Every 1-hour jump in HRPD led to at least 10-percent drop in the prevalence of residents with impaired outcomes.

According to multilevel longitudinal modelling analysis, each hour increment in HRPD decreased the prevalence of poor quality of care outcomes by 10.59 percent (estimate, –10.59±4.37; p=0.02).

“RNs are generally key human resources in residents’ outcomes,” the researchers said.

RNs are able to attend to NH residents’ needs in a much more directed fashion, removing fall hazards, preventing over-medication, improving nutrition, and helping with independence in daily living. RNs can also alert physicians to physical or cognitive changes that may require timely intervention.

“The accumulation of nurse-staffing research on residents’ outcomes continuously supports more RN hours. The long-term-care law in Korea that regulates NHs, however, does not yet apply these research findings,” the researchers added.

“This study again supports the regulation adjustment of nurse staffing and legislation, necessitating professional RNs to accomplish appropriate quality of care for residents in Korean NHs,” they added.