JAMDA
Volume 7, Issue 6 , Pages 366-376, July 2006

Systematic Review of Studies of Staffing and Quality in Nursing Homes

  • Jane E. Bostick, PhD, APRN, BC

      Affiliations

    • University of Missouri-Columbia, Columbia, MO
    • Corresponding Author InformationAddress correspondence to Jane E. Bostick, PhD, APRN, BC, University of Missouri-Columbia, S407 Sinclair School of Nursing, Columbia, MO 65211.
    • ,
  • Marilyn J. Rantz, PhD, RN, FAAN

      Affiliations

    • University of Missouri-Columbia, Columbia, MO
    • ,
  • Marcia K. Flesner, PhD, RN

      Affiliations

    • University of Missouri-Columbia, Columbia, MO
    • ,
  • C. Jo Riggs, PhD, RN, BC

      Affiliations

    • Central Missouri State University, Warrensburg, MO.

published online 26 April 2006.

Purpose

To evaluate a range of staffing measures and data sources for long-term use in public reporting of staffing as a quality measure in nursing homes.

Method

Eighty-seven research articles and government documents published from 1975 to 2003 were reviewed and summarized. Relevant content was extracted and organized around 3 themes: staffing measures, quality measures, and risk adjustment variables. Data sources for staffing information were also identified.

Results

There is a proven association between higher total staffing levels (especially licensed staff) and improved quality of care. Studies also indicate a significant relationship between high turnover and poor resident outcomes. Functional ability, pressure ulcers, and weight loss are the most sensitive quality indicators linked to staffing. The best national data sources for staffing and quality include the Minimum Data Set (MDS) and On-line Survey and Certification Automated Records (OSCAR). However, the accuracy of this self-reported information requires further reliability and validity testing.

Conclusions

A nationwide instrument needs to be developed to accurately measure staff turnover. Large-scale studies using payroll data to measure staff retention and its impact on resident outcomes are recommended. Future research should use the most nurse-sensitive quality indicators such as pressure ulcers, functional status, and weight loss.

Keywords:  Nursing homes , staffing , quality , review

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 The analyses upon which this publication is based were performed under Contract Number 500-02-CO01, funded by the Centers for Medicare & Medicaid Services, an agency of the U.S. Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The author assumes full responsibility for the accuracy and completeness of the ideas presented.

PII: S1525-8610(06)00051-X

doi:10.1016/j.jamda.2006.01.024

JAMDA
Volume 7, Issue 6 , Pages 366-376, July 2006

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