Calling all nurses-Now is the time to take action on improving the quality of care in nursing homes

Threads of Care: Unraveling the Impact of Agency Nursing Staff on Nursing Home Quality

OBJECTIVE

To assess the association of agency nursing staff utilization with nursing home (NH) quality.

BACKGROUND

Nursing staff are the primary caregivers in NHs, where high-quality care is contingent upon their adequacy and expertise. Long-standing staffing challenges, exacerbated by the COVID-19 pandemic, have led NHs to rely on agency/contract labor to alleviate staffing shortages.

METHODS

This study used the following secondary datasets: Payroll-Based Journal, Care Compare: 5-Star Quality Rating System, LTCFocus.org, Area Health Resource Files, and Rural-Urban Commuting Area codes for 2017-2022. Multivariable ordinal logistic regression with 2-way (facility and year-level) fixed effects was employed. The study included all Centers for Medicare and Medicaid Services certified U.S. NHs. Analytic data comprised 80,244 facilities, averaging 13,374 unique NHs per year. The study focused on the quality star rating (1-5 scale) from the 5-Star Quality Rating System as the dependent variable. Independent variables included the proportion of agency nursing staff hours per resident day for registered nurses, licensed practical nurses, and certified nursing assistants while controlling for facility and community characteristics that may affect NH quality.

RESULTS

A 10% increase in agency registered nurses, licensed practical nurses, and certified nursing assistants (logged) was associated with a decrease in the odds of achieving a higher star rating by 4%, 5%, and 4%, respectively (P < 0.001).

CONCLUSIONS

The use of agency nursing staff can negatively impact NH quality. Efforts to better integrate agency nursing staff into NHs, combined with strategies to recruit and retain permanent nursing staff, could lead to improved outcomes for residents.

Comparison of nursing home workforce with acute-care setting nursing workforce: Using a national sample survey

Nursing home nurse staffing is aggravated by poor working conditions, low wages, turnover, low nurse staffing ratios, and hours per resident day. Nursing workforce analyses on nursing home settings are limited. This study aimed to understand the national nursing home registered nurse workforce by comparing acute-setting registered nurse workforce characteristics. The study was conducted using cross-sectional secondary analysis. Around 60% of nursing home nurses reported having fewer than 5 years of experience in their primary nursing position compared to 48% of respondents in acute care. Nursing home nurses had a higher rate of licensed practical/vocational nurses and lower annual earnings compared to those in acute care. Total registered nurse hours worked per year, weekly hours scheduled, and weekly hours worked were all higher in nursing home care settings compared to acute-care settings. Enhanced systemic support to improve nursing home environments would help nurses focus on these identified areas.

Setting up a journal club for healthcare professionals in an older people's residential care setting

With the rise in the number of older people in the population and new developments in older people's services such as integrated care hubs, there is a need for healthcare professionals working with older people to keep up to date with the latest research. This article describes the process of establishing a multidisciplinary journal club in a residential care setting and recognising the potential of such clubs to develop staff members' critical thinking, presentation and communication skills. The authors emphasise the importance of fostering a culture of learning in older people's services and describe how a journal club can support healthcare professionals to maintain their knowledge and improve care.