The Impact of Recent State and Local Minimum Wage Increases on Nursing Facility Employment

Various U.S. states and municipalities raised their mandated minimum wages between 2017 and 2019. In some areas, minimum wages became high enough to bind for more professional workers, such as lower paid staff at nursing facilities. We add to the small prior literature on the effects of minimum wages on nursing facility staffing using novel establishment-level data on daily hours worked; these data allow us to examine changes in staffing hours along margins previously unexplored in the minimum wage literature. We find no evidence that minimum wage increases reduced hours worked among lower-paid nurses in nursing facilities. In contrast, we find that increases in state and local minimum wages increased hours worked per resident day by nursing assistants; increases occurred for the average of all days throughout the month and on weekend days. We also find that a higher minimum wage increased the share of days in the month that facilities meet at least 75% of the minimum recommended levels of staffing for nursing assistants. These results lessen concerns that minimum wage hikes may reduce the quality of resident care at nursing facilities.

Effects of resilience, burnout, and work-related physical pain on work-life balance of registered nurses in South Korean nursing homes: A cross-sectional study

BACKGROUND

While nursing homes increase, the number of registered nurses (RNs) working there continues to decline. This study explored the effects of resilience, burnout, and work-related physical distress on the work-life balance of RNs to improve retention rates.

METHODS

This cross-sectional study involved 155 RNs working in 37 nursing homes, spread across 10 South Korean cities. Data were collected from May to July 2019 using self-report questionnaires, with items relating to general and work-related characteristics, work-life balance, resilience, and burnout. Multiple regression analysis was performed to identify factors affecting participants' work-life balance, including variables that showed significant results in univariate analysis. All analyses were performed using the PASW SPSS win 26.0 program.

RESULTS

Participants' average age was 48.48 years, and they had been working as RNs for 17.36 years on average. Work-related physical pain was reported by 70.3% of participants. Resilience had a positive correlation with work-life balance (r = 0.38; P < .001), whereas burnout had a negative correlation with work-life balance (r = -0.45; P < .001). Work-related physical pain (β = -0.27; 95% confidence interval [CI], -25.89 to -7.48), resilience (β = 0.20; 95% CI, 0.02-0.70), and burnout (β = -0.33; 95% CI, -0.9 to -0.24) affected participants' work-life balance.

CONCLUSION

Interventions to facilitate work-life balance among nursing home RNs must aim to increase resilience and reduce burnout and work-related physical pain. A healthy work-life balance should improve RN retention in nursing homes, boosting the safety and quality of life of residents in turn.

State Regulation of Medication Administration by Unlicensed Assistive Personnel in Residential Care and Adult Day Services Settings

Residential care settings and adult day services are two community-based care options used by older adults with chronic health conditions. Most states have regulatory provisions that allow unlicensed assistive personnel (UAP) to administer medications. The current national policy study examined state regulations to identify which states permit UAP to administer medications, as well as staffing and training requirements. Key findings include states lack clear and adequate provisions for nurse oversight of UAP who administer medications, although adult day service regulations provide a greater level of nurse oversight than residential care settings. Specifically, 32 states require residential care to hire a nurse, but only six include provisions regarding nurse availability (e.g., on-call, on-site, number of hours). In contrast, 10 of 20 states that require adult day service programs to hire a nurse provide availability provisions. Nurse oversight of UAP is an important means of assuring quality care and reducing errors; thus, state regulatory agencies might need to strengthen nurse oversight provisions. [Res Gerontol Nurs. 2016; 9(5):209-222.].

Evaluation of a support worker role, within a nurse delegation and supervision model, for provision of medicines support for older people living at home: the Workforce Innovation for Safe and Effective (WISE) Medicines Care study

Background

Support with managing medicines at home is a common reason for older people to receive community nursing services. With population ageing and projected nurse shortages, reliance on nurses may not be sustainable. We developed and tested a new workforce model: ‘Workforce Innovation for Safe and Effective (WISE) Medicines Care’, which enabled nurses to delegate medicines support home visits for low-risk clients to support workers (known as community care aides [CCAs]). Primary study aims were to assess whether the model increased the number of medicines support home visits conducted by CCAs, explore nurses’, CCAs’ and consumers’ experiences with the CCAs’ expanded role, and identify enablers and barriers to delegation of medicines support.

Methods

A prospective before-after mixed-methods study was conducted within a community nursing service that employed a small number of CCAs. The CCAs’ main role prior to the WISE Medicines Care model was personal care, with a very limited role in medicines support. CCAs received training in medicines support, and nurses received training in assessment, delegation and supervision. Home visit data over two three-month periods were compared. Focus groups and interviews were conducted with purposive samples of nurses (n = 27), CCAs (n = 7) and consumers (n = 28).

Results

Medicines support visits by CCAs increased from 43/16,863 (0.25 %) to 714/21,552 (3.3 %) (p < 0.001). Nurses reported mostly positive experiences, and high levels of trust and confidence in CCAs. They reported that delegating to CCAs sometimes eliminated the need for duplicate nurse and CCA visits (for people requiring personal care plus medicines support) and enabled them to visit people with more complex needs. CCAs enjoyed their expanded role and were accepted by clients and/or carers. Nurses and CCAs reported effective communication when medicine-related problems occurred. No medication incidents involving CCAs were reported. Barriers to implementation included the limited number of CCAs employed in the organisation and reluctance from some nurses to delegate medicines support to CCAs. Enablers included training and support, existing relationships between CCAs and nurses, and positive staff attitudes.

Conclusions

Appropriately trained and supervised support workers can be used to support community nurses with providing medicines management for older people in the home care setting, particularly for those who are at low risk of adverse medication events or errors. The model was acceptable to nurses, clients and carers, and may offer a sustainable and safe and effective future workforce solution to provision of medicines support for older people in the home care setting.