nurse staffing issues - quality of care
Several Federal and State studies have found that a number of
nursing homes have seriously jeopardized the health and safety of
their residents to the point of causing serious injury or death in
some cases. These problems have been attributed in large part to
inadequate nurse staffing. To address the issue of staffing and
quality of care in nursing facilities, the Agency for Healthcare
Research and Quality supported (HS09814) a 1-day conference of
experts who met at New York University in April 1998.
The experts concluded that many nursing homes are indeed
operating with inadequate nursing staff levels that need to be
substantially improved. The expert panel recommended that there be
one full-time registered nurse (RN) director of nursing in every
nursing home and a full-time assistant director of nursing for
facilities with 100 beds or more (proportionately adjusted for
smaller facilities) to provide leadership and administration for
complex nursing services. In addition, at least one RN nursing
supervisor should be on duty on each shift 24 hours a day, 7 days
a week, in each nursing home due to the complex care requirements
of residents.
For 100-bed or larger facilities, the panel recommended a
minimum of three RNs—representing 10 minutes per resident day—and
a 24-hour RN nursing supervisor (15 minutes per resident day) for
a total of 25 administrative nursing minutes per resident day.
Facilities of this size also should have a full-time RN director
of in-service education to supervise an ongoing staff training
program. In addition to the licensed RNs, licensed vocational
nurses/licensed practical nurses (LVNs/LPNs) are needed to provide
direct care of residents (assessments, treatments and medications,
hands-on care, and supervision of nursing assistants).
The experts called for minimum ratios of one licensed nurse to
every 15 residents during the day shift, 1.20 in the evenings, and
1.30 at night. They also called for a ratio of one direct
caregiver (RNs, LVNs/LPNs, and nursing assistants) to five
residents on the day shift, 1.10 for evenings, and 1.15 for
nights. The panel recommended a shift away from the current use of
nursing assistants as the primary direct caregivers. At least 14
minutes of the total 2.93 hours of direct resident care per day
should be given by RNs or LPN/LVNs, according to the experts.
See "Experts recommend minimum nurse staffing standards for
nursing facilities in the United States," by Charlene Harrington,
Ph.D., R.N., Christine Kovner, Ph.D., R.N., Mathy Mezey, Ph.D.,
R.N., and others, in the February 2000 issue of The
Gerontologist 40(1), pp. 5-16.
Reprints are available from the AHRQ Publications
Clearinghouse.
These are excerpts from the AHRQ Research Activities,
you can read their full reports at
http://www.ahrq.gov/research/jun00/0600ra14.htm |