Feature Article 

Nurse Staffing, Quality of Care, and Quality of Life in U.S. Nursing Homes, 1996–2011: An Integrative Review

Juh Hyun Shin, PhD, RN; Sung-Heui Bae, PhD, MPH, RN

  • Journal of Gerontological Nursing
  • December 2012 - Volume 38 · Issue 12: 46-53
  • DOI: 10.3928/00989134-20121106-04


The purpose of this study was to complete an integrated literature review of the relationship between staffing and quality outcomes in nursing homes. The majority of the reviewed studies showed better outcomes with higher nursing staff but depended heavily on cross-sectional observational studies and failed to differentiate RNs from other nursing staff. A total of 28 articles relating nurse staffing and quality outcomes were systematically reviewed and synthesized. However, each study examined different aspects of staffing and different resident or organizational outcomes, making determination of appropriate staffing levels difficult. The reviewed studies have not clearly defined the relationship between differing levels of nurse-staffing skill mix and specific structure, process, outcome, and composite indicators of quality. The inconsistent findings suggest that further research is needed in this area.


Dr. Shin is Part-Time Lecturer, College of Health Sciences, Division of Nursing Science, Ewha Womans University, Korea, and Dr. Bae is Assistant Professor, School of Nursing, University at Buffalo, The State University of New York, Buffalo, New York.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Juh Hyun Shin, PhD, RN, C-1008, Samho Garden 3 cha, Banpo 1 dong, Seochogu, Seoul, Republic of Korea; e-mail: iamjoohyun@hotmail.com.

Received: October 10, 2011
Accepted: April 20, 2012
Posted Online: November 15, 2012



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