This month's issue contains an important review of the literature on the relationship between staffing in nursing homes and quality of care by Mary Ellen Dellefield. This article is particularly timely in light of recently published recommendations on rninimum nurse staffing standards for nursing facilities that appeared in The Gerontologist (Harrington et al., 2000), nursing home survey data from the U.S. Office of the Inspector General (1999) implicating inadequate staffing as a major contributor to poor quality outcomes, and a 1996 Institute of Medicine report to which I contributed (Maas, Buckwalter, & Specht, 1996) documenting the relationship between quality of care in nursing homes and nurse staffing patterns.
The nurse-led expert panel was convened in the spring of 1998 by the John A. Hartford Institute for Geriatric Nursing and included leading gerontological nurses, as well as long-term care administrators, consumers, health services researchers, and economists. Building on extensive review of data from government reports and research findings on this topic, the majority of the panel concluded that nurse staffing levels (RN, LVN/LPN) were critical factors in ensuring high-quality nursing home care, and supported the need for increased minimum nurse staffing levels in these facilities. The panel endorsed a series of recommendations covering (Harrington et al., 2000):
* Administrative staff.
* Licensed nursing staff.
* Direct care nurse staff.
* Adjusting for resident case mix.
* Staff at mealtime.
* Education and training.
* Training for nursing assistants.
* Costs associated with staff increases.
Journal of Gerontological Nursing readers are urged to familiarize themselves with the panel's report, in addition to related policy initiatives in their respective states, to continue to conduct and participate in research in the area of inadequate staffing and to advocate for increased resources to meet the needs of nursing home residents. Improving quality of care and reducing stafi attrition in nursing homes will continue to be a topic of high relevance for this journal. I invite your contributions of articles in this area, particularly to our Public Policy section.
Kathleen C. Buckwalter
- Harrington, C, Kovner, C, Mezey, M., Kayser-Jones, J., Burger, S., Mohler, M., Burke, R., & Zimmerman, D. (2000). Experts recommend minimum nurse staffing standards for nursing facilities in the United States. The Gerontologist, 40(1), 5-16.
- Maas, M., Buckwalter, K. & Specht, J. (1996). Nursing staff and quality of care in nursing homes. In: Institute of Medicine, Nursing staff in hospitals and nursing homes: Is it adequate? (pp. 361-424). Washington, DC: National Academy Press.
- U.S. Office of the Inspector General, Department of Health and Human Services (1999). Nursing home survey and certification: Deficiency trends (OE1-0298-00331). Washington, DC.