OBJECTIVE: A clear link has been demonstrated between lower nurse staffing levels in hospitals and adverse patient outcomes, but the results of studies of such relationships in long-term care facilities haven’t been as clear. This study explored the time nurses spent in direct care and how it affected outcomes in long-stay (two weeks or longer) nursing home residents.
METHODS: In a retrospective study of data collected as part of the National Pressure Ulcer Long-Term Study (NPULS), we analyzed data on 1,376 residents of 82 long-term care facilities whose lengths of stay were 14 days or longer, who were at risk of developing pressure ulcers but had none at study entry, and who had a Braden Scale score of 17 or less. Primary data came from residents’ medical records during 12-week periods in 1996 and 1997. Dependent variables included development of pressure ulcer or urinary tract infection (UTI), weight loss, deterioration in the ability to perform activities of daily living (ADLs), and hospitalization. Independent variables included resident demographics, severity of illness, nutritional and incontinence interventions, medications, and nurse staffing time.
RESULTS: More RN direct care time per resident per day (examined in 10-minute increments up to 30 to 40 minutes per resident per day) was associated with fewer pressure ulcers, hospitalizations, and UTIs; less weight loss, catheterization, and deterioration in the ability to perform ADLs; and greater use of oral standard medical nutritional supplements. More certified nursing assistant and licensed practical nurse time was associated with fewer pressure ulcers but did not improve other outcomes.
CONCLUSIONS: The researchers controlled for important variables in long-stay nursing home residents at risk for pressure ulcers and found that more RN direct care time per resident per day was strongly associated with better outcomes. There’s an urgent need for further research to confirm these findings and, if confirmed, for improving RN staffing in nursing homes to decrease avoidable adverse outcomes and suffering.
A new study explores the time nurses spent in direct care and how it affected outcomes in long-stay (two weeks or longer) nursing home residents.
Susan D. Horn is the senior scientist at the Institute for Clinical Outcomes Research (ICOR), vice president of research for International Severity Information Systems, Inc. (ISIS), and an adjunct professor, Department of Medical Informatics, University of Utah School of Medicine, Salt Lake City. Peter Buerhaus is the Valere Potter Professor and senior associate dean for research, Vanderbilt University School of Nursing, Nashville, TN. Nancy Bergstrom is the Theodore J. and Mary E. Trumble Professor of Aging Research and director of the Center on Aging, University of Texas Health Science Center, Houston. Randall J. Smout is the senior analyst, also at ISIS–ICOR. Contact author: firstname.lastname@example.org.
Disclosures: Ross Products Division of Abbott Laboratories and Hill-Rom, Inc. awarded ISIS a contract to design and manage the National Pressure Ulcer Long-Term Care Study (NPULS) that provided the data used for this research. Nancy Bergstrom was an unpaid consultant to the NPULS project. Analyses included in this paper were funded by ICOR. Susan Horn was the principal investigator on the development of the Comprehensive Severity Index (CSI) while she was a faculty member at The Johns Hopkins Medical Institutions in Baltimore, MD. The CSI is an assessment tool used in this and other research. CSI is owned by ISIS, a company in which Susan Horn holds stock.