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The Relationship Between Nursing Staff Levels, Skill Mix, and Deficiencies in Maryland Nursing Homes

Lerner, Nancy B. DNP, RN

doi: 10.1097/HCM.0b013e31828ef5f9

The objective of this data analysis was to explore whether nurse staffing levels and skill mix influenced the number and severity of nursing home deficiencies in Maryland nursing homes. Nursing staff levels and skill mix in relation to quality outcomes in nursing homes have been explored with inconsistent results. Two multiple regression analyses were done to explore factors influencing deficiencies and the severity of the deficiencies found during the annual survey process. The factors influencing the number of deficiencies were the number of nursing home beds (β = .29), nursing assistant hours per patient-day (β = −.206), and the location of the nursing home (β = −.138). The only factor influencing the severity of the deficiencies was RN hours per patient-day (β = −.199). In conclusion, it was determined that RN staffing, although not associated with the number of deficiencies, is associated with deficiency severity.

Author Affiliation: University of Maryland, School of Nursing, Baltimore.

The author has no conflicts of interest.

Correspondence: Nancy B. Lerner, DNP, RN, 655 W Lombard St, 325A, Baltimore, MD 21201 (

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins