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Jurisdiction Over Nursing Care Systems in Nursing Homes: Latent Class Analysis

Corazzini, Kirsten N.; Anderson, Ruth A.; Mueller, Christine; Thorpe, Joshua M.; McConnell, Eleanor S.

doi: 10.1097/NNR.0b013e31823a8cc2

Background: In the context of declining registered nurse (RN) staffing levels in nursing homes, professional nursing jurisdiction over nursing care systems may erode.

Objective: The aim of this study was to develop a typology of professional nursing jurisdiction in nursing homes in relation to characteristics of RN staffing, drawing upon Abbott’s tasks and jurisdictions framework.

Methods: The study was a cross-sectional, observational study using the 2004 National Nursing Home Survey (n = 1,120 nursing homes). Latent class analysis was used to test whether RN staffing indicators differentiated facilities in a typology of RN jurisdiction and compared classes on key organizational environment characteristics. Multiple logistic regression analysis related the emergent classes to presence or absence of specialty care programs in eight clinical areas.

Results: Three classes of capacity for jurisdiction were identified, including low capacity (41% of homes) with low probabilities of having any indicators of RN jurisdiction, mixed capacity (26% of homes) with moderate to high probabilities of having higher RN education and staffing levels, and high capacity (32% of homes) with moderate to high probabilities of having almost all indicators of RN jurisdiction. High-capacity homes were more likely to have specialty care programs relative to low-capacity homes; such homes were less likely to be chain-owned and more likely to be larger, provide higher technical levels of patient care, have unionized nursing assistants, have a lower ratio of licensed practical nurses to RNs, and have an administrator with higher education level.

Discussion: Findings provide preliminary support for the theoretical framework as a starting point to move beyond extensive reliance on staffing levels and mix as indicators of quality. Furthermore, findings indicate the importance of RN specialty certification.

Kirsten N. Corazzini, PhD, is Associate Professor; and Ruth A. Anderson, PhD, RN, FAAN, is Virginia Stone Professor of Nursing, School of Nursing and Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina.

Christine Mueller, PhD, RN, FAAN, is Professor, School of Nursing, University of Minnesota, Twin Cities.

Joshua M. Thorpe, PhD, MPH, is Associate Professor, School of Pharmacy, University of Pittsburgh, Pennsylvania.

Eleanor S. McConnell, PhD, RN, GCNS, BC, is Associate Professor, School of Nursing and Center for the Study of Aging and Human Development, Duke University Medical Center, and Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina.

Accepted for publication September 27, 2011.

This research was supported in part by a National Institutes of Health/National Institute of Nursing Research Gerontological Nursing Interventions Research Center (5P30NR003979-13)/Hartford Center for Geriatric Nursing Excellence, University of Iowa mentoring grant (K.N. Corazzini) and the National Council of State Boards of Nursing Center for Regulatory Excellence (P19004; K. N. Corazzini).

The authors have no conflicts of interest to disclose.

Corresponding author: Kirsten N. Corazzini, PhD, Duke University School of Nursing, Box 3322 Duke University Medical Center, Durham, NC 27710 (e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.