title: RN staffing time and outcomes of long-stay nursing home residents: pressure ulcers and other adverse outcomes are less likely as RNs spend more time on direct patient care.
abstract: 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.
authors.affiliation: Institute for Clinical Outcomes Research (ICOR). shorn@isisicor.com
authors.forename: Susan D
authors.initials: SD
authors.lastname: Horn
authors.forename: Peter
authors.initials: P
authors.lastname: Buerhaus
authors.forename: Nancy
authors.initials: N
authors.lastname: Bergstrom
authors.forename: Randall J
authors.initials: RJ
authors.lastname: Smout
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008134:Long-Term Care; D008297:Male; D009732:Nursing Care / Q000706:statistics & numerical data*; D009735:Nursing Homes; D009740:Nursing Staff / Q000600:supply & distribution*; D003668:Pressure Ulcer / Q000209:etiology*; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000209:etiology