title: Consistent assignment of nursing staff to residents in nursing homes: a critical review of conceptual and methodological issues.
abstract: OBJECTIVE
  Consistent assignment of nursing staff to residents is promoted by a number of national organizations as a strategy for improving nursing home quality and is included in pay for performance schedules in several states. However, research has shown inconsistent effects of consistent assignment on quality outcomes. In order to advance the state of the science of research on consistent assignment and inform current practice and policy, a literature review was conducted to critique conceptual and methodological understandings of consistent assignment.
  
  
  METHODS
  Twenty original research reports of consistent assignment in nursing homes were found through a variety of search strategies.
  
  
  RESULTS
  Consistent assignment was conceptualized and operationalized in multiple ways with little overlap from study to study. There was a lack of established methods to measure consistent assignment. Methodological limitations included a lack of control and statistical analyses of group differences in experimental-level studies, small sample sizes, lack of attention to confounds in multicomponent interventions, and outcomes that were not theoretically linked.
  
  
  CONCLUSIONS
  Future research should focus on developing a conceptual understanding of consistent assignment focused on definition, measurement, and links to outcomes. To inform current policies, testing consistent assignment should include attention to contexts within and levels at which it is most effective.
authors.affiliation: Geriatric Research Education & Clinical Center (GRECC), William S. Middleton Veteran Affairs Hospital, Madison, Wisconsin. School of Nursing, University of Wisconsin, Madison. tjbeal@wisc.edu.
authors.forename: Tonya
authors.initials: T
authors.lastname: Roberts
authors.affiliation: School of Nursing, University of Wisconsin, Madison.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Nolet
authors.affiliation: School of Nursing, University of Wisconsin, Madison.
authors.forename: Barbara
authors.initials: B
authors.lastname: Bowers
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006707:Homes for the Aged; D006801:Humans; D009723:Nurse-Patient Relations; D009728:Nursing Assistants / Q000600:supply & distribution*; D009735:Nursing Homes; D009740:Nursing Staff / Q000600:supply & distribution*; D010561:Personnel Staffing and Scheduling; D011787:Quality of Health Care / Q000592:standards / Q000706:statistics & numerical data; D000078329:Workforce
keywords: Consistent assignment; Nursing homes; Nursing studies; Organizational and institutional issues