Nursing homes using more agency staff have lower quality of care

Research Activities, June 2010, No. 358

Nursing homes have well-documented staffing problems, including high turnover rates, problems with absenteeism, and low staffing levels. Given these problems, many nursing homes use agencies to meet their staffing needs for nurse aides (NAs), licensed practical nurses (LPNs), and registered nurses (RNs). Nursing homes with the highest use of agency staff have a clinically significant lower quality of care, according to Nicholas G. Castle, Ph.D., of the University of Pittsburgh.

In many cases, the difference between no agency use and 25 percent or more agency use translates to a 1 or 2 percent difference in quality scores. Considered cumulatively, the impact on quality is large and may be meaningful for nursing home residents, notes the author. He examined how the use of agency staff affects the Nursing Home Quality Measures. Findings showed that 8 of 15 measures for NAs, 6 of 15 measures for RNs, and 4 of 15 measures for LPNs were significantly associated with the use of agency staff. He concluded that on the whole it was likely that no use of agency staff was associated with better care quality and higher use of agency staff was associated with worse quality.

Dr. Castle surveyed almost 3,900 nursing homes. More than 40 percent of these facilities used some NA agency staff, with fewer facilities using RN agency staff (30 percent) or LPN agency staff (20 percent). However, the actual percentage of positions filled by agency staff was around 5 percent for RNs, LPNs, and NAs. The author suggests that nursing homes carefully consider before using high levels of agency staff. This study was supported by the Agency for Healthcare Research and Quality (HS16808).

See "Use of agency staff in nursing homes," by Dr. Castle in Research in Gerontological Nursing 2(3), pp. 192-201, 2009.

Current as of June 2010
Internet Citation: Nursing homes using more agency staff have lower quality of care: Research Activities, June 2010, No. 358. June 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://archive.ahrq.gov/news/newsletters/research-activities/jun10/0610RA11.html