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Greater use of agency nurses in nursing homes may lead to poorer quality of care

Nursing homes often find it difficult to attract licensed nurses, due to lower salaries, greater administrative duties, and general lack of prestige. That, combined with the current nursing shortage, has prompted a growing number of nursing homes to use contract registered nurses (RNs) and licensed practical nurses (LPNs), commonly known as agency nurses. However, agency staffing is costly, disrupts continuity of care, and may contribute to poor quality of patient care, concludes a nursing home survey supported in part by the Agency for Healthcare Research and Quality (T32 HS00011).

Researchers found that use of agency nurses was associated with more nursing home deficiency citations, characteristics of poorer quality facilities, and tight labor markets. Twice as many nursing homes surveyed in 2002 used agency nurses than in 1992 (10 vs. 5 percent for RNs and 14 vs. 6 percent for LPNs). Nursing homes that heavily used agency nurses (5 percent or more of total full-time equivalent nurses) had the most health deficiency citations (indicating poor quality of care). Facilities that were for-profit without chain members were more likely to use 5 percent or more agency RNs or LPNS. Larger nursing homes in more competitive markets, rural facilities, and those with low occupancy rates and fewer private-pay residents also relied heavily on agency nurses.

These findings were based on analysis of 1992 through 2002 data from the On-line Survey Certification and Reporting System of resident data collected from 18,544 freestanding and hospital-based nursing facilities. These data are collected as part of the Federally required annual nursing home licensure and certification process. The researchers linked these data to provider records over time for each facility.

See "The use of contract licensed nursing staff in U.S. nursing homes," by Meg Bourbonniere, Ph.D., R.N., Zhanlian Feng, Ph.D., Orna Intrator, Ph.D., and others, in the February 2006 Medical Care Research and Review 63(1), pp. 88-109.

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