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Experts recommend minimum nurse staffing standards for U.S. nursing homes

Several Federal and State studies have found that a number of nursing homes have seriously jeopardized the health and safety of their residents to the point of causing serious injury or death in some cases. These problems have been attributed in large part to inadequate nurse staffing. To address the issue of staffing and quality of care in nursing facilities, the Agency for Healthcare Research and Quality supported (HS09814) a 1-day conference of experts who met at New York University in April 1998.

The experts concluded that many nursing homes are indeed operating with inadequate nursing staff levels that need to be substantially improved. The expert panel recommended that there be one full-time registered nurse (RN) director of nursing in every nursing home and a full-time assistant director of nursing for facilities with 100 beds or more (proportionately adjusted for smaller facilities) to provide leadership and administration for complex nursing services. In addition, at least one RN nursing supervisor should be on duty on each shift 24 hours a day, 7 days a week, in each nursing home due to the complex care requirements of residents.

For 100-bed or larger facilities, the panel recommended a minimum of three RNs—representing 10 minutes per resident day—and a 24-hour RN nursing supervisor (15 minutes per resident day) for a total of 25 administrative nursing minutes per resident day. Facilities of this size also should have a full-time RN director of in-service education to supervise an ongoing staff training program. In addition to the licensed RNs, licensed vocational nurses/licensed practical nurses (LVNs/LPNs) are needed to provide direct care of residents (assessments, treatments and medications, hands-on care, and supervision of nursing assistants).

The experts called for minimum ratios of one licensed nurse to every 15 residents during the day shift, 1.20 in the evenings, and 1.30 at night. They also called for a ratio of one direct caregiver (RNs, LVNs/LPNs, and nursing assistants) to five residents on the day shift, 1.10 for evenings, and 1.15 for nights. The panel recommended a shift away from the current use of nursing assistants as the primary direct caregivers. At least 14 minutes of the total 2.93 hours of direct resident care per day should be given by RNs or LPN/LVNs, according to the experts.

See "Experts recommend minimum nurse staffing standards for nursing facilities in the United States," by Charlene Harrington, Ph.D., R.N., Christine Kovner, Ph.D., R.N., Mathy Mezey, Ph.D., R.N., and others, in the February 2000 issue of The Gerontologist 40(1), pp. 5-16.

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