Effectiveness of State Minimum Staffing Standards in Achieving Safe Nurse-Staffing Levels in Nursing Homes


Staffing levels in nursing homes are associated with various client, nurse and organizational outcomes. Arising from the need to increase the number of professional healthcare providers in the nursing-home setting to better client outcomes, many states in the U.S. have developed minimum staffing standards, in addition to requirements by the federal government. This paper reviews whether such standards are effective guidelines to advise staffing practices in nursing homes. The paper used studies generated from searches in CINAHL, Ovid and Academic Search Complete to identify whether there is evidence of effect of state minimum staffing standards. Out of the generated results, five studies were chosen for review process based on the type of evidence and relevance to the topic. The evidence generated was equivocal regarding the use of such standards to advice safe staffing practices. Therefore, state minimum staffing standards may not offer a sound staffing guideline especially with nursing homes whose actual reported staffing levels are above such state defined minimums.

Keywords. State minimum staffing standards, Nursing home, Geriatric care


A challenge facing healthcare systems across the globe is the provision of quality care to all the population in need of such care. Many care-provision settings face this challenge out of the scarcity of healthcare professionals, thus necessitating the utilization of unregulated healthcare workers (UHWs) to meet the shortage (International Council of Nurses – ICN, 2006; Janes, Sidani, Cott, & Rappolt, 2008). In other settings (e.g. in institutionalized and home-based care for elderly), the use of UHWs is however driven more by cost considerations, with use of UHWs perceived to be cheaper than hiring of nursing professionals – e.g. RNs and LVNs (Janz 2004). Use of UHWs is however associated with adverse care outcomes (Janes et al., 2008), whereas nurse-staffing levels have been shown to correlate positively with resident outcomes in nursing homes (Dyck, 2007). Such a scenario has highlighted the need for safe-staffing practices in care environments.

Observations that care provision settings may be using UHWs as a cost-control approach has led to recommendations for government regulation in such settings (Janz, 2004). With respect to nursing homes, arising from such recommendations has been the development of standards in various states, additional to those provided by federal government, to guide such institutions on minimum nurse staffing (Harrington, 2008). Effects of such standards on alleviating nurse-staffing challenges in nursing homes are however ambiguous (Park & Stearns, 2009). Accordingly, this paper seeks to find out whether state minimum staffing standards are effective guides in developing optimal staffing levels in nursing homes. To answer this question, the paper presents a review of literature assessing effect of such standards and those comparing such standards with other staffing recommendations.

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