January 10th, 2018
state minimum staffing standards – Assessment of Evidence from the Literature Review
The studies evaluated provided equivocal support for use of state minimum staffing standards to advise staffing policies in nursing homes. Some findings indicated the importance of such standards in developing safe staffing procedures since state standards are generally higher than federal requirements, thus offering a basis for development of higher staffing standards. On the other hand, other findings were that state minimum standards could lead to decreased focus on staffing levels with indication that most nursing homes report staffing levels in excess of those specified by the standards. Recommendations from experts and nursing bodies however reveal higher minimal requirements than those envisaged in the standards and actual reports. Since two of the studies reviewed only relied on literature reviews, not involving meta-analysis, to support state minimum staffing levels, the level of evidence provided is not strong. Three studies that combined review of literature with independent evaluations however buttress the superiority of state minimum staffing standards over federal requirements, but also portray such standards’ inadequacy in guiding staffing practices in nursing homes.
Conclusion and Recommendations
Staffing levels in nursing homes are associated with various client, nurse and organizational outcomes. Out of an identified need for increased staffing, various states have developed minimum staffing standards to guide staffing in nursing homes. The focus of the current paper was to assess whether such standards offer effective guides to practice initiatives on staffing, through a review of literature.
From the reviewed literature, equivocal support of state minimum staffing standards in guiding staffing practices in nursing homes has been observed. Whereas such standards offer a guide due to their being higher than federal requirements, they nevertheless may demotivate nursing homes noted to have higher staffing levels than the standards, from focusing on enhancing staffing of their units. Additionally, recommendations from experts and nursing bodies suggest higher standards than those envisaged by the state minimum standards and the actual reported standards. Accordingly, this report recommends using such suggestions rather than state minimum staffing standards as the yardstick for ensuring safe staffing in nursing homes. Secondly, the study recommends increasing state minimum standards to make them cognizant of the actual staffing levels and expert recommendations. Increasing such standards should proceed through advocacy focused on state officials, with their general perspective that minimum staffing standards ought to be increased.
Dyck, M. J. (2007). Nursing staffing and resident outcomes in nursing homes: weight loss and dehydration. Journal of Nursing Care Quality, 22(1), 59-65.
Harrington, C. (2005a). Nurse staffing in nursing homes in the United States: part I Journal of Gerontological Nursing, 31(2),18-23.
Harrington, C. (2005b). Nurse staffing in nursing homes in the United States: part II. Journal of Gerontological Nursing, 31(3), 9-15.
Harrington, C. (2008). Nursing home staffing standards in state statutes and regulations. Retrieved May 27, 2011 from http://www.aanhr.org/factsheet/staffing.pdf
International Council of Nurses – ICN. (2006). Safe Staffing Saves Lives. Information and Action Tool Kit. Retrieved May 27, 2011, fromhttp://www.icn.ch/images/stories/documents/publications/ind/indkit2006.pdf
Janes, N., Sidani, S., Cott, C. & Rappolt, S. (2008). Figuring it out in the moment: A theory of unregulated care providers’ knowledge utilization in dementia care settings. Worldviews on Evidence-Based Nursing, (first quarter 2008), 13-24, doi:10.1111/j.1741-6787.2008.00114.x
Janz, K. (2004). All home care is not created equal – one view: Dramatic growth in home care industry creates unregulated workforce: More government oversight is needed. Geriatric Nursing, 26(1), 53-55. doi:10.1016/j.gerinurse.2004.11.011.
Maas, M. L., Specht, J. P., Buckwalter, K. C., Gittler, J. & Bechen, K. (2008). Nursinghome staffing and training recommendations for promoting older adults’qualityofcare and life: part 2. increasing nurse staffing and training. Research in Gerontological Nursing 1(2), 123-33. doi:10.3928/19404921-20080401-03.
Park, J. & Stearns, S. C. (2009). Effects of state minimum staffing standards on nursing home staffing and quality of care. Health Services Research, 44(1), 56-78, doi: 10.1111/j.1475-6773.2008.00906.x
Wells, J. C. (2004). The case for minimum nurse staffing standards in nursing homes: a review of literature. Alzheimer’s Care Quarterly, 15(1), 39-51.
Zhang, X. & Grabowski, D. C. (2004). Nursing home staffing and quality under the Nursing Home Reform Act. Gerontologist, 44 (1): 13–23, doi: 10.1093/geront/44.1.13.