Why Do We Require Registered Nurses in Nursing Homes? Using Longitudinal Hierarchical Linear Modeling

Abstract

Aims: To examine the relationship between nurse staffing and quality of care of nursing home residents, longitudinally. Background: Mixed results abound on the relationship between nurse staffing and quality of care of residents in nursing homes. Cross-sectional designs may underpin bias because the relationship between staffing and quality emerges over time, with latent unobserved variables. To offset this limitation, I used a longitudinal design in this study. Design: I used repeated quarterly survey methods. Methods: I measured staffing information with a formula developed by the Centers for Medicare & Medicaid Services. Outcome variables were 15 quality indicators and the Korean National Health Insurance Service 2015 nursing home evaluation manual. Results and Findings: As registered nurse hours per resident day increased by 1, the percentage of residents with depression decreased by 3.88%, and the prevalence of residents with nasogastric tubes increased by 1.17% in 3 months. Prevalence of residents with bed rest decreased by 5.72%, and residents with restraints decreased by 1.092%. More registered nurses and fewer certified nursing assistants or qualified care workers yielded a statistically significant negative influence on aggressive behavior, depression, weight loss, and bed rest. The higher turnover of total nursing staff related to more use of antidepressants. Conclusions: Results supported registered nurses' exclusive impact on resident outcomes. More longitudinal research is required to confirm the influence of nurses on nursing home residents' outcomes.