The effect of registered nurses on nursing home residents' outcomes, controlling for organizational and health care market factors

Abstract

Despite cumulative and integrative evidence of registered nurse (RN) staffing on nursing home residents' outcomes worldwide, few studies integrate the effects of residents' case mix, healthcare markets, and nurse staffing on psychotropic-medication use and weight loss in Korea. This article examined the relationship between nurse staffing and residents' quality-of-care outcomes, controlling for long-term healthcare market characteristics in Korea. Using a multilevel cross-sectional design, a disproportionate stratified random sampling was used. Of 87 nursing homes contacted, 60 agreed to participate. Weighted linear regression was used to test the hypotheses. RN hours per resident day (HPRD) had a statistically significant positive impact on reducing the number of residents with psychotropic medication (beta = -.331, p = .008). Greater RN HPRD positively marginally related to fewer residents with cognitive impairment (beta = - 0.201, p = .139). Higher turnover of RN staff related to decreased proportions of residents with weight loss (beta = -.331 p = .008). Policy-makers should cautiously consider requiring mandatory nurse staffing in nursing homes in Korea, where it is still acceptable to have certified nurse aids as substitutes for RNs. (C) 2018 Elsevier Inc. All rights reserved.