Feature ArticleThe effect of registered nurses on nursing home residents’ outcomes, controlling for organizational and health care market factors☆
Section snippets
Research design
A multilevel cross-sectional design was used to analyze nursing home data from 60 nursing homes in Korea. Disproportionate stratified random sampling was used to gain greater geographical representation across Korea. Using nursing home lists provided by the Korean National Insurance Corporation (total nursing home N = 1,647), the list was divided into subgroups of the 17 administrative districts and the researcher randomly assigned 1 to 5 nursing homes in each district. The researcher contacted
Variables and measures
Data accrued on nursing staff, organizational characteristics, and market-competition characteristics from participating organizations directly and from open-access government data.34
Independent variable
Organizational-level independent variables included RN HPRD and turnover rate, the proportion of Grade 1 and 2 (residents with severe need), and ownership (profit or nonprofit). RN staffing data for the previous week accrued directly from participating organizations and HPRD was calculated. Because the duty shift and allocation of nurse staffing differed by participating organizations, the exact number of hours during the previous week was collected. The method entailed dividing the total
Dependent variables
The dependent variables in this study were the proportion of residents with psychiatric medications (including antidepressants, antianxiety medications, and sleeping pills), and weight loss, which was applied based on the Minimum Data Set 3.0 Quality Measures by the Centers for Medicare & Medicaid.42
The proportion of residents with psychiatric medication was measured by the following formula:
Data analysis
A weighted linear regression model was used to test the hypotheses and perform preliminary analyses to confirm no violation of normality, linearity, and multicollinearity. RN HPRD and turnover data were entered at Step 1(Model 1); the proportion of residents with severe issues (Grade 1 and 2) at Step 2 (Model 2); and the HHI index, location, and RN number in each province and ownership type at Step 3 (Model 3).
Descriptive statistics on participating organizations
Table 1 summarizes the descriptive characteristics of participating organizations. Among the 60 participating organization, 68.4% did not employ any RN. The average number of beds was 74.53 (SD = 55.57). The average RN HPRD was 0.108 (6.48 minutes), CNA HPRD was 0.162 (9.72 minutes), and care worker HPRD was 2.58 (2 hours 34.8 minutes). The turnover rate of RNs was about 50.5%, of CNAs was 44.99%, and of care workers was 34.37%. Regarding residents’ health-related outcomes, each nursing home
Discussion
This study is quite meaningful in that it simultaneously entailed investigating RN characteristics and organizational and market characteristics on residents’ outcomes. The first and second hypotheses were partially supported. This study reported that the greater the supply of RNs in the province, the greater the use of psychotropic medications of residents, but supported the notion that more input of professional RNs in each nursing home (calculated as HPRD) aligned with a significant decrease
Limitations
The cause-and-effect relationship between nurse staffing and resident outcomes could not be confirmed in this observational cross-sectional design. All possible confounding factors that could relate to nurse staffing and resident outcomes should be investigated in the future, including financial resources or cost. Other healthcare factors should be studied in the future. Previous studies reported on size,14, 59 nursing home staff's demographic or educational characteristics and professional
Conclusion
This study had several policy implications for improving the quality of care of nursing home residents in Korea. Mandatory RN presence is required to decrease the number and incidence of residents with psychiatric medications and weight loss. A professional weight assessment, monitoring system, and medication-management system by RNs is urgent in nursing homes.
References (66)
- et al.
Comparing the nurse staffing in Korean and US nursing homes
Nurs Outlook
(2015) - et al.
To what extent do structural quality indicators of (nutritional) care influence malnutrition prevalence in nursing homes
Clin Nutr
(2015) - et al.
The effect of staffing on the quality of care at mealtime
Nurs Outlook
(1997) - et al.
Nutrition in care homes and home care: Recommendations—A summary based on the report approved by the Council of Europe
Clin Nutr
(2009) - et al.
Staffing subsidies and the quality of care in nursing homes
J Health Econ
(2015) Is long-term care insurance in South Korea a socializing care policy?
Crit Soc Policy
(2016)- Korean National Health Insurance Corporation. 2016Statistical Yearbook of Long-Term Care Insurance for the Elderly (No...
- et al.
Does market competition facilitate resident-centred care among nursing homes? A comparative analysis
Asia Pac J Soc Work
(2016) Work situation of care workers and an improvement plan
Welfare Trend
(2014)- et al.
The related factors with improvement of long-term care need of residents and quality of service in long-term care facility
Korean J Health Serv Manage
(2014)
Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care
BMJ Qual Saf
Why do we need registered nurses in nursing homes in Korea? Using a hierarchical linear model
J Nurs Scholarsh
Turnover, staffing, skill mix, and resident outcomes in a national sample of US nursing homes
J Nurs Adm
Nurse staffing and quality of care of nursing home residents in Korea
J Nurs Scholarsh
The influence of staffing characteristics on quality of care in nursing homes
Health Serv Res
Which organizational characteristics are associated with increased management of depression using antidepressants in US nursing homes?
Med Care
The relationship between registered nurses and nursing home quality: An integrative review (2008–2014)
Nurs Econ
Fall risk increasing drugs and injuries of the frail elderly—Evidence from administrative data
Pharmacoepidemiol Drug Saf
Potentially inappropriate medications in the elderly in Korean long-term care facilities
Drugs Real World Outcomes
Risk Factors of Potentially Inappropriate Medication Use and its Impact on Health Outcomes in Long-Term Care Settings (dissertation)
Status of polypharmacy and inappropriate medication use of the elderly in nursing homes
Korean J Health Serv Manage
Elderly nursing home residents, risk of malnutrition, and nutritional supplements: Our experience
Nutr Ther Metab
Nutritional management by dietitian at elderly nursing homes in Gyeonggi-do
J Korean Diet Assoc
Relationship of nursing home staffing to quality of care
Health Serv Res
The “nursing home compare” measure of urinary/fecal incontinence: Cross‐sectional variation, stability over time, and the impact of case mix
Health Serv Res
Cited by (0)
- ☆
This work was supported by a National Research Foundation of Korea (NRF) grant funded by the Korean Government (Ministry of Science, ICT & Future Planning), (2017R1A2B4003282).