Nursing Home Stress

According to Lee et al, one third of the 1.3 million NH residents live in nursing homes that have care quality and safety issues (Lee et al, 2014).

1 nurse: 40 residents… a dangerous and unsafe practice.

[endif]--Oh God, another call light just blinked, one CNA went to smoke again, Ms. Uptown (not her real name) ‘my wanderer’ is rolling along in her wheelchair with me and my med cart. Each time I enter a patient room; she rolls in, blocks the door and asks me “Aunty is you still going to call my mother for me when you’re done?” This was one of her constant requests, my 92-year-old frequent faller, demented, always wandering outside, and lovely patient. I was so full of adrenaline and moving so fast, all I could think was Ms. Uptown not again. My mind racing, slight panic, praying the infectious resident quarantined in the room at the end of the hall had gotten breakfast already. Some CNAs still did not accept how MRSA transmitted, without keen supervision, they may let this patient wait because they do not want to consistently gown up to enter his room. MRSA is resistant staph infection and requires personal protective equipment prior to entering the patient’s room. With one patient fall already this morning and that incident report incomplete, it was now 9:00 am and half my patients have not received their Am meds and feedings yet. An acute urge reminded me I had not peed, holding since 8:00 am and the restroom was definitely not an option right now! The speed, agility and quick wit required to conduct an AM med administration pass (7 to 3 shift in a nursing home) makes Spain’s running of the bulls pale in comparison. ![endif]--

The above scenario depicts understaffing in nursing homes; my assignment was one nurse: 40 residents; a dangerous and unsafe practice.

Over 1.6 million persons reside in nursing homes in the United States (Lowenstein, 2014). According to the Center for Public Integrity, residents of long-term care facilities are not treated equally (Lowenstein, 2014).

Ratio and Rates on Resident Quality of Life

Having witnessed firsthand the dangers of understaffing in nursing homes, and knowing that the greater number of nurses = less resident suffering and death. Perusal of the literature found data confirming what my initial fears were. Studies revealed:

Resident quality of life has a direct correlation to nurse staffing hours.

Residents’ quality of life and nurse staffing possesses a significant correlation with resident death (Hendrix, 2001).

When acute care nurses’ patient loads change from four to eight, mortality increased by 31% (Aiken, 2010).

A focus group study asserted that direct care nursing staff reported missing areas of care such as turning and repositioning patients, discharge planning, feedings, hygiene and ambulation, patient education. [endif]

Resident quality of life and nurse staffing hours is an indication of positive patient outcomes (Harrington et al, 2012).

Staff mix, nurse-staffing hours per resident day and overall nursing home staffing are significant variables to consider in evaluating outcomes for NH residents (Harrington et al, 2012).

Comparison of nurse staffing with quality of care illustrated that nursing homes with increased staffing rates achieved better performance on 13 of 16 elements of care.

Increased RN hours are associated with less decubiti pressure sores, (Lee, Blegen, & Harrington, 2014).

Understaffing Rates and Nurse Burnout

Nursing units with less nurses correlate with reduced patient outcomes, early ‘burnout’ and job dissatisfaction (Aiken, 2010).

Annual NH staff turnover rates 74.5% among NA, 56.1% among RNs, and 51.0% LPNs (Donoghue, 2010).

All nursing home direct care workers have one complaint in common: The consistent short staffing which produces very difficult working conditions and extreme safety risks for residents

Nurses complain of insufficient orientation to facility policies and procedures

Inadequate benefits contributes to nurse burn out

Fear for penalties to nursing license may trigger nurse burn out, job dissatisfaction and turnover

Best Practice Based On the Evidence

States should mandate increased nurse staffing levels in NH. Quality of care has substantially improved in Florida nursing homes since they increased nurse-staffing levels in 2001.

Nursing homes should increase number of nurses, namely registered nurses (McLellan, 2009).

NH in Florida, optimized costs by decreasing RN hours while, increasing NA and LPN.

Increased nurse to patient ratios is associated with better outcomes.-

Low staffing levels contribute to a culture of indignity for residents (Kim, 2009).

Increased RN staffing equals good quality of care outcomes.

Involve all direct care staff in resident care planning

Staff morale increases with team building

Develop mentor-mentee relationships when onboarding new staff