The Relationship Between Registered Nurses and Nursing Home Quality

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Nursing home care is expensive; it is second only to acute hospital care for impatient Medicare costs.  The increased focus on costs of care accrued by Medicare beneficiaries in Nursing Homes presents a valuable opportunity for registered nurses ((RNs) to further demonstrate quantitatively the value they add to the nursing home skill mix to provide cost-effective and efficient quality of care.  Paraprofessionals (nursing assistants, certified nursing assistants, restorative nursing assistants and licensed practical nurses (LPNs) have provided the majority of direct care to nursing home residents since 1965.  Registered nurses increase the skill mix of this workforce.  Skill mix refers to differences in education and licensure among the nursing staff. 

Researchers have reported a positive relationship between RN involvement in decision making and better clinical outcomes.  This review of research findings is made in an effort to advance the evidence –base supporting the proposition that RNs add value to nursing home resident’s experiences both directly through the level of RN staffing and indirectly through the clinical leadership they provide to members of the nursing skill mix.


Research on the relationship of RNs and nursing home quality must continue.  Nursing researchers are challenged to better demonstrate how the increased presence of RNs on each shift has the potential to enhance the cost effectiveness, efficiency and quality of nursing homes. Nursing faculty and leaders are challenged to find ways that help nursing students recognize RN practice in a nursing home as a complex, challenging, and a setting in which nursing homes will benefit on both an individual and system level from their presence.

  • The increased focus of costs of care by Medicare beneficiaries in nursing homes present a valuable opportunity for RNs to further demonstrate quantitatively the value they add to the capacity of the nursing home nursing skill mix to provide cost-effective and efficient quality care.
  • Most of the studies included in this review consistently reported that higher RN staffing and higher ratios of RNs in the nursing skill mix are related to better quality.
  • There are concerns about the costs of employing more highly skilled RNs and directors of nursing that have the potential to positively influence members of the nursing skill mix will continue to influence nursing home industry hiring practices.

Summary of Article in Medscape titled The Relationship Between RNs and Nursing Home Quality 6/30/2015. 


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