There are more than 1.3 million residents in over 15,000 US nursing homes. Nursing homes are complex environments serving a variety of resident needs, including rehabilitative post-acute, end-of-life, or custodial long-term care. Facilities may be stand-alone (independently owned or belonging to a network of facilities) or part of integrated care networks that include hospitals and clinics or continuing care communities. Nursing home residents have diverse care needs and diagnoses that vary within and across facilities. Within nursing homes, direct care nursing staff (ie, registered nurses [RN], licensed vocational or practical nurses [LPN], and nursing assistants [NA]) are the primary caregivers for residents; thus, the level and characteristics of nursing staff are likely to impact resident well-being, health, safety, and quality of life.

Contents

• PREFACE
• ACKNOWLEDGMENTS
• EXECUTIVE SUMMARY
  • INTRODUCTION
  • METHODS
  • RESULTS
  • DISCUSSION
• ABBREVIATIONS TABLE
• INTRODUCTION
  • PURPOSE
  • BACKGROUND
• METHODS
  • TOPIC DEVELOPMENT
  • KEY QUESTIONS (KQ)
  • PROTOCOL
  • DATA SOURCES AND SEARCHES
  • STUDY SELECTION
  • DATA ABSTRACTION AND QUALITY ASSESSMENT
  • SYNTHESIS & CERTAINTY OF EVIDENCE
• RESULTS
  • OVERVIEW OF ELIGIBLE STUDIES
  • PRESSURE ULCERS
  • NURSING HOME-ASSOCIATED INFECTIONS
  • PAIN (MODERATE-SEVERE)
  • URINARY CATHETERS
  • FUNCTIONING
  • QUALITY OF LIFE
  • HOSPITALIZATIONS
  • DEFICIENCY CITATIONS FOR QUALITY OF CARE
  • OTHER OUTCOMES
• DISCUSSION
  • SUMMARY OF KEY FINDINGS
  • IMPLICATIONS FOR VA POLICY
  • RESEARCH GAPS/FUTURE RESEARCH
  • LIMITATIONS
  • CONCLUSIONS
• REFERENCES
• APPENDICES
  • APPENDIX A. SEARCH STRATEGIES
  • APPENDIX B. EXCLUDED STUDIES
  • APPENDIX C. CRITERIA USED IN QUALITY ASSESSMENT
  • APPENDIX D. QUALITY RATINGS FOR ALL ELIGIBLE STUDIES
  • APPENDIX E. PEER REVIEW DISPOSITION
  • APPENDIX F. EVIDENCE TABLES

Suggested citation:

Jutkowitz E, Landsteiner A, Ratner E, Shippee T, Madrigal C, Ullman K, Linskens E, Wilt TJ, and Duan-Porter W. Effects of Nurse Staffing on Processes of Care and Resident Outcomes in Nursing Homes: A Systematic Review. Washington, DC: Evidence Synthesis Program, Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs. VA ESP Project #09-009; 2022.

This report was prepared by the Evidence Synthesis Program Coordinating Center located at the Minneapolis VA Health Care System, directed by Timothy J. Wilt, MD, MPH and Wei Duan-Porter, MD, PhD and funded by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development.

The findings and conclusions in this document are those of the author(s) who are responsible for its contents and do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (eg, employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.