Long-Term Care Nurse Staffing

**LONG-TERM CARE NURSE STAFFING**
Summary The purpose of this analysis was to determine the effect of nurse staffing patterns on pressure ulcer development and other resident outcomes in long-term care. A Clinical Practice Improvement study (the National Pressure Ulcer Long-Term Care Study (NPULS)) was conducted at 109 long-term care facilities between February 1, 1996, and October 31, 1997. More RN time/resident/day (based on increasing 10 minute increments with optimal being 30-40 minutes/resident/day) was associated with fewer pressure ulcers and better resident outcomes. More CNA and LPN time was associated only with fewer pressure ulcers, but not related to the other outcomes or treatments.
Primary QUESTION What is the optimal level of nurse staffing that is associated with better clinical outcomes for frail elderly long-term care residents? *Methods* We studied a total of 1,376 residents from the NPULS, 18 years of age or older, with length of stay at least 14 days, at risk of developing a pressure ulcer as defined by a Braden score of at most 17, but who did not have an existing pressure ulcer on entry to the study. Data were analyzed to determine long-term care outcomes that are associated with various nurse-staffing levels. Analyses were controlled for severity of illness, other patient factors, and facility characteristics. Multivariate analyses were performed on all data.	Results More RN time/resident/day (based on increasing 10 minute increments with optimal being 30-40 minutes/resident/day) was associated with fewer pressure ulcers, UTIs, hospitalizations, and deaths, and less weight loss, less deterioration of ADL function, less use of catheters, and greater use of oral medical nutrition supplements. More CNA and LPN time was associated only with fewer pressure ulcers, but not related to the other outcomes or treatments.
Impact Controlling for important variables in a large sample of long-term care residents at risk for pressure ulcers, RN time/resident/day was strongly and consistently associated with better outcomes. LPN and CNA time was weakly associated with only one outcome. Funding 30-40 minutes/resident/day of RN time would cost about $500,000 per 100 frail residents per year, but save $1,400,000 per year in avoided pressure ulcer treatment costs and hospitalization costs. Thus, about $9,000 per resident per year could be saved from what we are spending already to care for frail elderly long-term care residents.