Minimum Nursing Home Staffing Standards: A Good Start, But Not Quite There

Jasmine Travers

The pandemic shone a troubling spotlight on the unnecessary suffering resulting from substandard conditions in nursing homes. On Sep 6, 2023, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule for their widely anticipated minimum staffing requirements for long-term care facilities. A 2022 Nursing Home Staffing study that was convened to inform the development of these requirements followed an urgent plea from the Biden Administration and National Academies of Sciences, Engineering, and Medicine’s Committee on the Quality of Care in Nursing Homes for every nursing home to provide a sufficient number of staff so that the quality of care and safety in nursing homes might be addressed.

Tara Cortes

The proposed requirements.

An abundance of qualitative interviews, surveys, listening sessions, and comments from the public yielded the following staffing requirements:

  1. Minimum staffing hours per resident day (HPRD) for registered nurses (RNs)—0.55 HPRD—and nurse aides (NAs)—2.45 HPRD. Outside of these hours, sufficient additional nursing personnel, such […]
2023-10-19T10:05:15-04:00October 19th, 2023|Nursing, Nursing homes|1 Comment
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Staffing Tops ECRI 2022 Top 10 Patient Safety Concerns List for First Time

Staffing: the problem has ‘grown exponentially.’

Each year, ECRI Institute creates a list of top 10 patient safety concerns in order “to support organizations in their efforts to proactively identify and respond to threats to patient safety.” Over the years, some repeat offenders have made the cut, for example managing behavioral health, patient falls, and issues related to infection control.

Some of these concerns again appear on the 2022 top 10 patient safety concerns list, but the list also has some notable first-time offenders—a fact that reflects the conditions in which we’ve been living over the past two years during this global pandemic: These include COVID-19’s effect on clinicians’ mental health, vaccine coverage gaps, and supply chain disruptions, to name a few.

However, the number one concern this year is one that has been a central and unrelenting issue for nurses, even before the pandemic—staffing shortages.

According to the ECRI:

“The number one topic on this year’s list has been steadily growing throughout the COVID-19 pandemic and impacts patients and staff on all levels: staffing shortages…Prior to 2021, there was a growing shortage of both clinical and non-clinical staff, but the problem has grown exponentially. In early January 2022, it was estimated that 24% of US hospitals were critically […]

2022-03-24T10:04:38-04:00March 24th, 2022|Nursing|0 Comments
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No Country for Old People

In my editorial in the March issue, I ask, “Where do we go from here?’” in thinking about what’s next for nursing. In particular, I wonder if we’re going to make any strides in improving the quality of how we care for older adults who need long-term care.

Disasters give rise to assessments of what went wrong.

After prior disasters like hurricanes, heat waves, and flooding, there has often been a flurry of initial concern, with many committees convened to look at the deaths that occurred.

More recently, the New York Times has reported on the fate of nursing home residents during the Covid-19 pandemic in relation to the deterioration of quality in nursing homes once they are owned by for-profit entities—as 70% of nursing homes now are. So here we are once again, this time decrying the conditions revealed by Covid-19. Will things change this time?

In answer to this question, I’m especially pleased with the article in our March issue by 22 nurse gerontology experts. They issue a call (a challenge?) for the Centers for Medicare and Medicaid Services (CMS) Coronavirus Commission for Safety and Quality in Nursing Homes to rewrite standards to finally address under-resourcing and ensure residents get the care they […]

2021-03-15T15:33:48-04:00March 15th, 2021|COVID-19, nursing roles, patient safety, Patients|1 Comment
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Can We Ever Overcome Burnout in Nursing?

Reality shock redux.

Flickr / Harshit Sekhon

It seems to me that we’ve been talking about burnout about as long as I’ve been in nursing, and that’s over 40 years. In 1974, Marlene Kramer’s book Reality Shock: Why Nurses Leave Nursing reported on how nurses’ dissatisfaction with their inability to practice as they were taught was a major factor in their leaving the profession. (Here’s AJN’s 1975 review of the book.) In the 1980s, it was the downsizing of staff that caused many to leave (see the February editorial for my own experience). In the last decade, as health system changes and staffing (again) engendered moral distress and burnout among members, nursing organizations sought ways to mitigate distress among nurses.

Burnout’s persistence as an issue.

But the issue persists and arguably has gotten worse, with increasingly alarming reports of high levels of burnout—between 34% and 54% physicians and nurses report symptoms—and suicides.

To address the problem, the National Academies of Science, Engineering, and Medicine (NAM) established a 17-member committee to review the research on the […]

2020-02-18T11:56:44-05:00February 18th, 2020|Nursing|1 Comment
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Amidst Nursing’s Daily Challenges, a Longing for Enduring Meaning

Early ideals, current reality.

I recently co-facilitated a breakout session at a national nursing conference in which we had the participants reflect upon life experiences that sparked their initial desire to go into nursing.

Some knew from a very early age that they were drawn to providing care for others. Others, like myself, were second-career nurses who had spent time in other professions before making our way into nursing.

We spent time talking about our early idealism about the profession and the various experiences or issues that have challenged our ideals over time. I was struck by the deep and broad range of emotions in the room: pride, frustration, hope, discouragement, cynicism, and longing.

‘An almost palpable ache.’

It is the longing that stood out to me the most.

The nurses I met in that room, and nurses I meet everywhere, certainly express longing for better staffing, improved systems that facilitate smoother workflow, and a supportive work environment. But these are all longings that tie into one deeper longing, which is a longing for enduring meaning in our day-to-day work—as hard as some days may be—and a broader sense of […]

2019-05-06T09:17:18-04:00May 6th, 2019|Nursing, nursing career, nursing perspective, writing|1 Comment
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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