Nursing Homes Need Nurses

By Amy M. Collins, managing editor

nursing home

Photo by Ulrich Joho, via Flickr.

Recently, the Association of Health Care Journalists (AHCJ) released updated nursing home inspection data, which is “derived from a large file that is split up for easier use by members.” (Members get a data set containing three years of the most severe deficiencies found during inspections, as well as current ratings assigned by the Centers for Medicare and Medicaid Services

[CMS]. To register for membership and gain access to more detailed information, click here.)

A news release put out by AHCJ based on their analysis of these ratings isn’t pretty. The latest number of deficiencies recorded by the CMS (which range from “isolated incident of actual harm” to “widespread immediate jeopardy to resident health or safety”) has reached 16,806.

Medicare ratings themselves have also been called into question in a recent article suggesting that nursing homes with the highest ratings may be gaming the system. Despite these ratings being the gold standard in the industry, the data they are based upon on is largely self-reported by the nursing homes and not verified by the government. Often, details such as fines and other enforcement actions by the state, as well as complaints filed by consumers with state agencies, are left out.

Could part of the problem be there aren’t enough nurses in nursing homes? An article in the New York Times states that, in evaluating Nursing Home Compare, the American Association of Nurse Assessment Coordination estimates that at least 11.4% of nursing homes don’t have RNs available around the clock (since data is self-reported, this could be higher). Yet studies show that care is improved when there are more RNs in nursing homes. (We published a 2005 original research study that found that increasing the amount of time that RNs spend with long-stay nursing home residents reduces pressure ulcers, hospitalization, and urinary tract infections.)

Anecdotally, I can say that I am sometimes dismayed by what I’ve seen in the nursing homes my grandmother has been in. There always seems to be a lack of staff—and with so many residents these days suffering from varying levels of dementia and memory problems, staff are needed more than ever. I’ve spoken with nurses and nurses’ assistants working in these homes, and staff-to-resident ratio is always a common complaint of those working there. In my grandmother’s current home, residents are piling in by the dozen, while the number of staff seems to remain the same.

In addition, several cousins of mine who work as nurses in nursing homes have told me that one of the biggest problems they face is staffing—they see residents sitting around all day losing mobility because there aren’t enough people to watch them and encourage them to get up out of their chairs.

According to the same Times article, Representative Jan Schakowsky (D-IL) has introduced the Put a Registered Nurse in the Nursing Home Act, which would require a direct-care nurse on site 24 hours a day, seven days a week, in any nursing home that receives Medicare or Medicaid reimbursement. If passed, this might help address some of the deficiencies at these homes, but I also think more staff in general, such as CNAs, are needed if nursing home residents are to get the care they need. The decision to move a loved one into one of these homes is, after all, made in order to keep them safe.

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2016-11-21T13:03:59+00:00 September 4th, 2014|nursing perspective, nursing research|14 Comments

About the Author:

Managing editor, American Journal of Nursing


  1. Tom Dolan September 16, 2014 at 10:10 pm

    Many people, including me, think that all too often we nurses ( LPNs and RNs) are too often passive-aggressive and overly negative. Sometimes negative talk about work and humor are
    good ways of dealing with sad or difficult work situations. But it can be done to excess. ” Thanks for insulting me” is over-the top.

  2. amiemc September 16, 2014 at 11:04 am

    To respond to the last comment, while this blog post cites a specific study that looks at RNs in nursing homes, the post goes on to say that I believe more staff in general (not just RNs) are needed so that patients get the care they need. By more staff I mean LPNs, CNAs, etc. The scope and focus of this blog was not to pit one type of nurse against another, but to hopefully raise awareness of safety issues in a vulnerable population of patients who need better care.

  3. Stephen Williams September 16, 2014 at 2:41 am

    First off as an LPN let me just say thank you for insulting us and not including us as part of the nursing staff when we make up the majority of the nurses at most long term care facilities. Secondly most LTC facilities are staffing with brand new RNs who are not as qualified or experienced. Age and experience discrimination is rampant across the board in all of the nursing fields. a factor that is not being considered in any of these studies and is seriously putting people at risk. I have seen people die from inexperienced RN’s making mistakes that an experienced LPN would have never made. How about we assess the whole picture here. It’s not just an RN problem or RN solution. As always it comes down to the bottom line and all medical facilities are out to do nothing more than maximize their profits.

  4. Byrrni September 15, 2014 at 10:13 am

    Nursing homes are no longer “rest homes” but individual, sub-acute hospitals. Post-op orthopedic, cardiac, stroke care, along with rehab and wound care, bring with them outlandish amounts of regulations and paperwork. Add to that corporate financial officers who dictate the number of nurses and aides can work each shift, no matter the acuity of care needed, and you have the recipe for what you find in nursing homes today.
    There are also “Standards” for medication prescribing and administration. A previous nurse mentioned 46 patients and one nurse on night shift. Of those 46, how many had orders for medications that required “30 minutes before (or after) meals”, multiple insulins (long and short acting), multiple eye drops (administer individually with a wait between), multiple inhalers (also with waits)? Medicating ONE individual might mean 5-6 personal contacts! All of these must be recorded on the medication record and many must be documented on the patient’s chart.
    Twelve hour shifts are too long for this type of demand.

  5. Elda Heckart September 6, 2014 at 5:06 pm

    I was in a nursing home for 6 weeks after my knee replacement. I received great loving care. The food was plentiful and excellent,my room was private (as all of the rooms are there) I know many are understaffed, treat your employees right and they will stay. If anyone is unkind to a resident, fire them.

  6. smvlpn September 5, 2014 at 4:36 pm

    I am an LPN and work in a nursing home now, night shift. I have 46 patients to care for. Most people may think patients sleep at night so that would very easy- I can assure you that is not the case. I also get stuck with most of the clean up paperwork that no one on days wants to do and tasks such as restocking supplies. It doesn’t leave a lot of time for hands on detailed care. RN has nothing to do with it. It’s a bit insulting to claim that if more “nurses” meaning RN s, were on staff patients would get better care. 46 med-psych patients to 1 nurse is too many. Period. Your title doesn’t change that.

  7. Gina Bea September 5, 2014 at 12:06 pm

    I know that every state receives funding from DHHS to arrange state Waiver programs thereby keeping the elderly poor in their homes versus sending them to nursing homes that they cannot afford. The Waiver programs include nursing assistance of various ranges but the hands on contact of direct assistance is contracted out to personal aids who have no official training that I have come to learn about. My mother is a participant in the Michigan Waiver Program. While she enjoys living independently, she has Parkinson’s Disease. No assistance with learning to use a walker, no oversight of her living on her own should she fall; she is too poor to access a nursing home because these institutions are too damn greedy to make end of life years, the twilight, meaningful and worthwhile for the elderly who are not going to live forever.

  8. Michelle Davis September 5, 2014 at 6:19 am

    All due respect; there ARE nurses in nursing homes–licensed practical NURSES. I’m disappointed with the RNs who can’t find work now want what they didn’t want before. Tsk! Tsk!

  9. Audrey September 4, 2014 at 9:42 pm

    Non profit organizations are selling these homes to for profit organizations due to cost of providing care vs. Reimbursement. Most are in the red and cannot break even. Most residents have medicaid as a payor source. For profit organizations come in cut payrates and staffing to attempt to make a profit. It not quality but quantity which counts for them.

  10. Brent Thompson PhD RN September 4, 2014 at 8:31 pm

    Another unspoken issue is that nursing homes are not seen as a desirable workplace by young nurses or by high quality administrators. Lower pay and little room for advancement does not attract the best and brightest. Administrators walk a financial tight rope to keep the place profitable by keeping staffing at a minimum, which also does not lead to innovation or satisfied workers.

  11. Cindy Taylor September 4, 2014 at 3:55 pm

    I am an RN who was laid off at my job in a Midwest hospital ER. It seems that the Midwest has a “glut” of nurses, many of whom are ADNs. That is who gets the hospital jobs, and most jobs want 12 hr shift workers. That leaves out a bunch of us who are RNs but do not or cannot work 12 hr. shifts! We are getting laid off either because we are near retirement or physically cannot work 12 hrs. on our feet. It would be nice if SOME place offered 8 hr shifts once again. I understand the young Moms reason for wanting those 12 shifts, and also the schedulers reasons, but they do have their problems. Then some LTC facilities only want nurses with LTC experience. Again, it puts us “others” out of the running. I can’t find a job. Offices and clinics here want CNA help, not RNS. We have gotten ourselves put clear out of business! RNs need to wake up and realize what is going on. Age discrimination is indeed alive and well.

  12. Darcy Estavillo September 4, 2014 at 3:20 pm

    It is important to realize that the problem runs deeper than what was written. Nursing homes are getting more and more people with severe mental illnesses because these people have no place to go. The thing is, nursing homes are not adapting to these changes. There is not enough training and the facilities are not designed for this. When I worked at the nursing homes in Cheyenne, Wyoming, I felt that my license was at stake all of the time and it hurt to know that I could not give these people that care that they deserve. Also, if you don’t treat your employees like they make a difference and are important, then they end up not caring either. It is a very sad sad situation. A change must be made, but where does one start?

  13. Sue September 4, 2014 at 12:43 pm

    I agree! There isn’t enough staff to care for the residents. I have worked in LTC for 10 years, staffing has always been an issue. We have several residents that have alarms to indicate when they are up and moving because they are a high fall risk. Again lack of staff to meet their needs.

  14. Judy Holmstrom September 4, 2014 at 11:24 am

    I worked in a nursing homes for 12 years as an LPN! I agree with your assessment, we need more staff at every level, RN’s, LPN’s and CNA’s. Also extra activity staff helps get residents moving and involved. Judy H., Ca.

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