Variations in daily staffing levels at nursing homes were connected to higher quality and survey rankings, according to a new study published in JAMA Network Open. 

Investigators found that facilities with significant daily variations among both RNs and CNAs had lower quality and Five Star survey rankings. They also found a significant association between nursing home ownership and high staffing variability, suggesting that for-profit facilities tend to have less stable staffing and bring into question their quality. 

The California-based research team used data from more than 13,300 nursing homes between 2017 and 2018 to calculate daily hours worked for both registered nurses and certified nursing assistants. 

Findings, from an organizational perspective, mean that unstable staffing impedes management’s ability to create a high-reliability organization with consistent and safe workflows. 

“Everyday tasks, such as medication administration and monitoring, can be adversely affected by both inadequate staffing and a lack of stability in staffing availability,” investigators concluded

“Most of these consequences of short staffing cannot be fixed by additional staff on other days: more turning or toileting on extra-staffing days cannot eliminate the fall or the wound development that occurred when understaffed,” they added. 

The Centers for Medicare & Medicaid Services earlier this year began posting nursing home staff turnover rates and weekend staffing levels on the public-facing Compare website. The agency also will begin incorporating the data into the Five Star rating system starting in July.