Image of nurses' hands at computer keyboard

When it comes to caring for long-stay residents, rural nursing homes do better if they hit a staffing ratio of one full-time registered nurse for every four full-time nursing employees, according to recently published findings.

On average, rural facilities that reached this staffing ratio “significantly improved” on a composite quality score for long-stay residents, the investigators found. The composite score was determined using a variety of individual quality indicators, such as pressure sore and urinary tract infection prevalence.

“The higher the RN share was above this critical 25% point, the greater the impact it had on the composite quality measure,” the authors wrote.

The relationship between staffing and quality is not straightforward, the authors emphasized. For example, an increase in nurse hours per resident day was linked to generally poorer quality performance in freestanding rural facilities. However, boosting RN hours resulted in fewer physical restraints, and increasing aide hours improved pressure ulcer and daily living activities outcomes.

Further studies should focus on how different types of nurses contribute in particular ways to the care of long-stay residents, the investigators stated. They also acknowledged that hiring constraints might make it difficult for rural facilities to increase RN staffing.

Data came from a variety of government sources, including Certification and Survey Provider Enhanced Reports and Nursing Home Compare. The study covered the time period of 2006-2011 and included more than 5,000 rural nursing homes.

Complete findings appear in a policy brief from the University of Minnesota Rural Health Research Center.