Rural facilities with higher ratios of RNs are associated with better outcomes, but the right staffing mix might be difficult to achieve.

A study published early this year by the University of Minnesota Rural Health Research Center found that having at least one full-time equivalent registered nurse among every four full-time nursing employees led to significant improvements for long-stay residents in both hospital-based and freestanding nursing homes. The study compared hiring stats with quality indicators and a composite quality score included in the Nursing Home Compare database. 

Nearly 5,100 rural facilities were involved, with the study analyzing rates of pressure sores, catheter insertion, physical restraint, urinary tract infections and help with activities of daily living.

The authors found RN shares higher than the “critical” 25% marker had an even greater impact on the composite score. They also indicated further research was needed to understand how RN staffing affected specific patient care strategies.

Hiring more RNs in rural areas remains a challenge. There are fewer RNs per capita and many are nearing retirement age.

“These factors may make it especially difficult for many rural nursing homes with nursing shortages to increase the supply of RNs,” the authors reported.