The Relationship Between Nurse Staffing and Quality Outcomes in Georgia Nursing Homes

The Relationship Between Nurse Staffing and Quality Outcomes in Georgia Nursing Homes by Tamara Kathleen Stephens MSN, Walden University, 2012 ASN, Georgia Perimeter College, 2003 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Nursing Education Walden University August 2018 Abstract The quality of care in United States’ nursing homes has been of concern to consumers, government agencies, and researchers for several decades. Nurse staffing has been identified as a key factor influencing the quality of care in nursing homes. The purpose of this quantitative, correlational research was to determine if relationships existed between nurse staffing levels and three quality care outcomes in the state of Georgia. Donabedian’s quality conceptual framework guided the study. The framework encompasses three interrelated dimensions of quality including structure, process, and outcomes. Nurse staffing levels and facility bed size represented the structure of nursing homes and pressure ulcers, falls with major injury, and urinary tract infections each represented facility outcomes. The sample included 348 nursing homes in Georgia. Data was collected from the Nursing Home Compare website. The predictor variables in this study were nurse staffing levels of registered nurses, licensed practical nurses, certified nursing assistants, and total nurse staffing levels. The outcome variables were pressure ulcers, urinary tract infections, and falls with major injury. A cross sectional design and multiple regressions were used to analyze the relationship between nurse staffing and quality of care outcomes. While the results of the study did not reveal significant relationships between variables, the study nonetheless offers useful insight on how future studies can be enhanced. These findings have implications for social changes as they may help to inform Georgia policy makers in decisions regarding regulations that mandate minimum nurse staffing standards.The quality of care in United States’ nursing homes has been of concern to consumers, government agencies, and researchers for several decades. Nurse staffing has been identified as a key factor influencing the quality of care in nursing homes. The purpose of this quantitative, correlational research was to determine if relationships existed between nurse staffing levels and three quality care outcomes in the state of Georgia. Donabedian’s quality conceptual framework guided the study. The framework encompasses three interrelated dimensions of quality including structure, process, and outcomes. Nurse staffing levels and facility bed size represented the structure of nursing homes and pressure ulcers, falls with major injury, and urinary tract infections each represented facility outcomes. The sample included 348 nursing homes in Georgia. Data was collected from the Nursing Home Compare website. The predictor variables in this study were nurse staffing levels of registered nurses, licensed practical nurses, certified nursing assistants, and total nurse staffing levels. The outcome variables were pressure ulcers, urinary tract infections, and falls with major injury. A cross sectional design and multiple regressions were used to analyze the relationship between nurse staffing and quality of care outcomes. While the results of the study did not reveal significant relationships between variables, the study nonetheless offers useful insight on how future studies can be enhanced. These findings have implications for social changes as they may help to inform Georgia policy makers in decisions regarding regulations that mandate minimum nurse staffing standards. The Relationship Between Nurse Staffing and Quality Outcomes in Georgia Nursing Homes by Tamara Kathleen Stephens MSN, Walden University, 2012 ASN, Georgia Perimeter College, 2003 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Nursing Education Walden University August 2018 Dedication To my grandmother Julia Mae Hayes, while she is no longer with us in the physical form, I know without doubt that her strength is the strength that keeps me going. I love and miss you, Grandma. Acknowledgments I’ve used thousands of words throughout this document to explain my study; it would take thousands more to fully express my gratitude for my committee chair, Dr. Leslie Hussey. She did not forget me and for that I am eternally grateful. Dr. Hussey’s concise and quick feedback, along with her dedication to student progression and success provided me with the exact guidance and direction I needed to complete this academic journey. I also would like to acknowledge and express gratitude for my committee member, Dr. Debra Sullivan whose kindness, timeliness, and clear communication also helped me keep moving forward. Also to my husband, Andre and sons Khigh, Tahj, and Shai I would not have been successful without the love, patience, and support you each provided to me. I’m not sure how many dinners went uncooked because I needed to “do school work”, but thank you for not ever complaining and allowing me to take all the time I needed. I will always be convinced that I have the best family ever. Last but not least, to my parents whose unique ways of loving me was everything I needed to strive for greatness.