The relationship between nursing staffing levels and nursing home outcomes.

This study examined the effects of selected Minnesota nursing home attributes (size, ownership, noncompliance with a state correction order, and licensed and nonlicensed nursing hours) on specific outcomes (functional ability, discharge home, and death) for residents ages 65 and older, controlling for residents' age and previous functional ability. The functional outcome was operationalized by calculating the resident's Total Dependence Score (TDS), the total score on the assessment of eight activities of daily living (score range: 0-33). Ordinary least squares regression analysis was used to estimate the effects of facility attributes, admission TDS, and age on resident outcomes, and nonlinear probability analyses were used to estimate the effects of facility attributes, admission TDS, and age on the probability of death or discharge home. In the year after admission, licensed (but not nonlicensed) nursing homes were significantly related to improved functional ability, increased probability of discharge home, and decreased probability of death, but when limited to chronic residents, the role of professional nursing hours virtually disappears. Overall, the findings support greater use of licensed nurses in the nursing home setting.

Research considerations: nursing home quality perceptions.

1. One of our nation's most challenging health care problems is providing quality care for nursing home residents. Those of us who desire to evaluate and to improve the quality of care provided in a nursing home must attempt to define quality in specific terms, even though it is a product of many factors. 2. Ideally, there should be congruence between resident and staff perceptions of the importance and occurrence of indicators of quality in a nursing home setting. However, minimal to moderate congruence of perceptions was found in this study. 3. The fact that the majority of 30 residents in two nursing homes considered these 17 quality indicators to be important further validates them as markers of the quality of care in nursing homes. Use of a comprehensive quality assurance process that includes some or all of these indicators for evaluating and improving care in nursing homes could demonstrate a real commitment to quality that would go beyond only responding to the requirements of consumers and external regulators.

Gerontological nursing practice standards: achievement and importance.

The 1987 ANA Standards of Gerontological Nursing Practice is compared with the 1976 Standards and found to be a new document, not simply a revision. These 1987 standards are assessed using five queries: progression, timeliness, adequacy of scope, substance, and form. Eighteen nurses practicing at a long term care facility in the midwest rated both the achievement and importance of these new standards. Descriptive data analysis demonstrated unmet expectations for all but 1 of the 11 standards. One appropriate function of the gerontological clinical nurse specialist is ongoing evaluation of these nursing practice standards which will continue to describe and prescribe professional nursing practice.

Strategies for recruiting nursing students.

When the authors' baccalaureate nursing school was experiencing a decline in enrollment and faculty positions were being threatened, a structured recruitment plan was developed, implemented, and evaluated. This plan increased prospective applicants' access to reliable information about not only the school of nursing but also the profession of nursing. The components of the plan included publicity, prospective applicant contacts, and alumni involvement. The increased number of new entering freshmen with a major in nursing and faculty retention demonstrated the plan's effectiveness.