The Influence of Consistent Assignment on Nursing Home Deficiency Citations
ABSTRACT The association of consistent assignment of nurse aides (NAs) with quality of care and quality of life of nursing home residents is examined (using 5 groups of deficiency citations).
Data used came from a survey of nursing home administrators, the Online Survey Certification and Reporting data, and the Area Resource File. The information including consistent assignment and staffing variables of registered nurses, licensed practical nurses, and NAs were measured in 2007 and came from 3,941 facilities. Negative binomial regression and multivariate logistic regression models were used.
An average of 68% of nursing homes in this sample reported using consistent assignment. However, the actual level of NA consistent assignment used varied substantially. Only 28% of nursing homes using NA consistent assignment did so at the often recommended level of 85% (or more). In the multivariate analyses, consistent assignment was associated with the deficiency citations examined in 4 of the 5 models. That is, quality of life deficiency citations (resident), quality of life deficiency citations (staffing), quality of life deficiency citations (facility), and quality of care deficiency citations were significantly (p < .01) lower in facilities with the highest levels of consistent NA assignment. Few significant findings were found in nursing homes using lower levels of consistent assignment.
Consistent assignment has developed as a preferred practice in nursing homes based on little empirical evidence in the peer-reviewed literature. The findings presented here provide some justification for the use of this staffing practice for NAs.
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ABSTRACT: The need for personhood-focused long-term care (LTC) is well-documented. A myriad of sociocultural, political, nursing/professional and organisational contexts facilitate or hinder registered nurses (RNs)' capacity to ensure personhood-focused LTC. Complexities derive from the countless interrelated aspects of these contexts, blurring clear distinctions of causality, responsibility and accountability. Context-related complexities were highlighted at a recent international conference attended by invited experts in LTC leadership from six countries (Canada, USA, England, Northern Ireland, New Zealand and Sweden). The group was convened to explore the value and contributions of RNs in LTC (McGilton, , International Journal of Older People Nursing 7, 282). The purpose of this paper is to expand the discussion of personhood-focused care beyond RNs, to contexts that influence the RN's capacity to ensure personhood-focused practices are embedded in LTC settings. Consistent with key topics covered at the international conference, we selected four major contexts for discussion in this paper: (i) sociocultural, (ii) public policy/financing/regulation, (iii) nursing/professional and (iv) organisational. For each context, we provide a brief description, literature and examples from a few countries attending the conference, potential impact on personhood-focused practices and RN strategies to facilitate personhood-focused care. The knowledge gained from attending to the influence of contextual factors on the RN's role in facilitating personhood-focused practices provides critical insights and directions for interventions aimed to maximise RN role effectiveness in LTC. In practice, understanding linkages between the various contexts offers indispensable insight for LTC nurse leaders charged with managing day-to-day operations and leading quality improvement initiatives that promote personhood-focused practices.International Journal of Older People Nursing 12/2012; 7(4):295-302. DOI:10.1111/opn.12009
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ABSTRACT: Consistent assignment refers to the same caregivers consistently caring for the same residents almost every time caregivers are on duty. This article examines the association of consistent assignment of nurse aides with turnover and absenteeism. Data came from a survey of nursing home administrators, the Online Survey Certification and Reporting data, and the Area Resource File. The measures were from 2007 and came from 3,941 nursing homes. Multivariate logistic regression models were used to examine turnover and absenteeism. An average of 68% of nursing homes reported using consistent assignment, with 28% of nursing homes using nurse aides consistent assignment at the often recommended level of 85% (or more). Nursing homes using recommended levels of consistent assignment had significantly lower rates of turnover and of absenteeism. In the multivariate analyses, consistent assignment was significantly associated with both lower turnover and lower absenteeism (p < .01). Consistent assignment is a practice recommended by many policy makers, government agencies, and industry advocates. The findings presented here provide some evidence that the use of this staffing practice can be beneficial.Journal of Aging & Social Policy 01/2013; 25(1):48-64. DOI:10.1080/08959420.2012.705647 · 0.60 Impact Factor
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ABSTRACT: PURPOSE: Previous research examining improved provision of individualized care (I-Care) in long-term care (LTC) facilities has primarily considered contextual influences. Using Kanter's theory of structural empowerment, this study explored the relationship among contextual-level characteristics, individual-level characteristics, and access to empowerment structures on LTC staffs' perceived ability to provide I-Care.Methods:Multilevel models were used to examine 567 staffs' (registered nurse [RN], licensed practical nurses [LPN], care aides) reported ability to provide I-Care, nested within 41 LTC facilities. I-Care was first modeled as a function of within-person (e.g., age, job classification, experience) and between-context (e.g., facility ownership status, culture change models) variables. Independent of these predictors, we then assessed the influence of staffs' access to empowerment structures (information, support, opportunities, resources, informal power, and formal power) on reported ability to provide I-Care. RESULTS: The intraclass correlation coefficient indicated that 91.7% of the total variance in perceived ability to provide I-Care reflected within- versus between-person differences, with the 6 empowerment variables accounting for 31% of this within-person variance independent of the other context- and person-level covariates. In the final model, only informal power (i.e., quality of interprofessional relationships) and resources (i.e., adequate time and supplies) uniquely predicted I-Care. Notably, access to resources also attenuated the significant effect of support, suggesting a possible mediating effect. IMPLICATIONS: These findings suggest that both contextual- and individual-level factors exert considerably less influence on I-Care than factors associated to staffs' perceptions of empowerment. Consequently, interventions aimed at increasing I-Care in LTC settings should carefully consider staffs' access to structural empowerment.The Gerontologist 01/2013; 53(5). DOI:10.1093/geront/gns165 · 3.21 Impact Factor