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Policy, Politics, & Nursing Practice
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The Business Case for Nursing in Long-Term Care

Susan D. Horn, PhD

Institute for Clinical Outcomes Research, shorn{at}isisicor.com

Lower nurse staffing in hospitals has been associated with adverse patient outcomes; results in nursing homes (NHs) are less clear. We examined the association between nurses' direct care time and outcomes in long-stay NH residents and potential cost savings from decreased adverse outcomes versus additional wages for adequate nurse staffing. Data were from the National Pressure Ulcer Long-Term Care Study of 1,376 at-risk residents from 82 NHs. Primary data came from medical records. Hospital, pressure ulcer (PrU) treatment, and urinary tract infection (UTI) costs were from national statistics or cost-identification studies. Time horizon was 1 year. More registered nurse (RN) direct care time/resident/day was associated with fewer PrUs, hospitalizations, and UTIs. Annual net societal benefit was $3,191/resident/year in high-risk NH units with 30-40 min of RN time/resident/day versus units with <10 min. Thus, after controlling for important variables, more RN time/day was strongly associated with better outcomes and lower societal cost.

Key Words: nursing home staffing • business case for nursing staffing • nurse staffing associated with resident outcomes

Policy, Politics, & Nursing Practice, Vol. 9, No. 2, 88-93 (2008)
DOI: 10.1177/1527154408320420
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