Does Direct-care Staffing Impact Nursing Home Outcomes? A Systematic Review

The empirical evidence on the relationship between nurse staffing levels and quality in US nursing homes was reviewed. Studies were assessed using a newly developed 21-item qual- ity framework. The findings were systematically collected and stratified by nurse type. Most evidence identified was on highly educated registered nurses. According to our re- view, less qualified staff cannot be claimed to improve quality. Nursing home managers contemplating switching from highly to less educated staff to improve short-term financial performance should consider that this negatively impacts quality outcomes and therefore long-term business opportunities. Evidence on this relationship in the European environ- ment would be desirable, especially in the context of currently discussed health workforce policy harmonization efforts or health workforce qualification initiatives.