The Impact of Staffing Shortages in Nursing Homes
During the COVID-19 pandemic, staffing shortages in healthcare facilities, particularly in nursing professions, quickly became a heated issue. Healthcare facilities struggled to maintain adequate staffing as their workforce became ill, refused to work in COVID-19-specific units, or quit working in healthcare altogether due to the mental and physical demands. This shortage was felt across all types of settings such as hospitals, home health, and nursing homes. Nursing homes especially felt increased pressures to retain staff as their resident population was extremely susceptible to COVID-19 illness.1
Even before COVID-19, nursing homes were struggling to keep qualified direct care staff members. Numerous studies of nursing homes reveal a strong, positive relationship between the number of nursing home staff providing residential care and patient outcomes.2 Specifically, higher registered nurse (RN) staffing levels are associated with better resident quality care in terms of fewer pressure ulcers, lower restraint use, decreased infections, and less weight loss.2 When there is a lack of RNs in a facility, nursing leaders are needed on the floor to provide direct care to residents rather than fulfilling their administrative duties. It has been reported that 66% of nursing leaders say that they are routinely providing direct residential care.3 Between 2017-2018, 75% of nursing homes almost never met the CMS expected RN staffing levels based on patient acuity.2 In addition, COVID-19 exacerbated the nursing shortage, notably in nursing homes, and many have not yet recovered.
While shortages of registered nurses are a major issue in nursing home, all nursing staff job families are feeling the effects of shortages, especially those who provide direct care to patients. In 2017 and 2018, median turnover in most U.S. nursing homes was 94%.4 However, more specifically, mean turnover rates were 140.7% among registered nurses, 129.1% among certified nursing aides and 114.1% among licensed practical nurses.4 This could be due to a few reasons such as leaving for higher wages and burnout. Regardless, the facility incurs several additional costs, such as recruiting and training new staff members, and they must redirect nursing staff from direct patient care to training new staff.
As nursing home leadership looks towards the future, the need for sufficient healthcare staffing is going to continue to grow as the “Baby Boomer” generation ages. Currently, the United States has more people over the age of 65 than at any other time in its history.5 This population’s medical needs will continue to increase as older persons usually have many diagnoses and comorbidities that ultimately lead to a decline in function, requiring them to seek care and assistance in nursing homes.5 On the other hand, there are currently one million licensed nurses who are age 50 or older, meaning that one-third of this workforce will be at retirement age in the next ten years.5 The leadership of the nursing home industry will need to think creatively to incentivize nurses, especially registered nurses, to work in nursing homes. Without enough qualified nursing staff, facilities will have a very difficult time achieving or maintaining positive patient outcomes.
- McMichael T, Currie D, Clark S et al. Epidemiology of COVID-19 in a long-term care facility in King, County, Washington. N Engl J Med 2020;382:2005-11. doi: 10.1056/NEJMoa2005412.
- Harrington C, Dellefield ME, Halifax E et al. Appropriate nursing staffing levels for U.S. nursing homes. Health Serv Insights 2020;13. doi: 10.1177/1178632920934785.
- Stempniak M. 2019, February. Staffing ‘crisis’ hitting directors of nursing hard, new industry analysis finds. McKnight’s Long-Term Care News. Available at: https://www.mcknights.com/news/staffing-crisis-hitting-directors-of-nursing-hard-new-industry-analysis-finds/. Accessed June 23, 2021.
- Marselas K. 2021, March. ‘Alarming’ nursing turnover rates linked to quality, payment woes in major new nursing home study. McKnight’s Long-Term Care News. Available at: https://www.mcknights.com/news/alarming-nurse-turnover-rates-linked-to-quality-payment-woes-in-major-new-nursing-home-study/. Accessed August 13, 2021.
- Haddad L, Annamaraju P, Toney-Butler TJ. 2020, December. Nursing Shortage. StatPearls. Available at: https://www.ncbi.nlm.nih.gov/books/NBK493175/. Accessed June 23, 2021.