Central OC Times

A study led by the University of California, Irvine has uncovered the complex relationship between different staff disciplines and quality of care in nursing homes. The research, published in the Journal of the American Medical Directors Association, examined how registered nurses (RNs), licensed practical nurses (LPNs), and certified nursing assistants (CNAs) impact various quality measures such as antipsychotic medication usage and treatment of pressure sores.

“These novel results provide a more complex picture of the influence of staffing types on quality measures,” said first author Dana Mukamel, Distinguished Professor of Medicine. “The intricate relationship between nursing disciplines and resident care requires a nuanced approach to policies that go beyond simple headcounts. Hiring decisions, including ones about staffing mix, should be tailored to meet the needs of individual residents.”

The research team constructed separate models for six distinct quality measures using RNs, LPNs, and CNAs as key independent variables. They utilized previously unavailable payroll information from nursing homes across the country to gain a comprehensive view of staffing patterns, including weekends and holidays. The study's insights were derived using the Two Stage Least Squares economics technique.

Key findings indicated that higher numbers of RNs led to more frequent use of antipsychotic drugs but resulted in fewer hospitalizations and emergency room visits along with better care for pressure sores. Conversely, increased levels of CNAs were associated with decreased antipsychotic drug use and improvements in long-stay activities of daily living and short-stay functioning but also increased hospitalizations. RN and CNA staffing levels were found to be associated with better quality outcomes more often than LPNs.

“These outcomes suggest that RNs and CNAs have a different focus in their roles,” Mukamel explained. “CNAs are often closer to residents, enabling them to develop insights into residents’ routines and offer behavioral modifications to mitigate symptoms. In contrast, RNs might focus on communicating behavioral issues to prescribing providers and developing overall care plans. The difference in pressure sore improvement reflects the complexity of treatment which requires close guidance from RNs.”

Other contributors included Dr. Debra Saliba from UCLA; R. Tamara Konetzka from the University of Chicago; and Heather Ladd from UC Irvine's Department of Medicine.

This work was supported by the National Institute on Aging under award number R01AG066742.

UC Irvine’s Brilliant Future campaign aims to raise awareness and support for various initiatives at UC Irvine through engaging alumni and philanthropic investments.

For more information about UC Irvine or media access details, visit [www.uci.edu](http://www.uci.edu).

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