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Nursing Homes Using More Agency Staff Have Lower Quality of Care

Nursing homes have well-documented staffing problems, including high turnover rates, problems with absenteeism, and low staffing levels. Given these problems, many nursing homes use agencies to meet their staffing needs for nurse aides (NAs), licensed practical nurses (LPNs), and registered nurses (RNs).

Nursing homes with the highest use of agency staff have a clinically significant lower quality of care, according to Nicholas G. Castle, PhD, of the University of Pittsburgh.

In many cases, the difference between no agency use and 25% or more agency use translates to a 1% or 2% difference in quality scores. Considered cumulatively, the impact on quality is large and may be meaningful for nursing home residents, notes the author. He examined how the use of agency staff affects the Nursing Home Quality Measures.

Findings showed that 8 of 15 measures for NAs, 6 of 15 measures for RNs, and 4 of 15 measures for LPNs were significantly associated with the use of agency staff. He concluded it was likely no use of agency staff was associated with better care quality and higher use of agency staff was associated with worse quality.

For details, see Castle. (2009). Use of agency staff in nursing homes. Research in Gerontological Nursing, 2(3), 192-201.

From the GAPNA Newsletter: Fall 2010, Volume 29, Number 3

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