As nursing homes prep for the new staffing mandate, optimizing the role of the RN should also be considered

After decades of advocacy, the Centers for Medicare and Medicaid Services (CMS) released a highly anticipated final rule in April that  creates requirements for 24-hour, 7-day a week registered nurse (RN) staffing at nursing homes as well as setting a minimum of .55 hours per resident day of RN staffing. While the controversy around the RN staffing mandate continues – the national provider organizations are suing CMS and there is a bill to prevent CMS from moving these new regulations forward –the decision comes after multiple reports from the Institute of Medicine and research findings that indicate that higher RN to resident ratios improve health outcomes in nursing homes.

While agreeing the new requirements are long overdue, Professor Christine Mueller, PhD, RN, FGSA, FAAN, encourages policy makers, nursing home providers, regulators and researchers to broaden their attention to additional aspects of RN staffing to ensure nurse home residents receive the highest quality of care.

Mueller was the lead author, with Barbara Bowers, PhD, RN, and Ann Kolanowski, PhD, of RNs in nursing homes—It is not always about the numbers that was published in the April issue of the Journal of the American Geriatrics Society.

“There are other dimensions to RN staffing in nursing homes beyond the numbers or hours per resident day that influence the quality of care,” she says. “Without attending to a broader focus on nurse staffing, the benefits of increased RN staffing levels will not be achieved.”

The article explains how optimizing the role of RNs in nursing homes requires full understanding of a RN’s scope of practice and accountability. It outlines the four components of a nursing practice model, which was informed by Mueller’s previous research, that maximizes the RN role. The model maximizes the effectiveness of the RN by serving as a care role model, gerontological nurse expert, coordinator to ensure continuity of care, and mentor.

“A nursing home can use this as a blueprint to determine the best way to staff a unit,” says Mueller.

Mueller previously served on the National Academies of Sciences, Engineering, and Medicine Committee on the Quality of Care in Nursing Homes, whose findings were published in the report, The National Imperative to Improve Nursing Home Quality. It recommended the need for staffing standards, particularly for registered nurses, among other recommendations.

The Journal of the American Geriatrics Society article also calls on schools of nursing to strengthening gerontological nursing content and experiential learning in nursing curricula to ensure RNs are prepared to succeed in this new nursing practice model.

“All nursing programs, Bachelor of Science in Nursing and Associate Degree, could do a lot to improve gerontological teaching and create exemplary clinical experiences,” says Mueller.