Inadequate Nursing For Quality Care In Nursing Homes

Running Head: INADEQUATE STAFFING IN NURSING HOMES 1

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INADEQUATE STAFFING IN NURSING HOMES 2

Inadequate Nursing for Quality Care in Nursing Homes

The lack of adequate staff is defined in relation to the level of demand needed to offer

proper services to persons in need of care. Nursing homes main responsibility is to provide care

for those individuals unable to tend to themselves from being too old. The lack of enough staff to

cater for the needs of the elderly patients has raised some serious concerns from the public.

Majority of nursing homes do not have enough staff members to ensure adequate care for the

patients thoroughly. Despite their vital role in the society, nursing homes have turned into social

problems due to elder neglect, maltreatment, abuse, and despair.

There is no benefit at all with the lack of adequate nurses in the nursing homes. Shortage

of nurses in any nursing home will ultimately affect the quality of care residents receive. The

concern is that rarely does a nursing home have the adequate nurses needed for proper services.

This, therefore, translates to 9 out of 10 nursing homes having inadequate nurses which directly

translates to having cases such as neglect, liability issues and negligence of residents (Pear,

2018).

In nursing homes, patients were recorded to be needing an average of 4.1 hours each day

for nursing care. 1.3 hours from registered nurses and 2.8 hours from nursing aides according to

Pear, (2018). From this then the recommendation would be one nurse for every five residents. In

a majority of the nursing homes, one nurse aide served up to 14 residents in a single nursing

home. With this ratio then problems involving inadequate care begin to show themselves. For

some patients, they were unable to feed themselves despite having food placed in front of them

(Pear, 2018).

INADEQUATE STAFFING IN NURSING HOMES 3

Majority of the nursing homes have inadequate nurses due to a few reasons. One of the

main reasons is on labor costs (Reader & Gillespie, 2013). In nursing homes, the cost of labor is

at the peak compared to other costs. In the 9/10 nursing homes, a majority cannot afford to attain

enough qualified or registered nurses and assistant nurses as needed. As a result, the existing

nurses end up being stretched by the homes as much as they can.

Additionally, in other scenarios, nursing homes may also have a challenge in finding

nurses with the required medical education. This is because a massive majority of the qualified

nurses prefer to work in other healthcare settings to nursing homes. Due to the stress and

difficulty in caring for patients in the nursing homes, many of the nurses would prefer hospital

setting rather than working in the nursing homes. To top that up, nursing homes in the remote

areas also cannot find adequate qualified individuals to fill all the positions (Kydd et al., 2014).

As such nursing homes end up lacking sufficient nurses and also end up hiring unqualified

nurses to care for the residents.

Elderly abuse and neglect are one of the underlying issues affecting residents of nursing

homes across the nation. The leading cause of this is understaffing in the nursing homes

according to Zhang et al., (2014). In places where the nursing facilities do not have enough staff

for each patient’s attention, the most obvious mistakes will be neglect and negligence. To even

make matters worse, once the available team is extremely stressed due to overworking, the risk

of abusive care increases as frustration builds up (Zhang et al., 2014). It is more likely that these

nurses will end up committing intentional or unintentional abuse which might be very harmful to

the elderly patient.

More than 90% of the nursing homes in our country lack adequate nurses per the resident

population. Due to fewer nurses, the available nurses are more prone to being pushed to work

INADEQUATE STAFFING IN NURSING HOMES 4

overtime and get exhausted (Kydd et al., 2014). The feeling of being underpaid in addition to

overworking may significantly cause nurses to make mistakes during the caring of a patient.

According to studies done by scholars in understanding the quality of care in nursing homes,

residents living in these understaffed homes are prone to one or more of either being

malnutrition, dehydration, bed sores, pneumonia, and infections. The families of the patients in

these home have noticed the level of negligence in the homes and have started raising awareness

of other families according to Kydd et al., (2014).

Furthermore, the adverse effects of understaffing are obvious. The lack of adequate

nurses in any facility will only serve to ensure that each patient lacks the high level of care

needed. In a study involving nursing home nurses, close to 50% of the nurses in the survey

admitted to missing changes in a patient’s condition due to being overloaded or having an excess

workload (Backhaus et al., 2014). Negligence is the main result of lacking adequate nurses in a

nursing home facility. The understaffed nurses do not have adequate time to pay attention to

detail involving the patients and can, therefore, end up making mistakes or even causing a life of

misery to some of the residents resulting from negligence and neglect (Backhaus et al., 2014).

Neglect is one of the main issues identified in 9/10 nursing homes. Neglect is a crisis in

the quality of care regarding meeting the standard and also achieving a proper quality of life for

the patients. Patients that are immobile and cannot do much for themselves are at a greater risk

when the home lack enough staff members. The patients need help from nutrition, dressing to the

bathroom. Routine and regular checkup demands plenty of nurses or assistant nurses around the

clock according to Backhaus et al., (2014). Therefore, with these great demands, the numbers of

nurses per patients must be high to avoid negligence and neglect and ultimately liability issues.

INADEQUATE STAFFING IN NURSING HOMES 5

Unfortunately, it is not possible for nurses in the nursing homes to care for every patient

at the required level. The high workload in the nursing homes sometimes makes it even difficult

for these nurses to provide individualized care for the patients residing in these homes (Klisch &

Lee, 2014). In nursing homes, patients are not supposed to wander by themselves. To avoid cases

of falling leading to other injuries, it is better if each patient has an all-around assistant to ensure

their needs are met. It is here that some of the basic needs such as proper nutrition and bathroom

activities are neglected due to lack of adequate staff (Klisch & Lee, 2014).

According to the Older Americans Act, the quality expected of care in nursing homes

was raised in the nursing homes that received Medicaid and Medicare funds to ensure these

nursing homes meet the required standards. Additionally, these Act also provided the residents

with a means to ensure their rights are protected in the homes. Typical cases in the nursing

homes include elder abuse by slapping, hitting or verbal insults, physical restraints, lack of

privacy and, withholding of medical records (Klisch & Lee, 2014). A significant portion of these

complaints goes unreported because patients in these nursing homes fear reprisal from the staff

and the administration.

At the moment, current nursing homes have been put under well-designed systems of

rules and regulations designed to improve the quality of care for the elderly (Tolson et al., 2013).

Nursing homes are required to provide information or data regarding the use of physical

restraints, patients’ weight, skin abrasions and other measures of quality as indicated by Tolson

et al., (2013). Majority of the states have recorded improvements in nursing standards. However,

due to the much-needed paperwork, the human element of care has been lost due to the demands

placed by the federal and bureaucratic government. These emphases have taken away from the

emotional care that elderly patients residing in these nursing homes need.

INADEQUATE STAFFING IN NURSING HOMES 6

One of the main areas to improve is on increasing the levels of staffing and raising

minimum wages of nursing home nurses. This presents itself as the most apparent solution

although no single solution can adequately address the problem of inadequate quality care in

nursing homes. The training of nursing assistants should be a higher priority because once the

older nurses retire, these assistants will help fill the void left (Tolson et al., 2013). According to

the Bureau of Labor, nursing assistants are drawn from the lower socioeconomic class and may

or may not be required to be holders of a high school diploma. This is due to the little pay they

receive, and therefore this translates to the types or quality of services offered.

The concern over the issue of inadequate staffing in nursing homes was brought to light

by relatives of nursing home residents. On observation, the relatives noticed their relatives were

likely to experience bedsores, malnutrition and other issues resulting from inadequate care.

According to the federal study by the Bush administration, it was found that more than 90% of

the nation’s nursing homes had few workers to care for the patients (Backhaus et al., 2014).

One of the solutions recommended by the Bush government were to follow the market

forces and efficient use of available or existing nurses and nursing aides rather than setting a

minimum staffing level for nursing homes (Wiener, 2013). According to the government’s

report, it was not feasible for the nation to set a minimum level of nurses in each nursing home.

The cost was the main factor that made it impossible for the national government to set a

minimum ratio of nurses to patients. The overall cost would be an 8% increase over the current

spending which the government was keen not to increase according to Wiener (2013).

Therefore, the first steps in addressing the issue of inadequate staffing were through

publishing data on the number of nurses and workers in the nursing homes and also encourage

the nursing homes to adopt better management techniques (Nazir et al. 2013). These were the

INADEQUATE STAFFING IN NURSING HOMES 7

two methods used by the Bush administration to address the 90% nursing inadequacy. In the

publishing of data involving the number of workers at each home, the hope was nurses levels

would increase as a result of the high market demand created. On the other hand, better

management techniques would address a shortage through the achievement of high productivity

by nursing aides.

According to Anna Spinella, her friends and relatives were in nursing homes that were

extremely short staffed. She advocated for legislation that looked into protecting nursing home

residents. According to Anna, a lot of the residents were left in bed and labeled as incontinent

and bedbound however, the labeling was wrong as many of those labeled incontinent were in fact

continent (Preshaw et al., 2016). Due to the nursing homes lack of adequate staff, there was not

enough labor to transfer the residents from bed to bathroom, and therefore patients were left

bedbound for days (Preshaw et al., 2016).

Nine out of ten home need to increase their nursing levels by almost 50% or even more to

ensure adequate treatment of patients (Reader & Gillespie, 2013). With the huge deficit of nurses

in nursing homes, it remains such a task to get more nurses in these nursing homes at the same

time concerns over increased costs limit homes from getting enough staff members for their

patient population. Different studies have highlighted the difficulties experienced by nurses in

homes that are understaffed. When one nurse is responsible for over 14 patients, how will it be

possible for proper care to take place?

In conclusion, nursing homes without adequate staffing will end up having liability

issues, negligence, and neglect of residents. The current ratios of nurses to patients is below the

recommended average for proper care. More nurses need to be hired in the nursing homes to

reduce the number of patients for each nurse. Factors such as low wages, meager benefits and the

INADEQUATE STAFFING IN NURSING HOMES 8

tough working conditions in nursing homes play a role in not attracting more nurses to the

homes. Therefore, nursing homes remain understaffed as patient number increase. As a result,

cases such as malnutrition and poor care of nursing home residents continue to increase as family

members get concerned for their loved ones.

INADEQUATE STAFFING IN NURSING HOMES 9

References

Backhaus, R., Verbeek, H., van Rossum, E., Capezuti, E., & Hamers, J. P. (2014). Nurse staffing

impact on quality of care in nursing homes: a systematic review of longitudinal

studies. Journal of the American Medical Directors Association, 15(6), 383-393.

Kalisch, B., & Lee, K. H. (2014). Staffing and job satisfaction: nurses and nursing

assistants. Journal of nursing management, 22(4), 465-471.

Kydd, A., Touhy, T., Newman, D., Fagerberg, I., & Engstrom, G. (2014). Attitudes towards

caring for older people in Scotland, Sweden and the United States. Nursing Older

People, 26(2).

Nazir, A., Unroe, K., Tegeler, M., Khan, B., Azar, J., & Boustani, M. (2013). Systematic review

of interdisciplinary interventions in nursing homes. Journal of the American Medical

Directors Association, 14(7), 471-478.

Pear, R. (2018). 9 of 10 Nursing Homes in U.S. Lack Adequate Staff, a Government Study

Finds. Retrieved from https://www.nytimes.com/2002/02/18/us/9-of-10-nursing-homes-

in-us-lack-adequate-staff-a-government-study-finds.html

Preshaw, D. H., Brazil, K., McLaughlin, D., & Frolic, A. (2016). Ethical issues experienced by

healthcare workers in nursing homes: Literature review. Nursing ethics, 23(5), 490-506.

Reader, T. W., & Gillespie, A. (2013). Patient neglect in healthcare institutions: a systematic

review and conceptual model. BMC health services research, 13(1), 156.

INADEQUATE STAFFING IN NURSING HOMES 10

Tolson, D., Rolland, Y., Katz, P. R., Woo, J., Morley, J. E., & Vellas, B. (2013). An international

survey of nursing homes. Journal of the American Medical Directors Association, 14(7),

459-462.

Wiener, J. M. (2013). An assessment of strategies for improving quality of care in nursing

homes. The Gerontologist, 43(suppl_2), 19-27.

Zhang, Y., Punnett, L., Gore, R., & CPH-New Research Team. (2014). Relationships among

employees’ working conditions, mental health, and intention to leave in nursing

homes. Journal of Applied Gerontology, 33(1), 6-23.

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