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Nurse researchers to try and identify ‘optimal’ staffing level for care home quality

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Nurse academics are embarking on what is believed to be the first major UK study to look at the relationship between staffing and the quality of care in residential and nursing homes.

The study will investigate the impact of the ratio of nurses to care staff and other variations in skills mix on key quality indicators such as pressure ulcers, falls and unplanned hospital admissions.

“We know little of the relationships between this workforce and quality of care in UK care homes”

Project documents

The ultimate aim of the project will be to identify optimal staffing levels in both homes that employ nurses and those that do not and help shape workforce planning across the country.

The multi-faceted study, which got under way in July, will involve a number of different research projects and techniques.

It will draw on national data on quality and staffing, as well as gathering evidence from care home managers, frontline nursing and care staff, residents and their relatives, and visiting NHS staff.

Funded by the National Institute for Health Research (NIHR), the £920,000 study will be led by Karen Spilsbury, professor of nursing research at the University of Leeds.

It comes amid the increasing focus on the quality of care for some of the most vulnerable members of society in a sector, which has been recently hit by under-funding and staffing shortages.

“The nursing and care assistant workforce in the care home sector is the key means of ensuring quality of care for residents and relatives, yet we know little of the relationships between this workforce and quality of care in UK care homes,” said a document describing the study.

“The nursing and care assistant workforce in the care home sector is the key means of ensuring quality of care”

Project documents

The NIHR’s research protocol document stated that the work, which is due to be completed in 2020, “will be the first UK study to address this important focus”.

The project will look at current variations in skill mix in care and nursing homes, the needs of residents and relatives and how it is linked to staffing.

It will also investigate how different staffing models – including the deployment of new nursing and support roles – affect the quality of care, outcomes for residents and the use of NHS resources.

A key partner in the project is Bupa, one of the UK’s largest providers of care homes, which employs 4,500 nurses and 14,000 care workers.

The study will involve using Bupa’s own staffing and quality data, plus residents’ and relatives’ views and Care Quality Commission ratings to map variations in quality across homes.

Researchers will draw on existing research evidence and the opinions of Bupa’s senior nurse managers to explore the reasons behind those variations.

The study team also includes representatives from national training body Skills for Care, Newcastle University, the University of East Anglia, City University London and the University of Surrey.

University of Leeds

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Karen Spilsbury

This will include looking at the relationship between the amount of nursing and care worker care hours per resident per week or month and the ratio of registered nurses to unregistered staff, and quality measures such as pressure ulcers, falls, medication errors and unplanned admissions to hospital.

Other factors that will be explored include nursing staff vacancies, proportion of nurses that are agency staff, nursing staff turnover, how long nurses have been in their jobs, and sickness absences rates – and the impact these have on resident care.

Six care homes will be selected to look in detail at the relationship between staffing mix and quality of care with nursing and care staff asked to keep diaries of their experiences.

The study is one of a number of recent research projects into standards and practice in care homes funded by the NIHR, which has just published a themed review titled Advancing Care – Research with Care Homes.

The review, which focuses on the care of the “oldest old” people in care homes, encompasses 23 published and 21 ongoing studies covering areas such as end of life care, dementia care, nutrition, and continence.

The NIHR’s report highlighted the need for more many more studies in this area described as a “new and relatively underdeveloped” field of research.

Key areas for future research include looking at ways to achieve “the outcomes that matter to residents, relatives, carers and care home staff” and effective ways to support partnership work between health professionals, care home staff, residents and their families to develop new approaches to care.

Professor Jo Rycroft Malone, director of the NIHR Health Services and Delivery Research Programme, said: “Care homes are an important part of the health and care system, providing long term continuing care for around half a million people.

“It is vital that individuals in these homes are given the best quality of care possible and so I am pleased that our programme has funded research to help care home managers and commissioners of health care services understand how to make the best use of the staff employed in care homes,” she said.

She added: “We hope that the findings of this research will help to inform policy and practice to ultimately ensure that people living in care homes receive the most effective and efficient provision of care available.”

Study synopsis – Relationship between care home staffing and quality of care: a mixed methods approach (Spilsbury)

The aim of this study is to explore the relationship between the mix of staffing in the care home workforce and how this affects quality of care. Outcomes for residents, relatives and staff will be assessed. The research will examine how care is paid for and how this affects quality. It will involve a review of the literature and discussions with care home managers and staff. Information from key organisations (such as Skills for Care, Care Quality Commission and BUPA) will provide insight into UK-wide care homes. Six care homes will be selected to assess the relationship between staffing mix and levels and quality of care. Ultimately, the research aims to provide decision-makers, including care home managers and commissions, with important information about staffing and care quality. Due to publish 2020.

  • 4 Comments

Readers' comments (4)

  • Boy are you in for an eye-opener!

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  • It will be interesting to hear the results of a study that focuses on quality indicators instead of the usual mortality rate. Death is unavoidable but lousy care, which is anyway not cost effective, is avoidable and as Einstein said ( roughly) -That which is countable may not be worth counting and that which is worth counting may not be countable. Personally I think I'd rather have a better later life than a longer life.

    I sincerely hope this research will include a Namaste care home and if it goes into costs at all, then I hope that things like nurse and staff retention gets a mention as the need to import nurses and pay for their travel fares jacks up costs but may not show directly.

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  • karen Webb

    Wonderful news! Wonder how the big companies will respond to the results though? They rely on very low nurse numbers..

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  • I would be interested in seeing the results of this study as I certainly find it challenging at times having up to 40 nursing residents to one nurse. Trying to provide optimum nursing care and interventions, palliative care and associated interventions such as syringe drivers, relative and resident support, MDT meetings that can take 1-2 hours, care planning and assessments, medication rounds, external professional visits and referrals but never having enough hours in the day. This is not a new problem but safe nursing staff levels in nursing homes certainly needs to be addressed. However where are the nurses going to come from? There is already a shortage of nurses applying for nursing home positions. How are we going to retain them? Further education ie university courses are not currently aimed at nurses working in nursing homes, plus CPD is hard to come by due to staffing and funding issues.

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