How registered nurses, licensed practical nurses and resident aides spend time in nursing homes: An observational study

doi:10.1016/j.ijnurstu.2015.05.007

International Journal of Nursing Studies

Volume 52, Issue 9, September 2015, Pages 1475-1483

https://doi.org/10.1016/j.ijnurstu.2015.05.007 Get rights and content

Abstract

Background

Calls for improved conditions in nursing homes have pointed to the importance of optimizing the levels and skills of care providers. Understanding the work of care providers will help to determine if staff are being used to their full potential and if opportunities exist for improved efficiencies.

Objectives

To explore the activities of care providers in different nursing homes and to identify if variations exist within and across homes and shifts.

Methods

A multi-centre cross-sectional observational work flow study was conducted in seven different nursing homes sites in one Canadian province. Data were collected by a research assistant who conducted 368 h of observation. The research assistant collected data by following an identical route in each site and recording observations on staff activities.

Results

Findings indicate staff activities vary across roles, sites and shifts. Licensed practical nurses (nursing assistants) have the greatest variation in their role while registered nurses have the least amount of variability. In some sites both registered nurses and licensed practical nurses perform activities that may be safely delegated to others. Care providers spend as much as 53.7% of their time engaged in non-value added activities.

Conclusions

There may be opportunities for registered nurses and licensed practical nurses to delegate some of their activities to non-regulated workers. The time care providers spend in non-value activities suggest there may be opportunities to improve efficiencies within the nursing home setting.

Section snippets

Literature review

Staffing in nursing homes is an issue that has drawn international attention. Harrington et al.’s (2012) review of staffing standards across 6 countries revealed wide variation in staffing within and across countries. A key finding in the review was that consistent staffing models, such as standard numbers and combinations of care providers, are common in most countries. An observational study in a Canadian nursing home reported resident care provided by RAs is limited by factors such as the

Aim

To determine how care providers spend their time in nursing homes and to identify if variations exist across homes, shifts and licensure level. Understanding how care providers spend their time may help identify opportunities to improve efficiencies within the nursing home setting.

Design

A multi-centre cross-sectional observational work flow design was employed. A stratified purposive sampling strategy was used to access nursing homes. Nursing home selection was based on geographical location

Results

A total of 52,841 observations took place during the 368 h of data collection. Care providers in all sites were observed in a range of activities under the broad categories of direct, indirect and non-value added activities. A category of “other” was used for any activity that was not applicable to the other three categories (Table 2).

Chi-square test of homogeneity for the activities of each classification of care provider (RN, LPN and RA) for both day and evening shifts was 0.0000 respectively,

Discussion

In theory, staffing regulations and professional affiliations shape the division of labour in nursing homes; however in practice this may not be the case. As noted in this study and elsewhere (Corazzini et al., 2013, Mueller et al., 2012), at times the boundaries between care provider activities are blurred. It is possible that factors such as facility design, organizational culture, practitioner skills and relationships between providers have a greater impact on provider activities than

Conclusion

Knowing how staff spend time and the activities they are involved in provides important objective data to help improve efficiencies within nursing homes. Improving efficiencies is important as time constraints are a commonly cited reason for staffs’ inability to comply with safety practices and to provide quality care. The overlap in roles between RN, LPN and RA in our study raises questions about role clarity and the use of resources within nursing homes. The fact that staff spent so much of

Acknowledgments

We would like to thank WorkSafeNB for their financial support and the nursing homes participating in the study, especially the residents and care providers in the study sites.
Conflict of interest: None of the authors declare any conflicts of interest. Mrs. Cindy Donovan is the Chief Executive Officer of one of the nursing homes participating in this study.
Funding: The study was funded by WorkSafeNB. The funder did not have any involvement in the design, execution, analysis or reporting of the

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View full text

How registered nurses, licensed practical nurses and resident aides spend time in nursing homes: An observational study

Abstract

Background

Objectives

Methods

Results

Conclusions

Section snippets

Literature review

Aim

Design

Results

Discussion

Conclusion

Acknowledgments

J. Am. Med. Dir. Assoc.

J. Am. Med. Dir. Assoc.

Int. J. Nurs. Stud.

J. Nurs. Regul.

Geriatr. Nur. (Lond.)

Nurse Educ. Today

Int. J. Nurs. Stud.

J. Health Econ.

Int. J. Nurs. Stud.

J. Nurs. Regul.

Int. J. Nurs. Stud.

Int. J. Nurs. Stud.

J. Am. Med. Dir. Assoc.

Local interaction strategies and capacity for better care in nursing homes: a multiple case study

BMC Health Serv. Res.

Position Statement: Registered Nurse Roles in Long-term Care

A Review of Scopes of Practice of Health Care Professionals in Canada: A Balancing Act

LPN role advancement: from blueprints to ribbon cutting

J. Nurses Staff Dev.

Caring for elders: the role of registered nurses in nursing homes

Nurs. Inq.

High-performance workplace practices in nursing homes: an economic perspective

Gerontologist

How nurses manage time and work in long-term care

J. Adv. Nurs.

Long-term Care in Canada: Status Quo not an Option

When a Nursing Home is Home: How do Canadian Nursing Homes Measure up on Quality?

Measuring staff turnover in nursing homes

J. Gerontol.

Nursing home caregiver staffing levels and quality of care

J. Appl. Gerontol.