The Impact of the Registered Nurse in Skilled Nursing Facilities: Past, Present, and Future

Tuesday, July 12, 2011: 10:50 AM

Landa L. Stricklin, MSN
School of Nursing, Kennesaw State University, Kennesaw, GA
Kathie A. Aduddell, EdD, MSN, BSN, RN
Wellstar College of Health and Human Services/School of Nursing, Kennesaw State University, Kennesaw, GA

Learning Objective 1: The learner will be able to understand the positive impact of the registered nurse on obtaining quality in skilled nursing facilities.

Learning Objective 2: The learner will be able to support the argument that skilled nursing facilities with more registerd nurses have fewer deficiencies cited during the standard survey.


The purpose of this study is to present current evidence that supports the hypothesis: Skilled nursing facilities with higher Registered Nurse hours per resident day have fewer deficiencies cited during an annual standard survey.


Data was extracted from Nursing Home Compare public website which houses Centers for Medicare and Medicaid Services Online Survey Certification and Reporting (OSCAR) database. The data set included CMS Region Four nursing facilities located across eight southeastern states that had a standard survey in 2009. Using SAS, the researchers used generalized linear modeling in this secondary analysis.


The final analysis of the data set for this study contained information on 2,397 nursing homes in CMS Region Four. The generalized linear modeling suggests a correlation exists between registered nurse hours per resident day and fewer deficiencies cited during the standard survey. This provides current evidence to support that the number of registered nursing hours per patient per day does significantly decrease the total number of health related deficiencies cited during a standard survey.


The findings of this and previous studies provide evidence that quality care in nursing facilities is dependent upon the intrinsic and extrinsic qualities of the registered nurse. To meet the needs of a new generation of residents, nursing facilities may consider increasing the number of hours registered nurses are in direct care provision roles to obtain and maintain quality care.