The quality of care in long-term care (LTC) facilities continues to be a national concern, and inadequate nurse staffing has long been blamed as the reason for quality care concerns. The solution proposed by nursing and consumer advocates is to mandate minimum staffing standards. The premise is that staffing standards will lead to quality care in LTC facilities.

Four related research activities that were part of a project to provide recommendations to one state regarding staffing standards for LTC facilities found little evidence to support the relationship between the amount and type of nursing staff and quality outcomes. These activities included the following: (1) a comprehensive review of the literature on staffing and quality in LTC facilities, (2) an analysis of staffing standards and actual staffing in LTC facilities, (3) an analysis of nursing staff time and risk-adjusted process and outcome quality measures, and (4) group interviews with stakeholders regarding their perspectives on nurse staffing standards for LTC facilities.

The lack of a relationship between the amount and quality of care may be related to the fact that quality is a function of the way nursing care is organized and delivered. Nurse executives may need to ensure a certain minimum level of staffing as a necessary condition for good quality. However, after that, the most important determinants may be factors such as the expertise of direct care staff, staff morale/teamwork, facility and/or unit management practices, care-related technologies, and mechanisms to insure continuity of care through information systems and primary care providers. These factors may intervene between the amount and type of staff on a nursing unit and its impact on clinical and quality of life outcomes for residents in LTC facilities.