Jurisdiction over nursing care systems in nursing homes: latent class analysis.

BACKGROUND

In the context of declining registered nurse (RN) staffing levels in nursing homes, professional nursing jurisdiction over nursing care systems may erode.

OBJECTIVE

The aim of this study was to develop a typology of professional nursing jurisdiction in nursing homes in relation to characteristics of RN staffing, drawing upon Abbott's tasks and jurisdictions framework.

METHODS

The study was a cross-sectional, observational study using the 2004 National Nursing Home Survey (n = 1,120 nursing homes). Latent class analysis was used to test whether RN staffing indicators differentiated facilities in a typology of RN jurisdiction and compared classes on key organizational environment characteristics. Multiple logistic regression analysis related the emergent classes to presence or absence of specialty care programs in eight clinical areas.

RESULTS

Three classes of capacity for jurisdiction were identified, including low capacity (41% of homes) with low probabilities of having any indicators of RN jurisdiction, mixed capacity (26% of homes) with moderate to high probabilities of having higher RN education and staffing levels, and high capacity (32% of homes) with moderate to high probabilities of having almost all indicators of RN jurisdiction. High-capacity homes were more likely to have specialty care programs relative to low-capacity homes; such homes were less likely to be chain-owned and more likely to be larger, provide higher technical levels of patient care, have unionized nursing assistants, have a lower ratio of licensed practical nurses to RNs, and have an administrator with higher education level.

DISCUSSION

Findings provide preliminary support for the theoretical framework as a starting point to move beyond extensive reliance on staffing levels and mix as indicators of quality. Furthermore, findings indicate the importance of RN specialty certification.