Department of Health Sciences, Towson University, Towson, MD, USA.
School of Nursing, University of Maryland School of Nursing, Baltimore, MD, USA.
J Am Med Dir Assoc. 2023 Nov;24(11):1767-1772. doi: 10.1016/j.jamda.2023.07.019. Epub 2023 Aug 24.
A growing number of nurse practitioners (NPs) are employed in nursing homes (NHs) through various NP staffing mechanisms. The purpose of this study was to examine if having NH-employed NPs was associated with nursing staff turnover and resident care outcomes measured as hospital utilization, infection control citations, and substantiated complaints in NHs in 2021-2022.
A cross-sectional, retrospective study.
A total of 13,966 NHs from payroll-based journal (PBJ) and claim-based quality measures published by the Centers for Medicare and Medicaid Services in 2021-2022.
Facilities were identified as having NH-employed NPs if at least 1 employed NP with paid working hours ≥10 per week was reported through the PBJ. We examined if having NH-employed NPs was associated with nursing staff turnover rates, unplanned hospital utilization, infection control citations, and substantiated complaints using doubly robust estimation that combined inverse probability weight representing the NH's likelihood of employing NPs and outcome regression.
Approximately, 2.8% of NHs had employed NPs. Facilities with NH-employed NPs tended to be larger, hospital affiliated, and not for profit with greater medical and nursing staff availability. In addition, a significantly higher proportion of facilities with NH-employed NPs were in metropolitan areas or states with full NP practice independence. We found that facilities with NH-employed NPs had significantly lower registered nurse (adjusted β, -5.40; 95% CI, -9.50 to -1.30) and certified nursing assistant turnover rates (adjusted β, -3.35; 95% CI, -6.29 to -0.40). Facilities with NH-employed NPs also had significantly fewer long-stay resident hospitalizations, infection control citations, and substantial complaints compared with those with no NH-employed NPs.
This study highlights the value of NH-employed NPs to improve registered nurse and certified nursing assistant staff retention and NH resident outcomes. NH stakeholders and policymakers may consider various strategies to incentivize NP employment in NHs such as removing regulatory barriers to NP practice.
越来越多的执业护士（NPs）通过各种 NP 人员配备机制在养老院（NH）中工作。本研究的目的是检验 2021-2022 年 NH 雇佣的 NPs 是否与护理人员流动率以及居民护理结果相关，这些结果以医院利用、感染控制引文和 NH 中的实质性投诉来衡量。
横断面、回顾性研究。
2021-2022 年，医疗保险和医疗补助服务中心发布的基于工资单的期刊（PBJ）和基于索赔的质量措施共 13966 家 NH。
如果通过 PBJ 报告至少有 1 名每周工作时间≥10 小时的全职雇佣 NP，则将设施确定为 NH 雇佣的 NPs。我们使用双重稳健估计来检验 NH 雇佣的 NPs 是否与护理人员流动率、非计划性医院利用、感染控制引文和实质性投诉相关，该估计结合了代表 NH 雇佣 NPs 的可能性和结果回归的逆概率权重。
大约 2.8%的 NH 雇佣了 NPs。NH 雇佣 NPs 的设施往往更大，与医院有关联，非营利性，医疗和护理人员的可用性更高。此外，NH 雇佣 NPs 的设施在大都市地区或完全享有 NP 实践独立性的州的比例显著更高。我们发现，NH 雇佣 NPs 的设施的注册护士（调整后的β，-5.40；95%CI，-9.50 至-1.30）和认证护理助理流动率（调整后的β，-3.35；95%CI，-6.29 至-0.40）显著较低。与没有 NH 雇佣 NPs 的设施相比，NH 雇佣 NPs 的设施的长期居住者住院、感染控制引文和实质性投诉也明显较少。
本研究强调了 NH 雇佣的 NPs 对提高注册护士和认证护理助理的员工保留率和 NH 居民的结果的价值。NH 利益相关者和政策制定者可以考虑各种激励 NP 在 NH 就业的策略，例如消除 NP 实践的监管障碍。
