Nurse staffing, quality of care, and quality of life in US nursing homes, 1996–2011: an integrative review.

The purpose of this study was to complete an integrated literature review of the relationship between staffing and quality outcomes in nursing homes. The majority of the reviewed studies showed better outcomes with higher nursing staff but depended heavily on cross-sectional observational studies and failed to differentiate RNs from other nursing staff. A total of 28 articles relating nurse staffing and quality outcomes were systematically reviewed and synthesized. However, each study examined different aspects of staffing and different resident or organizational outcomes, making determination of appropriate staffing levels difficult. The reviewed studies have not clearly defined the relationship between differing levels of nurse-staffing skill mix and specific structure, process, outcome, and composite indicators of quality. The inconsistent findings suggest that further research is needed in this area.