The Essential Workforce in a Nursing Home: Ensuring Quality Care through Sufficient Staffing

The Essential Workforce in a Nursing Home: Ensuring Quality Care through Sufficient Staffing

Introduction

Nursing homes serve as critical centers for healthcare providers to render necessary care and support to elderly and infirm individuals in need of assistance with daily activities, nursing and medical care.
Sufficient staffing is a fundamental requirement for maintaining a safe and caring environment within nursing homes. An appropriate staff-to-resident ratio ensures that staff members have the time, resources, and capacity to properly address the individual needs of each resident. Adequate staffing promotes personalized care, allows for regular monitoring of residents’ health, facilitates timely response to emergencies, and fosters a nurturing atmosphere where neglect and abuse are less likely to occur.
Research studies and investigations have consistently shown that understaffed nursing homes are more prone to incidents of neglect and abuse towards residents. Staff members may become overwhelmed, overworked, and unable to provide the necessary care and attention to each resident. This can result in basic needs being overlooked, such as missed meals, inadequate hygiene, or insufficient medication administration.
Moreover, understaffing creates an environment where rushed and hurried care becomes the norm. Staff members may be forced to prioritize tasks, sacrificing the crucial time required for proper monitoring, patient care, emotional support, and social engagement with residents. Instances of neglect can include failure to assist with personal hygiene, provide necessary medication, or attend to medical concerns promptly. Emotional neglect may occur when residents are isolated, ignored, or not provided with opportunities for social interaction and mental stimulation.
The lack of staff availability and supervision can create an atmosphere where neglect and abuse can go undetected or unaddressed for extended periods. Patients can suffer preventable falls due to a lack of adequate monitoring, or develop pressure sores due to a lack of assistance with repositioning. Other harms can range from preventable infections due to inadequate infection control practices, patients wandering from the facility and into danger due to a lack of supervision, illness from not receiving medications in a timely manner, and the like. In sum, it is important to look for warning signs of an inadequately staffed nursing home.

A properly staffed, trained and supervised workforce is necessary to ensure the well-being and quality of life for residents. In this article, we will explore the different types of workers commonly found in nursing homes, emphasizing the critical role that sufficient staffing plays in guaranteeing that patients receive the care they require.

1. Nursing Home Administrator: The nursing home administrator is responsible for overseeing the overall operation of the facility and ensuring that it functions smoothly, and in conformance with state and federal regulations, to meet the needs of its residents. This administrative position involves significant responsibilities that are necessary to the well-being of both the staff and residents. The administrator is responsible for managing the day-to-day operations, developing and implementing policies and procedures, and ensuring compliance with regulatory guidelines and standards.
   One of the primary responsibilities of the nursing home administrator is to oversee the recruitment, hiring, and training of staff members. They must ensure that the facility has a competent, well trained, properly supervised, and sufficient workforce to meet the needs of the residents. The administrator also plays a key role in maintaining staff morale, fostering a positive work environment, and addressing any staffing issues that may arise. They collaborate with department heads to develop staffing schedules that ensure adequate coverage and continuity of care.
2. Director of Nursing (DON): The Director of Nursing (DON) holds a critical position within a nursing home, serving as the leader of the nursing department and playing a pivotal role in ensuring the delivery of high-quality care to residents. The DON’s responsibilities encompass a wide range of areas, including clinical oversight, staff management, care coordination, and regulatory compliance. One of the primary responsibilities of the DON is to provide clinical leadership and direction to the nursing staff. They must work closely with registered nurses and licensed practical nurses to ensure that residents’ medical and healthcare needs are met. The DON establishes and maintains clinical policies and procedures, ensuring they align with current evidence-based practices and regulatory requirements.
3. Medical Director: The Medical Director holds a crucial role in a nursing home, and is responsible for coordinating medical care and helping to develop, implement and evaluate resident care policies and procedures to ensure they reflect current standards of care. The Medical Director, who is typically a licensed physician, should collaborate closely with the nursing staff, administrators, and other healthcare professionals to establish and maintain clinical standards, protocols, and policies within the facility in order to make sure the entire patient population is receiving the care required by their individual circumstances.
4. Registered Nurses (RNs): Registered nurses are typically the most educated and trained of the nursing staff. RNs assess residents’ conditions, communicate with physicians and other healthcare providers, coordinate care plans, administer medications, among other duties. By closely collaborating with physicians, implementing healthcare protocols, and providing direct supervision to other staff members, RNs are responsible for ensuring the effective monitoring of residents’ health, timely response, and proper execution of physician orders. Adequate staffing of registered nurses is vital to maintaining high standards of care and safeguarding the well-being of nursing home residents.
5. Licensed Practical Nurses (LPNs): Licensed Practical Nurses (LPNs) have less formal training than RNs and their permitted scope of practice is much more limited. LPNs are not qualified to perform all of the assessments and nursing functions of an RN, but LPNs typically work under the supervision and at the direction of RNs to provide hands-on care to nursing home residents. These professionals monitor vital signs, administer medications, assist with wound care, and perform routine nursing functions. LPNs play an important role in supporting the nursing team and maintaining the overall well-being of residents. In most facilities, there are many more LPNs than RNs.
6. Certified Nursing Assistants (CNAs): Certified Nursing Assistants (CNAs) typically provide the most hands-on care in a nursing home. Certified nursing aides do not have the training of an RN or an LPN and are limited in the nursing role that they may perform. CNAs provide direct daily assistance to residents with activities of daily living (ADLs) such as bathing, dressing, toileting, and eating. CNAs also observe and report changes in residents’ conditions to the licensed nursing staff, offer emotional support, and promote social engagement. It is important that CNAs forge strong relationships with residents, ensuring their comfort, dignity, and overall well-being. Adequate staffing of CNAs is crucial as it allows them to devote sufficient time and attention to each resident, preventing neglect and ensuring that residents’ individual needs are met.
7. Social Workers: Social workers play a vital role in addressing the psychosocial needs of nursing home residents. They conduct comprehensive assessments, develop care plans, and connect residents with community resources. Social workers provide counseling to residents and their families, facilitate family communication, and advocate for residents’ rights. They play a crucial role in addressing emotional and adjustment issues, promoting social interactions, and ensuring that residents’ social and emotional well-being is prioritized. Sufficient staffing of social workers is necessary to ensure that each resident receives the necessary support and that social workers have adequate time for assessments, counseling, and coordination of care.
8. Activities Coordinators: Activities coordinators organize and implement engaging programs tailored to residents’ preferences and abilities, promoting physical, cognitive, and social stimulation. These activities contribute to the mental and emotional well-being of residents, combating social isolation and fostering joy and fulfillment. Adequate staffing of activities coordinators allows for a diverse range of programs and individualized attention, ensuring that residents have access to meaningful and stimulating activities.
9. Dietary Staff and Nutritionists: Dietary staff and nutritionists in nursing homes ensure that residents receive proper nutrition while catering to their dietary needs. Collaborating with healthcare professionals, they create well-balanced menus that meet specific dietary requirements and consider individual preferences and cultural considerations. Sufficient staffing of dietary staff and nutritionists is crucial to ensure that residents’ nutritional needs are met and that personalized dietary plans are effectively implemented. This is particularly important for residents with specific dietary restrictions or medical conditions.
10. Physical and Occupational Therapists: Physical and occupational therapists play a vital role in enhancing residents’ functional abilities and promoting independence. They design personalized therapy programs to improve mobility, strength, balance, and cognitive skills. With sufficient staffing, therapists can provide regular therapy sessions, closely monitor residents’ progress, and adjust treatment plans accordingly. This ensures that residents receive the necessary rehabilitative care, enabling them to perform daily tasks and enjoy a higher quality of life.
11. Custodial or Janitorial Staff: Custodial or janitorial staff members are responsible for maintaining a clean, safe, and comfortable environment within the nursing home. They perform essential tasks such as cleaning resident rooms, common areas, and dining spaces, disinfecting surfaces, and ensuring proper waste management. Adequate staffing of custodial or janitorial staff members is crucial to uphold cleanliness standards, minimize the risk of infections, and promote the overall well-being and comfort of residents. Additionally, these dedicated individuals serve as additional eyes and ears, reporting maintenance issues or safety concerns to the appropriate personnel, ensuring a safe and pleasant environment for residents.

Conclusion

A well-functioning nursing home requires a diverse and dedicated workforce that includes registered nurses, licensed practical nurses, certified nursing assistants, social workers, activities coordinators, dietary staff and nutritionists, physical and occupational therapists, and custodial or janitorial staff. Each member of this workforce plays a crucial role in ensuring that residents receive the care they need to maintain their well-being and quality of life. Sufficient staffing is vital to guaranteeing that nursing home residents receive the attention, support, and personalized care necessary for their physical, social, and emotional well-being. By recognizing the importance of adequate staffing, we can contribute to creating nurturing environments where elderly individuals can age with dignity and receive the care they deserve.

Jeff Powless is an attorney and the author of the 2017 book, Abuses and Excuses: How To Hold Bad Nursing Homes Accountable.  Abuses and Excuses breaks new ground in helping patients and families hold bad nursing homes accountable, sharing a wealth of insider strategies and insights. It’s an eye-opening account of corporate greed, acts of neglect and abuse, an insidious industry culture of cover-up, and the actual harm that inevitably befalls vulnerable nursing home patients all across the country with shocking frequency.

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