Workplace access, burnout, and prescription drug misuse among Korean hospital nurses: a cross-sectional study.

BACKGROUND: Prescription drug misuse has been identified as a global issue of concern. Nurses' prescription drug misuse is linked to personal health problems and impaired nursing care. This study explored the level of South Korean hospital nurses' prescription drug misuse and examined associations with workplace access and burnout. METHODS: This cross-sectional study used data from 1142 nurses working in South Korean hospital settings. Nurses completed the online survey anonymously. Descriptive analysis, logistic regression, and Shapley value assessment were conducted. RESULTS: Pain relievers (44.2%), IV drips (26.8%), and antibiotics (13.5%) were the most commonly misused drugs among hospital nurses. Accessibility in the workplace was high, with nurses reporting frequent administration of IV drips, pain relievers, and antibiotics and perceiving these drugs as easily accessible. Logistic regression demonstrated that perceived availability was significantly related to misuse across all drug types. Burnout was associated with IV drips, sleeping pills, and steroids, increasing the likelihood of misuse. Shapley feature importance analysis highlighted perceived availability as the most influential factor for IV drips, pain relievers, and steroids, while burnout emerged as crucial for antibiotics and sleeping pills. Notably, age played a significant role in appetite suppressant misuse, distinguishing it from other drugs. CONCLUSION: Our results revealed that workplace access and burnout are associated with nurses' prescription drug misuse. Effective educational strategies are essential for enhancing nurses' willingness to seek help for personal health issues. Hospital organizations play a crucial role in facilitating access to healthcare and fostering a supportive environment for nurses to seek treatment when necessary. Additionally, governmental policies should prioritize the implementation of active surveillance systems to monitor medication usage in healthcare settings, thereby mitigating drug misuse among healthcare professionals. By addressing these issues, we can ensure the well-being of nurses and promote a safer healthcare environment.

Individual-level positive psychological capital that enhances managers' transformational leadership effectiveness on nurse career success.

AIMS: This study investigated the impact of nurse managers' transformational leadership on the subjective career success of staff nurses, particularly through exploring potential variations in this relationship based on nurses' positive psychological capital. BACKGROUND: Amid a challenging nursing environment, nurses' perceptions of career success affect their individual psychological satisfaction and improve work performance. Human resource strategies often include factors for workers' subjective career success, e.g., managers' transformational leadership and individual-level positive psychological capital. METHODS: This cross-sectional study collected survey data in 2021 from 348 staff nurses in 40 wards of a Korean tertiary hospital. The survey instruments included the Transformational Leadership tool, the Subjective Career Success Inventory, and the Psychological Capital Questionnaire. Multilevel hierarchical regression analysis and a simple slope test were used to examine moderating effects. The STROBE checklist was used for reporting. RESULTS: Nurses reported significantly higher subjective career success when they worked in units where unit managers' transformational leadership was greater. This relationship strengthened when nurses had high positive psychological capital. DISCUSSION: To enhance staff nurses' perceptions of career success, both managers' transformational leadership and individual nurses' positivity should be emphasized in nursing practice and education. IMPLICATIONS FOR NURSING AND NURSING POLICY: Comprehensive efforts to highlight managers' transformational leadership and staff nurses' positive psychological capital can enhance subjective career success, which in turn improve nurses' job performance and intention to stay. Nursing policymakers should value transformational leadership among managers so nurses can achieve their subjective goals. An organization-wide institutional system should be developed so nurses can receive support to strengthen their positivity. Future research should include interventions to foster managers' leadership and nurses' positive capital.

Translations and psychometric validation of the Korean version of the Nursing Teamwork Survey.

Enhancing nursing teamwork benefits both patients and nurses. The Nursing Teamwork Survey is a reliable, valid tool to evaluate nursing teamwork. This study was conducted to translate and psychometrically validate the Nursing Teamwork Survey for nurses in Korea. In Phase 1, the Nursing Teamwork Survey was translated into Korean using forward and backward translations. Content and face validity were determined using expert review and pilot testing, respectively. In Phase 2, we evaluated construct and convergent validity and internal consistency, and test-retest reliability. We used survey data from 1119 hospital nursing staff; 98 of whom completed the Korean version of the Nursing Teamwork Survey after 2 weeks. Confirmatory factor analysis showed an acceptable fit (χ2 /df ratio = 3.96, root mean square error of approximation = 0.05, standardized root mean square residual = 0.05, comparative fit index = 0.91, and Tucker-Lewis index = 0.90) with good internal consistency (Cronbach's α = 0.76-93) and test-retest reliability (rs = 0.63-0.83). Convergent validity was supported by the correlation between the subscales of the Korean version of the Nursing Teamwork Survey and the Teamwork Within Units subscale of the Hospital Survey on Patient Safety Culture (rs = 0.45-0.69, ps < 0.01). These findings indicate that the Korean version of the Nursing Teamwork Survey is a reliable and valid measurement for assessing nursing teamwork. The Korean version of the Nursing Teamwork Survey can inform management strategies to promote nursing teamwork and improve patient safety and nurses' well-being.

Nursing teamwork is essential in promoting patient-centered care: a cross-sectional study.

BACKGROUND: There has been little research regarding nursing teamwork, despite its important role in multidisciplinary teamwork in healthcare settings and its significance in ensuring high-quality nursing care. This study aimed to determine the teamwork levels of Korean nurses and examine the relationship between nursing teamwork and patient-centered care while controlling for other individual and work-related factors. METHODS: We conducted a cross-sectional analysis of online survey data. The study population consisted of 992 Korean registered nurses employed in hospitals who had a minimum of six months of clinical experience. We performed latent profile analysis to identify latent teamwork subgroups based on response patterns. We performed analysis of variance and Chi-square tests to examine differences in individual and work-related characteristics according to teamwork group. We used multiple linear regression to investigate how nursing teamwork could affect patient-centered care after controlling for covariates. RESULTS: We identified three nursing teamwork subgroups: low, mid, and high. Nurses with a higher level of teamwork in their units tended to work fewer hours with more adequate staffing (F = 5.88, p = 0.003 for working hours; F = 7.68, p < 0.001 for staffing adequacy). There was a significant positive association between nursing teamwork and patient-centered care after controlling for personal and work-related characteristics. Compared with low teamwork, mid and high teamwork increased patient-centered care scores by 0.32 (95% confidence interval [CI] = 0.23-0.40) and 0.57 (95% CI = 0.48-0.66), respectively. CONCLUSION: Our findings indicate that enhancing nursing teamwork can serve as an effective strategy for promoting patient-centered care. Providing nurse education and training to equip nurses with the necessary knowledge and skills for effective teamwork is a crucial step. Additionally, fostering management commitment to create a supportive working environment, including adequate staffing, can facilitate improved nursing teamwork and, subsequently, patient-centered care.

Factors associated with COVID-19 vaccination hesitancy in South Korea: A cross-sectional study.

Vaccination against COVID-19 has been promoted as a way to protect oneself and others from infection. To ensure the comprehensive acceptance of COVID-19 vaccines, the factors that affect COVID-19 vaccination hesitancy should be examined. This study aimed to identify the factors that affect COVID-19 vaccination hesitancy among Korean adults, focusing on COVID-19 knowledge and attitudes toward vaccination. This was a cross-sectional study conducted with 2286 Korean adults aged 20-64 years. Demographic characteristics, knowledge regarding COVID-19, and attitudes toward vaccination were assessed. A generalized linear model with Poisson regression was used to identify factors associated with COVID-19 vaccination hesitancy. Approximately 67% of the COVID-19 knowledge-related questions were correctly answered. A neutral attitude toward vaccination and relatively low vaccination hesitancy were found. COVID-19 vaccination hesitancy was affected by individuals' attitudes toward vaccination, as well as their gender and age, but not by their knowledge. Interventions or policies considering gender and age could be helpful in reducing COVID-19 vaccination hesitancy. Strategies to disseminate more accurate and novel information related to the COVID-19 vaccines should be implemented.

Workplace Exposures and Prescription Drug Misuse Among Nurses.

OBJECTIVE: This study examined the association between workplace exposure and prescription drug misuse in nurses. BACKGROUND: Studies have found RNs and other health providers have higher rates of prescription misuse than the general population and have suggested that workplace exposures along with excessive job demands create circumstances fostering misuse. METHODS: Survey data from 1170 RNs on workplace exposures (availability, frequency of administration, knowledge of substances, and workplace controls) were described by workplace, position, and specialty. Exposures were then related to prescription drug misuse using logistic regression. RESULTS: Each workplace exposure was associated with past year prescription drug misuse. An index combining all exposures was significantly related to misuse ( P = 0.001), and odds of misuse increased by 38% for each point increase in the exposure index. CONCLUSIONS: Consideration of the health and well-being of nurses at higher odds of exposure to prescription drugs with misuse potential is warranted. Workplace support to help nurses maintain and restore their health should be a priority.

Smartphone-based home workout program for shift-work nurses working during the COVID-19 pandemic.

This study aimed to develop a smartphone-based home workout program for shift-work nurses to increase their levels of exercise and examine its effects on health (sleep disturbance, fatigue, musculoskeletal problems, and resilience) and nursing performance. For this quasiexperimental study with a nonequivalent control group, 54 shift-work nurses were recruited from two general wards at a hospital in Korea and assigned to the intervention and control groups. Nurses in the intervention group were encouraged to exercise regularly using the home workout application for 18 weeks. For the first 12 weeks, text-message counseling and environmental improvement were carried out; only environmental improvement was implemented in the remaining 12-18 weeks. The control group did not receive any intervention. After excluding dropouts, the data of the final 25 participants in the intervention group and 24 participants in the control group were analyzed. Compared with the control group, the intervention group showed statistically significant improvements in physical and psychological health. Hospital organizations could adopt a smartphone-based home workout program to overcome obstacles to exercise, which could lead to positive health outcomes for shift-work nurses.

Work Schedule Characteristics, Missed Nursing Care, and Organizational Commitment Among Hospital Nurses in Korea.

PURPOSE: This study describes Korean nurses' work schedule characteristics and identifies their components to investigate associations of work schedule components with missed nursing care and organizational commitment. DESIGN: This cross-sectional secondary analysis used survey data of 1,057 nurses in 111 units at six hospitals in South Korea. Data were collected between April 2017 and March 2018. METHODS: A self-administered survey, including seven work schedule characteristic items, the Korean version of the MISSCARE Survey, and the Korean version of the Organizational Commitment Questionnaire, was employed. To construct independent components of work schedule characteristics, a principal component analysis was performed. The associations of work schedule components with missed nursing care and organizational commitment were analyzed using multiple linear regression models with generalized estimating equation methods. FINDINGS: The average number of daily work hours was 9.7. Nearly half of the study population worked while sick once or more per month. The two components of nurses' work schedule characteristics were "long work hours" and "lack of rest," and these components showed variations between units. Unhealthy work schedule components were linked to frequently missed nursing care and decreased organizational commitment. CONCLUSIONS: This study showed that proper work hours and adequate rest are important to reduce missed nursing care tasks and enhance organizational commitment, both of which are critical for better patient care and organizational outcomes. CLINICAL RELEVANCE: Healthcare organizations should provide adequate nursing staff and assign reasonable workloads. Furthermore, hospitals should periodically monitor the work schedule characteristics of nurses and actively intervene in cases of scheduling issues to resolve them.

Unit work environment, psychological empowerment and support for patient activation among nurses.

AIMS: To investigate the relationship between the unit work environment and psychological empowerment of nurses and their perceptions of patient activation. BACKGROUND: Nurses' support for active patient roles in the care process is critical for better patient outcomes. The factors influencing nurses' support for patient activation should be thoroughly investigated. METHODS: This study was a cross-sectional secondary data analysis using the survey data of 1,042 nurses in 98 units at six hospitals in Korea. RESULTS: Nurses with perceptions that their work was valuable and autonomy in their work were more likely to work in units where managers had greater managerial and leadership skills and staffing and resources were sufficient. Those with confidence in their work were more likely to work in units with adequate staffing and resources. Nurses who worked with adequate staffing and resources and considered their work meaningful were more likely to perceive patient activation as more important. CONCLUSION: Favourable work environments at unit level and psychological empowerment at nurse level can strengthen nurses' support for patient activation. IMPLICATIONS FOR NURSING MANAGEMENT: To strengthen nurses' support for active patient roles, organisations should ensure optimal staffing and resources to each unit and help nurses find value in their work.

Three-factor structure of the eHealth Literacy Scale and its relationship with nurses' health-promoting behaviours and performance quality.

AIMS: To examine the factorial validity of the eHealth Literacy Scale among hospital nurses and to investigate the associations of its components with health-promoting behaviours and nursing performance quality. DESIGN: This cross-sectional study used survey data of 484 Korean hospital nurses, which were collected between March-May 2016. METHODS: The three-factor structure was tested using confirmatory factor analyses. Multiple linear regression was conducted to test associations of the three components' scores with health-promoting behaviours and self-rated nursing performance quality. RESULTS: The eHealth Literacy Scale supported a three-factor structure: awareness of internet health resources (awareness), having skills needed to access resources (skills), and the ability to evaluate the quality of internet health resources (evaluation). All the three components were significantly associated with higher quality of nursing performance and better interpersonal relations. Stress management, spiritual growth, and health responsibility were linked with evaluation or skills but physical activity and nutrition were not. CONCLUSION: Strategies to enhance eHealth literacy among nurses could improve nurses' health and further patient care. Training to build nurses' self-efficacy to evaluate internet health information could improve eHealth literacy and should be developed and examined. IMPACT: To improve nurses' health and patient care, training programs to build nurses' self-efficacy to access and evaluate internet health information should be developed.

Comparing residential long-term care regulations between nursing homes and assisted living facilities.

BACKGROUND: Nursing homes (NHs) are federally regulated under uniform standards, whereas assisted living facilities (ALFs) use individual state regulations for staffing, training, and oversight of care quality and safety. PURPOSE: To describe ALF staffing, training, inspection, and enforcement regulations for 50 U.S. states and the District of Columbia, and compare them to NH regulations. Publication of ALF quality and safety outcomes data also was assessed and compared to NHs. METHODS: Regulatory data were compiled from administrative and regulatory data sources, state websites, and regulatory compendia. FINDINGS: NHs followed a standard set of regulations, whereas ALF regulations varied widely. Overall, state ALF regulations were less stringent than NH in all categories. DISCUSSION: As ALF populations and acuity levels increase, staffing, training, nursing presence, and outcomes data requirements are warranted, and could be tailored from NH regulations to protect ALF quality and safety.

Association between nursing work environment and compassion satisfaction among clinical nurses.

AIM: This study investigated the association between nursing work environment and compassion satisfaction among clinical nurses. BACKGROUND: Nursing work environment and compassion satisfaction are important factors for preventing burnout and decreasing clinical nurse turnover. METHOD: This study used a secondary analysis and obtained data from a previous cross-sectional study. RESULTS: The mean scores (mean ± SD) for the nursing work environment and compassion satisfaction were 2.54 ± 0.34 and 33.40 ± 6.69, respectively. As the results of hierarchical regression, staffing and resources (ß = 0.175, p = .002) and collegial nurse-physician relationships (ß = 0.103, p = .038) were significantly associated with compassion satisfaction. CONCLUSION: Improving the nursing work environment could be an effective way to boost compassion satisfaction among nurses. Therefore, organizational support for adequate human resources and materials and mutual relations among nurses and physicians are needed. IMPLICATIONS FOR NURSING MANAGEMENT: Improvements to the work environment and the management of human resource may increase compassion satisfaction in clinical nurses.

Changes in health behaviours and health status of novice nurses during the first 2 years of work.

AIMS: To explore changes in health behaviours and health status of novice nurses during the first 2 years of work. BACKGROUND: Novice nurses experience many difficulties in maintaining healthy behaviours while adapting to clinical settings. However, studies about the health of novice nurses have not focused on changes over time. DESIGN: Longitudinal descriptive study with self-reported questionnaires. METHODS: Data were collected from 493 novice nurses who started work between September 2014 - December 2015 at a tertiary hospital in Seoul. Dietary behaviours, sleep, depressive symptoms, perceived stress and health status were measured at six time points during the first 2 years of work (the first day of orientation before ward placement, 6 weeks after starting work and 6, 12, 18 and 24 months of work). Changes were examined using means or percentages and 95% confidence intervals. RESULTS: Unhealthy dietary behaviours increased across 6 months, continuing for 2 years. Sleep quality and quantity, depressive symptoms, perceived stress and health status first worsened and then improved; however, they were worse than at baseline. CONCLUSION: Organizational support for novice nurses is urgently needed. Workplace health education programmes will help them adjust to rotating shift work and maintain better health status.

Shift-work nurses' work environments and health-promoting behaviours in relation to sleep disturbance: A cross-sectional secondary data analysis.

AIMS AND OBJECTIVES: To examine the association of nursing work environments and health-promoting behaviours with shift-work nurses' sleep disturbance. BACKGROUND: Shift-work nurses reportedly have sleep problems, which affect their sleep quality and quantity. Given the high risk of developing performance decrements and medication errors in sleep-disturbed nurses, factors related to sleep disturbance among shift-work nurses should be investigated. DESIGN: A cross-sectional secondary data analysis. METHODS: Our study analysed data from 339 nurses who had been involved in rotating shift work including night shifts for more than 6 months. To examine associations of nursing work environments and health-promoting behaviours with sleep disturbance, multiple linear regression models were generated. This study is reported in accordance with the STrengthening the Reporting of OBservational studies in Epidemiology guideline. RESULTS: Nurses with more collegial relations with physicians were significantly less likely to have high levels of sleep disturbance (B = -4.01, p = 0.04). Those with higher levels of sleep disturbance were significantly more likely to report less stress management (B = -9.56, p < 0.01) and higher health responsibility (B = 9.30, p < 0.01). CONCLUSIONS: To alleviate shift-work nurses' sleep disturbance, organisational supports for collaborative relations with physician and increased healthcare accessibility are needed. Individual nurses should develop healthy lifestyles to reduce occupational stress and alleviate sleep disorders. RELEVANCE TO CLINICAL PRACTICE: To improve shift-work nurses' sleep, collegial relations with physicians and healthy lifestyles should be promoted.

Authentic leadership, job satisfaction and organizational commitment: The moderating effect of nurse tenure.

AIMS: To examine the associations between unit managers' authentic leadership with job satisfaction and organizational commitment and to investigate whether nurse tenure has a moderating effect on these associations. BACKGROUND: Authentic leaders create trusting relationships with their staff and help nurses become more satisfied with their jobs and committed to their organizations. Because nurses have different perceptions of their working environments based on their tenure, the effectiveness of managerial leadership differ accordingly. METHODS: This study is a cross-sectional secondary analysis using survey data from 1,118 staff nurses. To determine the significant tenure range for the associations between authentic leadership, job satisfaction and organizational commitment, the Johnson-Neyman method was used. RESULTS: Authentic managerial leadership perceived by staff nurses had positive associations with job satisfaction and organizational commitment. The strengths of these associations were attenuated with nurse tenure and were no longer significant for nurses with more than 20 years of tenure. CONCLUSIONS: Although authentic leadership in managers was effective, the strengths of its effectiveness varied based on nurse tenure. IMPLICATIONS FOR NURSING MANAGEMENT: According to nurse tenure, differentiated approaches are needed to increase the job satisfaction and organizational commitment of staff nurses.

Associations Among Nursing Work Environment and Health-Promoting Behaviors of Nurses and Nursing Performance Quality: A Multilevel Modeling Approach.

PURPOSE: This study aimed to determine the relationships among the unit-level nursing work environment and individual-level health-promoting behaviors of hospital nurses in South Korea and their perceived nursing performance quality. METHODS: This study used a cross-sectional design. Data were collected using self-reported questionnaires from 432 nurses in 57 units at five hospitals in South Korea. Nursing performance quality, nursing work environment, and health-promoting behaviors were measured using the Six Dimension Scale of Nursing Performance, Practice Environment Scale of the Nursing Work Index, and Health Promoting Lifestyle Profile-II, respectively. RESULTS: Nurses working in units with nurse managers who were characterized by better ability and by quality leadership, and who provided more support to nurses exhibited significantly greater health responsibility and physical activity. Nurses working with sufficient staffing and resources reported better stress management. Positive collegial nurse-physician relationships in units were significantly associated with more healthy eating among nurses. Nurses working in units with sufficient staffing and resources, and who had a higher level of spiritual growth and health responsibility, were more likely to perceive their nursing performance quality as being higher. CONCLUSIONS: To improve the quality of nursing practice, hospitals should focus on helping nurses maintain healthy lifestyles, as well as improving their working conditions in South Korea. Organizational support for adequate human resources and materials, mutual cooperation among nurses and physicians, and workplace health-promotion interventions for spiritual growth and health responsibility are needed. CLINICAL RELEVANCE: Organizational efforts to provide sufficient staffing and resources, boost the development of personal resources among nurses, and promote nurses' responsibility for their own health could be effective strategies for improving nursing performance quality and patient outcomes.

Associations of eHealth literacy with health-promoting behaviours among hospital nurses: A descriptive cross-sectional study.

AIMS: To investigate the associations of eHealth Literacy with health-promoting behaviours among hospital nurses in South Korea. BACKGROUND: Health-promoting behaviours of nurses are crucial for their own improved health and health-related behaviours of patients. eHealth literacy refers to the ability to search, understand and evaluate health information available online. With the growing use of the Internet, eHealth literacy is emerging as an important factor enhancing health-promoting behaviours. DESIGN: Descriptive cross-sectional design with self-reported questionnaires. METHODS: Data were collected between March-May 2016 from five hospitals in South Korea. Health-promoting behaviours and eHealth literacy were assessed using Health Promoting Lifestyle Profile-II and K-eHEALS, respectively. Multiple linear regression models were used to examine the associations of eHealth literacy and health-promoting behaviours. RESULTS: Nurses with high level of eHealth literacy had significantly positive overall health-promoting behaviours, stress management, interpersonal relations, self-actualization and health responsibility, but not for nutrition and physical activity. CONCLUSION: Improving eHealth literacy through various strategies could be an effective way to boost health-promoting behaviours among nurses. However, improvement of actual health-promoting behaviours such as nutrition and physical activity will require systematic and organizational changes.

A psychological intervention programme for patients with breast cancer under chemotherapy and at a high risk of depression: A randomised clinical trial.

AIMS AND OBJECTIVES: To develop a nurse-led psychological intervention programme and to evaluate its effects on psychological distress and quality of life in patients with breast cancer undergoing chemotherapy and at a high risk of depression. BACKGROUND: Depression is common among patients with breast cancer undergoing chemotherapy. Psychological intervention programmes that improve psychological distress and quality of life have previously been lacking in South Korea. DESIGN: This was a pre- and post-test randomised controlled trial. METHODS: The nurse-led psychological intervention programme comprised seven weekly counselling sessions delivered face to face and telephonically. These aimed to provide emotional support to patients and to enable them to express their feelings. Patients at a high risk of depression were recruited from an oncology outpatient clinic in a university hospital. Sixty participants were evenly and randomly allocated to either the intervention group or the control group. The effects of the intervention on psychological distress (mood disturbance, anxiety and depression) and quality of life were examined using linear mixed models. RESULTS: Compared with the control group, the intervention group reported significantly lower mood disturbance, anxiety and depression and showed an improved global health status and physical, role and emotional functions. They also reported fewer symptoms such as fatigue, nausea/vomiting, pain and insomnia. CONCLUSIONS: Our nurse-led psychological intervention programme might reduce patients' uncertainty and encourage them to be proactive and self-controllable. RELEVANCE TO CLINICAL PRACTICE: Nurse-led psychological intervention programmes should be implemented to reduce psychological distress and improve quality of life in patients with breast cancer, particularly those at a high risk of depression.

Longitudinal associations of nursing staff turnover with patient outcomes in long-term care hospitals in Korea.

AIMS: To describe the characteristics of long-term care hospitals in 2010-2013 and to examine the longitudinal associations of nursing staff turnover with patient outcomes. BACKGROUND: The number of long-term care hospitals has exploded in Korea since the national long-term care insurance was launched in 2008. The care quality deviation across long-term care hospitals is large. METHODS: This was a longitudinal secondary data analysis using the Health Insurance Review and Assessment Service's data. RESULTS: From 2010 to 2013, the nursing staff turnover rate decreased. The number of patients per registered nurse increased while that per total nursing staff and skill mix decreased. All adverse patient outcomes decreased. Higher nursing staff turnover and lower RN proportions were associated with adverse patient outcomes. CONCLUSIONS: Since the launch of the long-term care insurance, total nursing staffing, turnover rate and patient outcomes have improved, while the skill mix has decreased. Systematic efforts to decrease nursing staff turnover should be implemented for better long-term care patient outcomes. IMPLICATIONS FOR NURSING MANAGEMENT: In addition to maintaining high levels of nurse staffing and skill mix, supportive work environments and competitive wages and benefits could reduce turnover, and ultimately adverse patient outcomes. Health care policy should separate nursing staffing levels for registered nurses and certified nursing assistants.

Variation Across U.S. Assisted Living Facilities: Admissions, Resident Care Needs, and Staffing.

PURPOSE: Though more people in the United States currently reside in assisted living facilities (ALFs) than nursing homes, little is known about ALF admission policies, resident care needs, and staffing characteristics. We therefore conducted this study using a nationwide sample of ALFs to examine these factors, along with comparison of ALFs by size. DESIGN: Cross-sectional secondary data analysis using data from the 2010 National Survey of Residential Care Facilities. METHODS: Measures included nine admission policy items, seven items on the proportion of residents with selected conditions or care needs, and six items on staffing characteristics (e.g., access to licensed nurse, aide training). Facilities (n = 2,301) were divided into three categories by size: small, 4 to 10 beds; medium, 11 to 25 beds; and large, 26 or more beds. Analyses took complex sampling design effects into account to project national U.S. estimates. FINDINGS: More than half of ALFs admitted residents with considerable healthcare needs and served populations that required nursing care, such as for transfers, medications, and eating or dressing. Staffing was largely composed of patient care aides, and fewer than half of ALFs had licensed care provider (registered nurse, licensed practical nurse) hours. Smaller facilities tended to have more inclusive admission policies and residents with more complex care needs (more mobility, eating and medication assistance required, short-term memory issues, p < .01) and less access to licensed nurses than larger ALFs (p < .01). CONCLUSIONS: This study suggests ALFs are caring for and admitting residents with considerable care needs, indicating potential overlap with nursing home populations. Despite this finding, ALF regulations lag far behind those in effect for nursing homes. In addition, measurement of care outcomes is critically needed to ensure appropriate ALF care quality. CLINICAL RELEVANCE: As more people choose ALFs, outcome measures for ALFs, which are now unavailable, should be developed to allow for oversight and monitoring of care quality.