Journal
JOURNAL OF NURSING CARE QUALITY
Volume 37, Issue 1, Pages 21-27Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/NCQ.0000000000000604
Keywords
advanced practice registered nurse; nursing homes; registered nurse; regulations; social work
Categories
Funding
- Centers for Medicare & Medicaid (CMS) Innovations Center and Medicare-Medicaid Coordination Office [1E1CMS331080, 1E1CMS331489]
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US nursing homes need to establish regulations to enhance nurse and social work requirements, and remove barriers for APRN services in order to support staff and residents.
Background: US nursing homes (NHs) have struggled to overcome a historic pandemic that laid bare limitations in the number and clinical expertise of NH staff. Problem: For nurse staffing, current regulations require only one registered nurse (RN) on duty 8 consecutive hours per day, 7 days per week, and one RN on call when a licensed practical/vocational nurse is on duty. There is no requirement for a degreed or licensed social worker, and advanced practice registered nurses (APRNs) in NHs cannot bill for services. Approach: It is time to establish regulation that mandates a 24-hour, 7-day-a-week, on-site RN presence at a minimum requirement of 1 hour per resident-day that is adjusted upward for greater resident acuity and complexity. Skilled social workers are needed to improve the quality of care, and barriers for APRN billing for services in NHs need to be removed. Conclusions: Coupling enhanced RN and social work requirements with access to APRNs can support staff and residents in NHs.
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