Most of my life I lived “inside the beltway,” which is DC speak for an area that includes Washington DC and the close suburbs of Maryland and Virginia. August was always my favorite month in DC. Not because the weather is hot and humid, but because the city is quiet. Congress is on recess; the staffers, the lobbyists and everyone else connected with “The Hill” take time away from the city. There is very little traffic and one can get into any restaurant in town.
It also meant that very little legislation was drafted. So I was surprised on July 31 (ok, not technically August) when Representative Jan Schakowsky, Democrat of Illinois, introduced “the bluntly titled Put A Registered Nurse in the Nursing Home Act, or House Vote 5373. It would require that a direct-care registered nurse (not an administrator) be present 24 hours a day, seven days a week, in all the nearly 16,000 nursing homes that receive Medicare or Medicaid reimbursement” (NYTimes.com).
What’s behind this new legislation? Congress has long been concerned about the quality of care and staffing in skilled nursing facilities (SNFs). Attempts to regulate nurse staffing began in 1987 when Federal guidelines for minimum staffing (OBRA, 87) were enacted. The guidelines, in place today, include requirements for a RN DON in each facility, and an additional RN at least 8 consecutive hours per day, 7 days per week in facilities with 60 or greater beds.
In 2008, Congress asked CMS to develop the Nursing Home Compare Five Star Rating Program. This rating system was the first attempt to highlight the RN staffing. Why highlight RN staffing? Because historically many long term care providers have used the concept of licensed nurse in their staffing plans. This approach means that RN and LPNs are assigned interchangeably even though they have different licenses and scope of practice.
Again in 2014 there is renewed federal interest in legislating nurse staffing in SNFs. Undoubtedly, this new legislation is partially in reaction to the fact that the SNF today bears little resemblance to the nursing home when OBRA 87 was enacted. Today the patients and residents who recuperate or live in SNFs are increasingly frail and medically complex. Increased acuity and frailty, coupled with increased numbers of admissions and discharges, lead to the need for nursing staff to have advanced assessment skills that are part of an RN’s education and scope of practice. Additionally, studies have repeatedly pointed to the importance of registered nurses staffing and improved clinical, quality, and financial outcomes.
This continuous Congressional focus on staffing, especially registered nurse staffing, will undoubtedly cause SNF providers to take a renewed look at their staffing plans and philosophies. Providers will need to adopt a more sophisticated, data driven approach to staffing. Regardless of legislation, providers who make staffing decisions based on patient/resident need and unit activity, especially admissions and discharges, will be in the best position to achieve increases in quality of care, satisfaction among the nursing team and compliance with existing and potentially new regulatory requirements.
Learn more about a data drive approach to staffing by downloading one of our resources below:
