Effects of Nursing Practice Environments on Quality Outcomes in Nursing Homes

The prevalence of pressure ulcers among nursing home residents is an important indicator of quality of care. Another indicator is the number of deficiency citations issued during federally-mandated inspections. While several initiatives have been directed at improving theses two quality-related outcomes, none have focused on modifiable characteristics of the nursing work environment.

This study investigated the relationships between facility characteristics and the practice environment on the occurrence of pressure ulcers and deficient citations in 63 New Jersey nursing homes. The percentage of residents with pressure ulcers ranged from 3 percent to 33 percent. The reported deficiencies ranged from 0 to 17.

Key Findings:

  • A more supportive nursing practices environment was associated with better outcomes.
  • For-profit status was the only facility characteristic associated with the prevalence of pressure ulcers. For-profit status also was inversely associated with the nursing practice environment. Together, for-profit status and the practice environment explained 17 percent of the variation in pressure ulcers.
  • Facility size was the only facility characteristic associated with deficiency citations. The nursing practice environment and facility size explained 25 percent of variation in deficiencies.

“Administrative initiatives to create environments that support nursing practice may hold promise for improving quality indicators in nursing homes,” the authors conclude.