Evid Based Nurs doi:10.1136/ebn.2011.100186
  • Care of the older person
  • Systematic review

Reviewing the evidence base for nurse staffing and quality of care in nursing homes

  1. Nicholas G Castle
  1. Department of Health Policy&Management, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Nicholas G Castle
    Graduate School of Public Health, University of Pittsburgh, A610 Crabtree Hall, Pittsburgh 15261, Pennsylvania, USA; CastleN{at}

Commentary on:

Implications for practice and research

  • There is some evidence that the registered nurse to nursing auxiliary ratio has an impact on the quality of care but further research is needed.

  • There is a need to consider other factors such as staff turnover and the use of agency staff when considering the quality of care in nursing homes (NHs).

  • Further research is needed to identify quality indicators that take into account what is important to residents and their families.

  • There are a number of methodological challenges to undertaking research in this area.


This research comes at a time when NHs are being increasingly asked to do more with less. Revenues for NHs do not appear to be keeping up with inflation. Given that …

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