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.

Context

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 …