This study was intended to determine if the American Nurses Association (ANA) nurse sensitive quality indicators, originally developed for acute care facilities, could be applied to long-term care facilities. Six patient specific (pressure ulcers, falls, satisfaction with pain management, educational information, nursing care, and overall care) and two ANA nurse specific indicators (skill mix of RNs, licensed practical nurses, and unlicensed staff; total nursing care hours provided per patient day) were rated by long-term care nursing experts. The authors conclude that long-term care facilities can participate in the national reporting of nurse sensitive quality indicators for benchmarking purposes with minimal effort, as long-term care facilities already collect data on four of the eight indicators examined in this study.

Background: This study was intended to determine if the American Nurses Association (ANA) nurse sensitive quality indicators (QI), originally developed for acute care facilities, could be applied to longterm care facilities. "Nurse sensitive" indicators are those that measure nurse staffing and (positive) outcomes. In long-term care settings, measuring the association between nurse staff levels and quality care is even more critical because fewer professionally licensed staff provide care to residents of longterm care facilities. Specifically, six patient specific (pressure ulcers, falls, satisfaction with pain management, educational information, nursing care, and overall care) and two ANA nurse specific indicators (skill mix of RNs, licensed practical nurses, and unlicensed staff; total nursing care hours provided per patient day) were studied. Currently, only two of the ANA specific quality indicators are similar to indicators routinely measured by the federally mandated Minimum Data Set (pressure ulcers and falls) for Medicare/Medicaid reimbursement.

Methods: Long-term care nursing experts were asked to complete a questionnaire probing their opinions on nurse-sensitive quality indicators. Nursing experts were defined as being a member of the National Association of Directors of Nursing Administration in Long-term Care and ANCC-certified gerontological nurse practitioners and specialists. The Centres for Medicare and Medicaid Services On- Line Survey and Certification Record (OSCAR) database was used to calculate nursing hours per resident day.

Findings: Of the 500 questionnaires mailed out, only 106 were returned (21% response rate). Respondents indicated that satisfaction with pain management was the most nurse sensitive QI, followed by satisfaction with educational information, pressure ulcers, satisfaction with nursing care, falls, and satisfaction with overall care. The respondents indicated that falls and pressure ulcers were the most relevant ANA QIs for long-term care facilities.

The greatest concern for the ANA QIs were related to satisfaction because many residents of longterm care facilities have mild to severe cognitive impairment and may not be able to provide valid responses. Respondents also noted a need for common and consistent definitions (e.g., pressure ulcers). Analysis of the OSCAR database revealed that the total direct-care nursing hours per resident day was 3.35, with RNs providing 13% of those hours. Certified nursing assistants provided 68% of the care.

Conclusions: The long-term care-nursing experts supported the relevance of the set of ANA quality indicators for use in long-term care facilities. Definitions must be adjusted to meet the specific needs of the long-term care environment. Experts as having moderate sensitivity to professional nursing care rated five of the six patient-specific indicators. These indicators could be applied to a national database for nurse staffing in long-term care facilities. The authors conclude that long-term care facilities can participate in the national reporting of nurse sensitive quality indicators for benchmarking purposes with minimal effort, as long-term care facilities already collect data on some of the eight indicators examined in this study.

Reference: Mueller C, Karon SL. "ANA nurse sensitive quality indicators for long-term care facilities". Journal of Nursing Care Quality, 2004; 19, 39-47.

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