Nurses’ Impact on Nursing Home Care


Gregg Warshaw, MD

Medical Editor


In the long-term care (LTC) setting, nurses are on the front lines of care. They are the ones tending to residents’ medical and everyday needs and are often the first ones to spot complications and other healthcare challenges. Because of their level of interaction with residents and residents’ families, nurses have a profound impact on resident care and on how care is perceived. In this issue of Annals of Long-Term Care: Clinical Care and Aging®, we examine the many ways nurses impact nursing home care.

In “Improving Medication Safety in Long-Term Care by Considering Route of Medication Administration,” the author discusses the importance of not only considering which medications are being administered, but also their formulation (eg, extended-release, continuous-release, sustained-release) and manner of administration (eg, intact, crushed, chewed). In some cases, medications are being administered in ways they are not intended to be, such as crushing an extended-release product. Because nurses are the ones administering medications to residents, the author notes that it is important for nurses to know how to appropriately administer these medications. This is especially crucial for LTC nurses because residents’ conditions can change, leading to problems taking their medications as prescribed. Once a patient can no longer swallow pills, it may be tempting to crush or otherwise alter them, but if the medication formulation is not designed to be administered in an altered form, medication safety issues arise and residents’ conditions may not be optimally treated.

In our second article, “Administrator Turnover and Quality of Care in Nursing Homes,” the authors report the findings of their Iowa-based study, which examined whether higher nursing home administrator turnover rates impact care quality in nursing homes. The authors assessed various records for 151 nursing homes and found that those with higher turnover rates also had more deficiencies. They speculate that this is because administrators heavily influence facility operations, thereby significantly impacting the quality of care at LTC facilities. Although the study was restricted to facilities in Iowa, the authors suggest that their findings are likely to be applicable nationwide. As they note, nursing homes throughout the United States have similar staffing characteristics and face similar socioeconomic environments and market forces. Because quality care assessments have largely focused on direct care staff, the authors call for more research on administrative turnover, including the causes behind it and how it can be prevented.

Our last article, “How Nurses Affect Pain Management Practices in Nursing Homes and Shape Families’ Perceptions of Care,” examines how nurses impact pain management for LTC residents, how they affect the perception of pain management and overall care by residents’ families, and how pain management can be improved. The author, a registered nurse, notes several major barriers to effective pain management with regard to nursing staff: lack of education, attitudes regarding family involvement, and lack of communication between nursing staff and care providers. By accepting the involvement of families and closely listening to their concerns regarding pain management, nurses can facilitate more effective pain management practices and improve family satisfaction with care delivery.

Let us know your thoughts about any of the articles in this month’s issue. You can send them to our associate editor, Allison Musante, at We also encourage you to visit to take our monthly poll. This month we would like to know what you consider to be the biggest obstacle for nurses with regard to ensuring quality of care in nursing homes.  

Thank you for reading!

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