Background: Recent evidence suggests that an increase in baccalaureate-educated registered nurses (BRNs) leads\nto better quality of care in hospitals. For geriatric long-term care facilities such as nursing homes, this relationship is\nless clear. Most studies assessing the relationship between nurse staffing and quality of care in long-term care\nfacilities are US-based, and only a few have focused on the unique contribution of registered nurses. In this study, we\nfocus on BRNs, as they are expected to serve as role models and change agents, while little is known about their\nunique contribution to quality of care in long-term care facilities.\nMethods: We conducted a cross-sectional study among 282 wards and 6,145 residents from 95 Dutch long-term\ncare facilities. The relationship between the presence of BRNs in wards and quality of care was assessed, controlling for\nbackground characteristics, i.e. ward size, and residents� age, gender, length of stay, comorbidities, and care\ndependency status. Multilevel logistic regression analyses, using a generalized estimating equation approach,\nwere performed.\nResults: 57% of the wards employed BRNs. In these wards, the BRNs delivered on average 4.8 min of care\nper resident per day. Among residents living in somatic wards that employed BRNs, the probability of experiencing a\nfall (odds ratio 1.44; 95% CI 1.06-1.96) and receiving antipsychotic drugs (odds ratio 2.15; 95% CI 1.66-2.78) was higher,\nwhereas the probability of having an indwelling urinary catheter was lower (odds ratio 0.70; 95% CI 0.53-0.91). Among\nresidents living in psychogeriatric wards that employed BRNs, the probability of experiencing a medication incident\nwas lower (odds ratio 0.68; 95% CI 0.49-0.95). For residents from both ward types, the probability of suffering from\nnosocomial pressure ulcers did not significantly differ for residents in wards employing BRNs.\nConclusions: In wards that employed BRNs, their mean amount of time spent per resident was low, while quality of\ncare on most wards was acceptable. No consistent evidence was found for a relationship between the presence of\nBRNs in wards and quality of care outcomes, controlling for background characteristics. Future studies should consider\nthe mediating and moderating role of staffing-related work processes and ward environment characteristics on quality\nof care.
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