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Nursing Home Staff
Staff Profiles of Nursing Home Workers

Quality Improvement involves the Staff

Improving care and it's quality in nursing homes is a top element that affects staff disciplines.

The Advancing Excellence Campaign lists ideas to involve all nursing homes staff to achieve quality care.

They believe that every person and every organization plays an important role and has responsibility in making improved nursing home a reality by bringing excellence.

The goals of excellence in nursing homes focus on:

  1. Reduce pressure ulcers
  2. Improving pain management
  3. Increase mobility
  4. Reduce infections
  5. Reduce antipsychotic use in residents with dementia
  6. Increase staff retention
  7. Improve consistent assignment
  8. Reduce unnecessary hospitalizations
  9. Promote person-centered care

Nursing Home Staff

Staff at Nursing Homes
Staff at Nursing Homes

Nursing homes certified by Medicare and Medicaid must have a registered nurse (RN) director of nursing (DON); an RN on duty at least 8 hours a day, 7 days a week; and a licensed nurse (RN or LPN) on duty the rest of the time.

No minimum staffing levels for nurse's aides, who provide most of the day-to-day care, have time and schedule requirements.

Nursing homes must have sufficient staff and services available in order to provide the highest possible level of physical, mental, and psychosocial well-being to each resident. They must give 75 hours of training for nurses aides.


The administrator leads the nursing home organization and directs its operations. That person sets the tone of the nursing home culture.

The administration staff consist of people responsible for individual departments:

  • Quality Assurance
  • Staff Development
  • Environmental Services
  • Food Services
  • Nursing
  • Social Services
  • Activities
  • Finance
  • Human Resources

Most states require nursing home administrators to have a license to run a facility and you can feel free to ask about the administration's education, philosophy, and experience.

Minimum requirements expected; extensive experience in a long-term care facility. Other considerations: knowledge of Federal and State licensure requirements for nursing home operations, knowledge of resident rights, confidentiality, Equal Employment Opportunity and the American Disability Act.

Nursing home administrators must have a bachelor's or master's degree from an accredited college or university or an associate degree combined with substantial experience to work in a smaller facility.

Direct Care Staff

The direct staff, who care for residents on a daily basis, are the most important people at the facility. The following are the titles of the direct care staff who work in all nursing homes:

  • Registered Nurse (RN)
  • Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN)
  • Certified Nursing Assistant (CNA)

Staffing Requirements - Federal law requires all nursing homes to provide enough staff to adequately care for residents. Yet, no federal standards exist today. Nursing homes today, the facilities take the initiative to raise the bar and set high standards in care quality given by the staff.

Standards of Staff Hours

The nursing home must have at least one RN for at least 8 straight hours a day, 7 days a week, and either an RN or LPN/LVN on duty 24 hours per day. Certain states may have additional staffing requirements.

CNAs provide twenty-four hour care to nursing home residents seven days a week.

Activities directors plan and carry out events; daily and weekly educational and social activities, coordinating special visitors and religious services. Larger facilities may have multiple staff members, like chaplains or activity assistants, who take on these roles.

Physical,occupational, and speech therapy staff is available, depending on the home.

Each nursing home reports its staffing hours to its state survey agency. These staffing hours are from a two-week period just before the state inspection. Staffing hours per resident per day is the average amount of hours worked divided by the total number of residents. It doesn't necessarily show the number of nursing staff present at any given time, or reflect the amount of care given to any one resident. In our nursing home directory, we list the average staff hours per resident per day that Medicare uses as a comparison metric for staffing levels.

It's important to know the turnover rate of the direct staff members. How long they stay may provide you with additional information about the safety and health of the facility.

Support Staff

Nursing Home Support
Nursing Home Support

The custodians, maintenance staff, and groundskeepers, keep the inside and outside of the building in clean, working order. they focus on the buildings and grounds. Even though they are not in direct contact with residents, it's important that a criminal background check is performed on these individuals.

Other personnel can include people who may have some contact with your loved one in the nursing home, but not on a daily or regular basis.

Make Nursing Homes Better Places to Live, Work and Visit

1.5 million residents live in nursing homes in the U.S. Every nursing home resident should experience person-centered care.

The Advancing Excellence Campaign suggest nursing homes follow these guidelines to make facilities better places to live, work and visit. When researching and evaluating nursing homes for a loved one, ask if they implement the following factors:

Consistent and Stable Staff

Consistent staff assignment happens when the nursing home residents receive the same type and quality care by the same caregiver. Consistent assignment increase familiarity with residents and strengthens relationships between caregivers, residents and families.

Patients and residents alike are more comfortable with caregivers they know. When staff remains stable, serving the same residents consistently, they learn the resident's needs and preferences. A nursing home benefits from experience and knowledge of a stable and consistent staff, while residents benefit from strong bonds with the caregivers.


Residents who transfer to hospitals because of an acute change in a health condition, take on many risks. If nursing homes can safely manage acute health conditions, residents can avoid trauma and risks associated with hospitalization.

Staff must better prepare and have necessary resources available to safely manage conditions.

Patient-Centered Care

Person-centered care promotes choice, purpose and meaning in daily life. It gives residents the support needed to achieve higher levels of physical, mental and psychosocial well-being. It means keeping the resident at the center of the care planning and decision-making process. Care plans reflect a person's changing needs.

Infection Control

Residents are at risk of infections because as they enter the facility after a hospital stay, residents receive more hands-on, complex care. The complex care includes wound care and maintenance of indwelling devices, which leads to bacteria exposure.

Living in a shared community, opens up the potential to easily transmissible viral infections for residents and staff.

Medication Use

When used appropriately, medications promote the resident's well-being. Nursing homes can administer effective care by focusing on techniques that help residents receive medications needed and appropriate for their condition.

Mobility Enhancement

Maintaining mobility helps residents function better. Mobility addresses more than just walking. Other issues include the range of motion, bed mobility, transferring, walking, eliminating physical restraints, wheelchair mobility, and reducing fall risk.

A residents' health and life quality improves with added freedom of movement and activity.

Pain Management

Pain management involves assessing and managing resident's pain. Nursing homes can give appropriate care to prevent and minimize episodes of moderate to severe pain. By managing pain in residents, it lessens depression, sleeplessness, restlessness, and weight-loss.

Pressure Sore Management

An ulcer or bed sore is an injury to the skin caused by constant pressure over a bony area. It's causes reduced blood supply to the area. It happens when a patient lays too long in one position or by tubing or devices that press on the skin.

Pressure ulcers are dangerous and painful. And if left untreated, introduces infection into the body and deepen to the point where they expose the bone.

The Advancing Excellence in America's Nursing Homes Campaign is a major initiative of the Advancing Excellence in Long Term Care Collaborative. The Collaborative assists all stakeholders of long-term care.

Carol Marak
Carol Marak

After seven years of helping her aging parents, Carol Marak has become a dedicated senior care writer. Since 2007, she has been doing the research to find answers to common concerns: housing, aging and health, staying safe and independent, and planning long-term.