LAUSR

Key Points Question Is day-to-day staffing instability of registered nurses, licensed practical nurses, and certified nurse aides, measured as the percentage of days substantially below average levels, associated with nursing home quality? Findings In this quality improvement study of 14 717 nursing homes, after controlling for average staffing levels, staffing instability of licensed practical nurses and certified nurse aides was associated with lower quality across standard quality measures. Meaning This study suggests that day-to-day staffing instability is an important marker of nursing home quality, limiting measurement, reporting, or policy to average hours per resident-day likely will miss important opportunities to improve care.