Pulse brief · 2 cited sources · August 13, 2026
Higher RN Share Is Associated With Lower Acute-Care Use
A nationwide panel of 14,993 nursing homes associates RN-intensive staffing with lower hospitalization and outpatient ED use without establishing cause.
A nationwide panel of 14,993 nursing homes and 399,820 facility-quarter observations separates staffing volume from staff mix. The panel ran from 2018Q4 through 2025Q2, with outcomes measured in rolling 12-month windows. Holding total nursing hours constant, a 10-percentage-point higher registered-nurse share was associated with lower hospitalization and outpatient ED visit rates among long-stay residents. Total nursing hours were not independently associated with either outcome in the joint model, and the RN associations stayed negative in sensitivity analyses. The study is observational and does not establish cause. A prior report says the administration repealed a federal rule that would have required 3.48 hours of daily nursing care per resident and at least one registered nurse on site 24 hours a day. Will CMS add registered-nurse share to nursing-home staffing quality measures after this nationwide panel study?
Evidence
Each statement shown below is a verified claim this source supports.
- Holding total nursing HPRD constant, a 10-percentage-point higher registered-nurse share was associated with lower hospitalization and outpatient ED visit rates among long-stay residents.
- The study sample comprised 14,993 nursing homes and 399,820 facility-quarter observations.
- The observational nursing-home findings do not support causal inference.
- The nursing-home study distinguishes registered-nurse staffing intensity and registered-nurse share from total nursing staffing volume.
- The nationwide quarterly panel ran from 2018Q4 through 2025Q2, and outcomes used rolling 12-month windows refreshed quarterly.
- Total nursing HPRD was not independently associated with either outcome in the joint model, and registered-nurse associations stayed negative in the sensitivity analyses.
- The study used CMS Care Compare data and says staffing composition should be considered alongside total nursing hours in quality improvement and workforce policy.
- A prior report says the administration repealed a federal rule that would have required 3.48 hours of daily nursing care per resident and at least one registered nurse on site 24 hours a day.