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Improving nursing home care has easy solution—hire advanced nurses

New research from the University of Missouri provides substantial evidence that full-time APRNs have a significant impact on improved outcomes

July 10th, 2018

Story Contact: Sheena Rice, 573-882-8353,

COLUMBIA, Mo. – Nursing homes hoping to provide the best care to their residents need to budget for hiring advance practice registered nurses (APRNs) to work full time. Continued research from a team of nursing experts at the University of Missouri has resulted in significant evidence that APRNs have a positive effect on improving outcomes for nursing home residents.

“Never before have there been such clear findings of the impact of APRNs on quality measures that are key to five-star ratings for all nursing homes in the country,” said Marilyn Rantz, Curators Professor of Nursing in the Sinclair School of Nursing at MU. “Star ratings are used by consumers when they are trying to find the best quality of care for their loved ones.”

Since 2012, Rantz has been leading the Missouri Quality Initiative for Nursing Homes, a partnership between MU, Centers for Medicare and Medicaid Services and state Medicaid groups that was initiated to improve care at nursing facilities in the St. Louis area. Since its launch, the effort has significantly reduced hospitalizations and lowered health care costs. In the latest study, Rantz and her team examined the specific impact APRNs had on quality measures used in nursing homes.

APRNs were embedded full time in 16 nursing homes that were participating in the nursing home initiative. They were expected to help the nursing home staff and leadership reduce unnecessary hospital and emergency room visits; improve resident health outcomes; and reduce overall health care spending. Their efforts were compared to 27 nursing homes that didn’t have full-time APRNs on staff. Overall the nursing homes with APRNs had much better results in commonly used measures of quality of care, including fewer:

  • Falls that led to major injury.
  • Residents who experienced pressure ulcers and urinary tract infections.
  • Residents who had a catheter left in their bladder, had to be physically restrained or had lost too much weight.
  • Residents who required assistance with physical activities or needed antipsychotic medication.

“We were really excited to see these results to help consumers and providers offer the best care for their residents,” Rantz said. “Hiring APRNs is a common-sense solution as they keep residents healthier and reduce avoidable hospitalizations.”

“Impact of advanced practice registered nurses on quality measures: the Missouri Quality Initiative Experience,” recently was published in JAMDA, the Journal of American Medical Directors Association.

Rantz’s pioneering work in nursing homes’ care quality spans more than 30 years. She is regarded as a premier international expert in quality measurement in nursing homes and research programs to improve the quality of care of older people.

Other MU nursing school researchers involved in the project include, Greg Alexander, professor; Lori Popejoy, associate professor; Amy Vogelsmeier, associate professor; Cathy Murray, project coordinator; and Jessica Mueller, program coordinator. MU researchers from other colleges and schools include Kelli Canada, assistant professor in the College of Human Environmental Sciences’ School of Social Work; and Greg Petroski, biostatistician in the Medical Research Office.

Subcontractors on the grant are Primaris, a federally designated organization that works to improve health care quality and affordability for Missouri residents, and Missouri Health Connections, a non-profit organization that creates secure health information networks to connect patients and providers in the state.