Staffing Patterns and Pressure Injury Incidence in Swiss Long-Term Care: A Time-to-Event Study

Pressure injuries are a safety concern in long-term care (LTC). With increasing clinical complexity among residents and workforce shortages it is important to understand the impact of staffing configurations on resident safety. This study explored the relationship between clinical supervisory shifts (CSSs) provided by registered nurses in expanded roles (RNX) and skill-mix patterns of direct care team and the risk of pressure injuries.

Retrospective cohort study based on administrative resident and staff roster data from 2018 to 2023.

Seven units from a multisite nursing home in Switzerland (180 beds). Data from all long-stay residents and nursing staff linked to the 7 units were included.

Generalized additive Cox models were used to examine the association of CSSs and direct care staffing configurations [registered nurse (RN) and certified nursing assistant (CNA) skill mix] with institution-acquired pressure injuries.

Data from 1138 admissions [937 residents, 54.5% female, age mean = 80.5 (SD =10.6)] were included. The overall pressure injury incidence was 17.6% (n = 167). Exposure to CSSs was associated with a statistically significant reduction in pressure injury risk (hazard ratio, 0.99; 95% CI, 0.98-0.99; P < .001). Analysis of direct care staffing patterns revealed that recommended minimum proportion of RNs (>25%) and maximum proportion of CNAs (<50%) was protective. When RN staffing fell below recommended levels, increased CNA staffing appeared more protective than increased licensed practical nurse staffing.

This study provides evidence that CSSs by RNX are associated with reduced pressure injury incidence in Swiss LTC. This protective effect has become more pronounced in recent years, highlighting the importance of expanded roles in addressing current LTC challenges. The findings also suggest evaluating protective staffing patterns to enhance resident safety. Further research is needed to validate these results across diverse settings and to explore how staffing configurations impact care quality and outcomes.