APRN, clinical nurse specialist, COVID-19, nursing home, nursing home legislation, nursing home staffing



  1. Matays, Jennie DNP, RN, CNS, CCRN, CCNS
  2. Scruth, Elizabeth PhD, MPH, RN, CNS, CCRN-K, CCNS, FCCM, FCNS, CPHQ
  3. Kawar, Lina Najib PhD, RN, CNS
  4. Cluff, Sarah Comey MS, RN, AGCNS-BC
  5. Fogli, Alexandra MS, RN, AGCNS-BC
  6. Salas, Mary MSN, RN, AGCNS-BC
  7. Harrington, Charlene PhD, RN


Introduction: Nursing homes have been disproportionally affected by the COVID-19 pandemic, particularly because of resident vulnerability, inadequate staffing, and poor quality of care.


Current State: Despite billions of dollars in funding, nursing homes often do not meet minimum federal staffing requirements and are frequently cited for infection prevention and control deficiencies. These factors significantly contributed to resident and staff deaths. For-profit nursing homes were associated with more COVID-19 infections and deaths. Nearly 70% of US nursing homes are for-profit ownership, where quality measures and staffing levels are often lower than their nonprofit counterparts. Nursing home reform is urgently needed to improve staffing and care quality in these facilities. Some states, such as Massachusetts, New Jersey, and New York, have made legislative progress in establishing standards for nursing home spending. The Biden Administration has also announced initiatives, through the Special Focus Facilities Program, to improve nursing home quality and the safety of residents and staff. Concurrently, the "National Imperative to Improve Nursing Home Quality" report from the National Academies of Science, Engineering, and Medicine made specific staffing recommendations, including an increase in direct care registered nurse coverage.


Conclusion: There is an urgent need to advocate for nursing home reform by partnering with congressional representatives or supporting nursing home legislation to improve care for this vulnerable patient population. Adult-gerontology clinical nurse specialists have an opportunity to leverage their advanced knowledge and unique skill set to lead and facilitate change to improve quality of care and patient outcomes.