Registered Nurse Workload and Resident Outcomes in Nursing Homes: A Scoping Review of Workforce Sustainability and Nursing Management.

AIM: To map RN workload, staffing indicators, resident outcomes, workforce sustainability and nursing-management context in nursing homes.

BACKGROUND

Staffing ratios and hours per resident day (HPRD) quantify staffing but not role complexity, interruptions, supervisory demands, resident acuity, continuity or work environment.

EVALUATION: Following JBI guidance and PRISMA-ScR, five databases were searched using an RN-specific strategy and updated on 4 September 2026. Following source-level eligibility reassessment and reconciliation of the updated search, 20 studies meeting the RN-specific resident-outcome criteria formed the primary synthesis. Seven studies that did not meet these criteria but provided relevant workforce or nursing-management evidence were retained as a separately labelled contextual evidence layer and excluded from the primary synthesis and PRISMA included-study count. Primary studies underwent full data charting, whereas contextual studies underwent restricted extraction for interpretive purposes only.

KEY ISSUES: Evidence was predominantly observational. Greater RN availability and more favourable work environments were generally associated with better resident outcomes, although findings varied by outcome, timing, staffing configuration and organisational context.

CONCLUSIONS

RN workload is multidimensional and cannot be reduced to staffing ratios alone. Current evidence does not establish a universal RN staffing threshold or support causal conclusions across nursing-home settings.

IMPLICATIONS FOR NURSING MANAGEMENT: Managers should interpret staffing metrics alongside resident acuity, staffing continuity, workload intensity, skill mix, agency use and work-environment indicators.