Four recent studies using different databases, criteria, dates, and states all confirm that nursing facilities that have more nurses are more successful in containing coronavirus cases and deaths among residents than facilities with lower nurse staffing levels.
Data from 4,254 nursing facilities provided by eight state health departments for the period January 1, 2020-June 3, 2020 indicate that facilities rated highly on nurse staffing levels, as reported on Nursing Home Compare, had fewer COVID-19 cases than facilities with lower nurse staffing ratings.
Examining CMS Nursing Home COVID-19 data, as of June 14, 2020, researchers find that while nurse staffing levels may not determine whether COVID-19 gets into a nursing facility, both higher nurse aide staffing and total nurse staffing “are associated with lower probability of a larger outbreak and fewer deaths.” Although the impact of staffing levels is “relatively small” and dwarfed by the impact of COVID-19 in the community, staffing levels are important in “implementing efforts to stem transmission, such as regular testing and cohorting of both residents and staff.”
A study of all 215 Connecticut nursing facilities with confirmed COVID-19 cases and deaths as of April 16, 2020 finds that every 20 minutes per resident day of increased staffing by registered nurses was associated with 22% fewer confirmed cases of COVID-19 and 26% fewer COVID-19 deaths.
Data from the California and Los Angeles Departments of Public Health, reflecting nursing facilities reporting COVID-19 infections between March 15 and May 4, 2020, show that “a higher proportion of nursing homes with COVID-19 residents had lower RN hprd [hours per resident per day] and lower total nursing hprd” as well as “lower CMS Medicare five-star total staffing and lower RN ratings.”
Kaiser Health News reported the importance of registered nurses in California’s nursing facilities. As of April 28, 2020, California facilities that had one or more residents with COVID-19 “had on average 25% fewer registered nurses per resident in the final three months of 2019.”
Avoiding COVID-19 entirely may, in some instances, be a matter of luck, but containing COVID-19 and reducing the number of COVID-19 deaths are related to increased nurse staffing levels.
Aug. 13, 2020
 “Association of Nursing Home Ratings on Health Inspections, Quality of Care, and Nurse Staffing With COVID-19 Cases,” Journal of the American Medical Association (Research Letter) (published online Aug. 10, 2020), https://jamanetwork.com/journals/jama/fullarticle/2769437?guestAccessKey=258f9d19-b7c2-43e2-9218-55c23d3914bc&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&utm_content=olf&utm_term=081020. The researchers used state health department data, which they view as more reliable than the national COVID-19 data set. The states are California, Florida, Illinois, Maryland, Massachusetts, New Jersey, and Pennsylvania.
 Rebecca J. Gorgees, R. Tamara Konetzka, “Staffing Levels and COVID-19 Cases and Outbreaks in US Nursing Homes,” Journal of the American Geriatrics Society (published Aug. 8, 2020), https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.16787.
 Yue Li, H Temkin-Greener, S Gao, X. Cai, “COVID-19 infections and deaths among Connecticut nursing home residents: facility correlates,” Journal of American Geriatrics Society (2020), https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.16689.
 Charlene Harrington, L Ross, S Chapman, E Halifax, B Spurlock, D Bakerjian, “Nurse Staffing and Coronavirus Infections in California Nursing Homes,” Policy Politics & Nursing Practice, https://journals.sagepub.com/doi/10.1177/1527154420938707?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
 Jordan Rau and Anna Almendrala, “COVID-Plagued California Nursing Homes Often Had Problems In Past,” Kaiser Health News (May 4, 2020), https://khn.org/news/covid-plagued-california-nursing-homes-often-had-problems-in-past/.