Date of Conferral

8-19-2025

Degree

Doctor of Healthcare Administration (D.H.A.)

School

Health Services

Advisor

Suzanne Richins

Abstract

Skilled nursing facilities (SNFs) in New Jersey, which provide both short-term rehabilitation and long-term residential care, are faced with mounting pressure due to mandated staffing ratios for certified nursing assistants (CNAs). The purpose and review question for this integrative review centered on best practices and strategies for nursing home leaders to meet the new Centers for Medicare & Medicaid Services and New Jersey standards for CNA staffing ratios in nursing homes. This review used the systems theory to look at SNFs as connected networks where staffing, leadership, finances, and care delivery all work together. An examination of the literature published within the past 5 years identified over 100 relevant articles. From these articles, 25 empirical and nonempirical articles were selected for further analysis using the Johns Hopkins evidence-based practice model and seven major themes and 14 subthemes emerged. The major themes included enhance patient-centered care, implement quality care standards, remove policy barriers, strengthen recruitment and retention, improve communication through leadership support, develop teamwork strategies, and education programs that enhance career paths. An analysis of the themes resulted in six recommendations to improve CNA compliance in New Jersey nursing homes. This led to a five-phase plan aimed at turning around struggling NJ nursing homes. The plan focuses on assessing internal operations, strengthening leadership and staff development, policy adaptation, improving communication, and building long-term stability through continuous feedback and reinvestment. These recommendations can strengthen staff retention and ensure the delivery of high-quality care to New Jersey’s vulnerable elder population by implementing evidence-based strategies, thereby emphasizing positive social change.

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