There are few studies of voluntary and involuntary turnover in the nursing home literature. Previous research in this area has focused mainly on the linear effects of individual and organizational characteristics on total turnover.
The purpose of this study was to examine both linear and nonlinear effects of organizational and environmental conditions on voluntary and involuntary nursing home staff turnover.
We analyzed both primary and secondary data on 854 nursing homes in six states. A negative binomial regression model was used to study both linear and curvilinear effects of organizational and environmental factors on voluntary and involuntary turnover among registered nurses, licensed practical nurses, and nurse aides.
Staffing levels and deficiency citations were the organizational characteristics most consistently linked with turnover among all nurse types. Links were also found between unemployment and type of location (urban or rural) and turnover, indicating that the economic environment is influential for retention.
The results of this study support the notion that policy makers need to consider both the organization and the environment when evaluating the nature of nursing home staff turnover. The findings also offer further evidence that the antecedents of voluntary and involuntary turnover are not necessarily the same.
"seeking better pay, promotional opportunities, seeking better working conditions or organizations to work for, problems with supervision or administration, mid-career change, spousal move, military transfer, relocation, further education, remaining at home to care for dependents or not returning to the job after pregnancy leave, excessive workload, stress, and burnout (Cavanagh, 1989; Hayes et al., 2006; Strachota, Normandin, O'Brien, Clary, & Krukow, 2003; Tai et al., 1998; Wagner, 2007; Zengaro & Soeken, 2007). Unavoidable reasons for turnover include dismissal, layoff, forced retirement, illness/disability, and death (Abelson, 1987; Donoghue & Castle, 2007). "
[Show abstract][Hide abstract] ABSTRACT: High turnover of nursing assistants (NAs) has implications for the quality of nursing home care. Greater understanding of correlates of NA turnover is needed to provide insight into possible retention strategies.
This study examined nursing home organizational characteristics and specific job characteristics of staff in relation to turnover of NAs.
Cross-sectional data on 944 nationally representative nursing homes were derived from the 2004 National Nursing Home Survey. Using a 3-month turnover rate, 25% of the facilities with the lowest turnover rates were classified as low turnover, 25% of the facilities with the highest turnover were classified as high turnover, and the remaining 50% of the facilities were classified as moderate turnover. Multinomial logistic regression was used to examine organizational and job characteristics associated with low and high turnover compared with moderate turnover.
One organizational characteristic, staffing levels at or greater than 4.0 hours per patient day, was associated with greater odds of low NA turnover and reduced odds of high NA turnover. Job characteristics including higher wages and union membership were associated with greater odds of low NA turnover, whereas wages, fully paid health insurance, employee assistance benefits, and involvement in resident care planning were associated with reduced odds of high NA turnover.
The results of this study suggest that job characteristics of NA staff may be particularly important for turnover. Specifically, the provision of competitive wages and benefits (particularly health insurance) and involvement of NAs in resident care planning could potentially reduce NA turnover, as could maintaining high levels of nurse staffing.
Health care management review 04/2009; 34(2):182-90. DOI:10.1097/HMR.0b013e31819c8b11 · 1.30 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to examine the associations between nursing home administrator (NHA) leadership style and staff turnover.
We analyzed primary data from a survey of 2,900 NHAs conducted in 2005. The Online Survey Certification and Reporting database and the Area Resource File were utilized to extract organizational and local economic characteristics of the facilities. A general linear model (GLM) was used to estimate the effects of NHA leadership style, organizational characteristics, and local economic characteristics on nursing home staff turnover for registered nurses (RNs), licensed practical nurses (LPNs), and nurse's aides (NAs).
The complete model estimates indicate that NHAs who are consensus managers (leaders who solicit, and act upon, the most input from their staff) are associated with the lowest turnover levels, 7% for RNs, 3% for LPNs, and 44% for NAs. Shareholder managers (leaders who neither solicit input when making a decision nor provide their staffs with relevant information for making decisions on their own) are associated with the highest turnover levels, 32% for RNs, 56% for LPNs, and 168% for NAs.
The findings indicate that NHA leadership style is associated with staff turnover, even when the effects of organizational and local economic conditions are held constant. Because leadership strategies are amenable to change, the findings of this study may be used to develop policies for lowering staff turnover.
The Gerontologist 05/2009; 49(2):166-74. DOI:10.1093/geront/gnp021 · 3.21 Impact Factor
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