Methods: Using a series of data sets (collected between 2003 and 2004), researchers obtained information about nursing staff turnover levels, nursing home organization characteristics and geographic economic conditions (e.g., urban versus rural locale, unemployment rate, number of available nursing home beds, and income per capita of the county where the facility was located) for a sample of 1426 nursing home facilities in six states. Staff turnover rates for RNs, LPNs and NAs were reported annually. Data were also collected on the average level of need of residents at each facility and the quality of care at each facility. Statistical analysis was used to examine the impact of the organizational and environmental factors listed above on voluntary and involuntary turnover of RNs, LPNs and NAs.

Findings: Overall, both voluntary and involuntary turnover rates for RNs and LPNs were lower than those of NAs. Voluntary/involuntary turnover rates for RNs, LPNs and NAs were: 30%/4%; 31%/6%; and 43%/10%, respectively. These results indicate that quitting and layoff rates fell with increased nursing qualifications. Facilities with high staff levels of RNs and LPNs experienced high levels of both voluntary and involuntary turnover. High NA staff levels, however, were associated with lower levels of turnover for all types of nursing. This may be attributed to less burdensome workloads when high levels of NAs are present. These findings may indicate that high NA staff levels contribute to retention of all types of nursing staff. Another key finding was the association between low quality of care and high levels of turnover for all types of nursing. Facilities may therefore achieve higher quality of care by increasing involuntary turnover (layoffs) of under performing nurses. The rate of regional unemployment was associated with low voluntary turnover for all nursing types. Rural areas had lower levels of involuntary turnover than urban areas.

Conclusions: The results of this study may indicate that high staffing levels of NAs reduce both voluntary and involuntary turnover of all nursing types. This suggests that when NAs are present, RNs and LPNs are more able to make use of their higher skill levels, leading to greater satisfaction on the job. This may have implications for nursing home administrators as they develop human resource management strategies to address staff turnover. While these results indicate relationships between turnover rates and organizational and environmental factors in nursing homes, they cannot be considered causal and so caution should be used when considering these results.

Reference: Donoghue, C., Castle, N.G. Organizational and Environmental Effects on Voluntary and Involuntary Turnover. Health Care Management Review. 2007; 32(4):360-369.

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