News Digest: Research into union impact on turnover and retention
Research Examines Health Care Staff Turnover and Quality of Care at Nursing Homes
In this cross-sectional study of 1.45 million facility-weeks (corresponding to 13 826 unique facilities), within a given facility periods of greater turnover of nursing staff were associated with lower quality of care along multiple measures according to health inspection citations and resident assessments
Findings from this study suggest that efforts to monitor and reduce nursing home staff turnover may be well founded, as turnover appears to be negatively associated with resident health and safety.
Shen, Karen, et al. “Health Care Staff Turnover and Quality of Care at Nursing Homes.” JAMA Internal Medicine, vol. 183, no. 11, American Medical Association, Nov. 2023, p. 1247. https://doi.org/10.1001/jamainternmed.2023.5225.
COMMENTARY: Nursing Home Staff Turnover and the Whole-of-Person Framework for Staff Retention
…While Dean et al have added important evidence to the role of labor unionization to combat the US nursing home staff turnover crisis, it may be worth reviewing staff retention policies in a truly earnest fashion. What is it that makes a person stay? Exploring policies that promote a community approach to recruitment and retention and build an organic sense of belonging-in-place may be key for legislators and health care policy experts trying to solve the problem of US nursing home staff turnover.
Bergman, Christian. “Nursing Home Staff Turnover and the Whole-of-Person Framework for Staff Retention.” JAMA Network Open, vol. 6, no. 10, Oct. 2023, p. e2337827. https://doi.org/10.1001/jamanetworkopen.2023.37827.
Researchers say retention needs more attention as feds push to increase nursing home staffing levels
With so much of the nursing home staffing spotlight honed lately on increasing staffing levels, new study results emphasize the importance of experienced nurse and administrator retention as perhaps equally important for providing quality care.
“Given the recently announced federal minimum staffing mandates, there is a lot of policy focus at the moment on boosting the number of staff hours per president day. But our results suggest that we should also be giving similar weight to finding ways to retain staff and reduce turnover in an effort to improve nursing home quality,” said study co-author Brian McGarry, PhD, of the Division of Geriatrics and Aging, in the Department of Medicine at the University of Rochester.
Berklan, James M. “Researchers Say Retention Needs More Attention as Feds Push to Increase Nursing Home Staffing Levels.” McKnight’s Long-Term Care News, 9 Oct. 2023, www.mcknights.com/news/researchers-say-retention-needs-more-attention-as-feds-push-to-increase-nursing-home-staffing-levels.
High Staff Turnover in Nursing Homes Linked to Decreased Quality of Care
If nursing homes want to improve quality of care, it is imperative that they reduce staff turnover, and focus their efforts more on retention than recruitment.
This is according to a JAMA study released Monday, which also revealed that the average annual turnover rate in nursing homes was as high as 128%, indicating a revolving door of staff.
High staff turnover rates can disrupt the continuity of care, hinder the formation of vital staff-resident relationships, and limit the acquisition of skills and institutional knowledge through on-the-job experience, JAMA researchers said.
Grebbin, Shelby. “High Staff Turnover in Nursing Homes Linked to Decreased Quality of Care.” Skilled Nursing News, 9 Oct. 2023, skillednursingnews.com/2023/10/high-staff-turnover-in-nursing-homes-linked-to-decreased-quality-of-care.
RESEARCH LETTER: Labor Unions and Staff Turnover in US Nursing Homes
Among 12,633 nursing homes with total nursing staff turnover data available, the mean (SD) staff turnover rate was 52.6% (15.5%). After excluding 1216 facilities with missing data on covariates, 11 417 nursing homes (1971 [17.3%] with unions) were included in our analyses. We found that the presence of a union was associated with a 1.7 percentage point decrease in staff turnover (95% CI, −2.72 to −0.63 percentage points; P = .002) (Table). We also found that this association was significantly larger when the county-level proportion of nursing homes that were unionized was high.
Dean, Adam, et al. “Labor Unions and Staff Turnover in US Nursing Homes.” JAMA Network Open, vol. 6, no. 10, Oct. 2023, p. e2337898. https://doi.org/10.1001/jamanetworkopen.2023.37898.
Unionization may decrease staffing turnover in nursing homes: study
As nursing homes prepare for the Centers for Medicare & Medicaid Services’ proposed minimum staffing mandate — 0.55 hours per resident day for registered nurses and 2.45 hours per resident day for nurse aides — many are left wondering about the effect on staffing turnover.
Senior care advocates LeadingAge and the American Health Care Association estimate that the proposed mandate could cost up to $7.1 billion in the first year alone. They also argue that high rates of staff turnover would make it difficult for many employers to comply with this proposed requirement.
According to a recent study published in the Journal of the American Medical Association, however, “labor unions representing nursing home workers, such as the Service Employees International Union (SEIU), argue that unions can decrease turnover by improving job quality, thus helping to maintain a stable workforce and improving resident care.”
Gaivin, Kathleen Steele. “Unionization May Decrease Staffing Turnover in Nursing Homes: Study.” McKnight’s Senior Living, 18 Oct. 2023, www.mcknightsseniorliving.com/home/news/business-daily-news/unionization-may-decrease-staffing-turnover-in-nursing-homes-study.
Union Presence – Especially at a County Level – Associated with Lower Turnover at Nursing Homes
Unionization in the nursing home space may decrease staff turnover, and help employers meet proposed staffing minimums – especially in counties where most nursing homes are unionized.
The presence of a union is associated with a 1.7 percentage point decrease in staff turnover, according to a study published on Friday in JAMA Network Open. This association was “significantly larger” when the county-level proportion of nursing homes that were unionized was high, researchers noted.
Specifically, when more than 75% of nursing homes in a county were unionized, facility-level presence of a union was associated with a 9% decrease in staff turnover.
Stulick, Amy. “Union Presence – Especially at a County Level – Associated With Lower Turnover at Nursing Homes.” Skilled Nursing News, 13 Oct. 2023, skillednursingnews.com/2023/10/union-presence-especially-at-a-county-level-associated-with-lower-turnover-at-nursing-homes.
Unions to the rescue?
Ben Franklin famously assured us life has two guarantees. They are higher taxes and death. If Ben were alive today and owned a nursing home, he’d probably add a third: Unions will ruin everything.
Skilled care operators tend to see unions and their members as sycophants at best, predators at worst. Unions, it seems, are always demanding higher wages and better working conditions. Lofty goals, perhaps. But each can put a real strain on already tight budgets.
Unionized employees also can undermine the ability of managers to, well, manage. But perhaps most unforgivable of all, they often serve as a catalyst for more rules and regulations.
O’Connor, John. “Unions to the Rescue?” McKnight’s Long-Term Care News, 16 Oct. 2023, www.mcknights.com/daily-editors-notes/unions-to-the-rescue.
New research ties unions to lower nursing home staff turnover. Could they be a key partner ahead of federal mandate?
Union representation is linked to a significant reduction in nursing home staff turnover, according to a first-of-its-kind research letter published Friday in JAMA Network Open.
Among the 17.3% of nursing homes that were unionized in 2021, researchers found a 3.2% relative drop in turnover. In counties where more than 75% of nursing homes were unionized, the effect was a 17.1% reduction.
“Unions fight to make jobs better for workers, and that could mean higher wages and better benefits, safer working conditions … infection control policies, PPE and protection from COVID-19 during the pandemic,” said Adam Dean, PhD, associate professor in the Department of Political Science at George Washington University. “So in all the ways that unions fight to make jobs better, we would expect workers to stay in those jobs because they’re better jobs.”
Marselas, Kimberly. “New Research Ties Unions to Lower Nursing Home Staff Turnover. Could They Be a Key Partner Ahead of Federal Mandate?” McKnight’s Long-Term Care News, 16 Oct. 2023, www.mcknights.com/news/new-research-ties-unions-to-lower-nursing-home-staff-turnover-could-they-be-a-key-partner-ahead-of-federal-mandate.
