SNF operators should treat PBJ-reported turnover rates as a direct quality and compliance variable, as facilities with high total nurse staff turnover were found to be 16 percentage points more likely to hold a one-star rating and 20.3 percentage points less likely to hold five stars.
This study is of particular interest as it was funded by a grant from CMS. Authors include Evan Shulman, currently Director of the Nursing Homes division at CMS and three employees of ABT Associates, a CMS contractor working on the Five Star Quality Rating System since 2008.
Mean annual turnover rates were about 44% for RNs and 46% for total nurse staff. On average, there was one administrator leaving each nursing home during this period although about half of nursing homes had no administrator turnover. Turnover rates varied greatly across nursing homes. For-profit and larger nursing homes had higher turnover rates. Higher turnover was consistently associated with lower quality of care. In January 2022, CMS started posting turnover measures on Care Compare to allow consumers to use this information in their assessment of nursing home quality and to motivate nursing homes to implement innovative strategies to retain staff.
Zheng, Qing, et al. “Association between Staff Turnover and Nursing Home Quality – Evidence from Payroll-Based Journal Data.” Journal of the American Geriatrics Society, vol. 70, no. 9, Wiley, 07 May 2022, pp. 2508–2516. https://doi.org/10.1111/jgs.17843
Prioritizing Nursing Home Staff and Leadership Consistency to Improve Quality
The work by Zheng et al in this issue provides further evidence that turnover in nursing homes is associated with measures of nursing home care quality and healthcare utilization. Prior research has described the relationship of staffing levels to quality of care. There has been less work focused on the relationship of quality to turnover and retention; although any person who has lived in, had a family member in, or worked in a nursing home will attest to the value of staff who have a consistent presence. Facility-level administrators need to be empowered, supported, and inspired to create cultures where clinical staff thrive. Policymakers at the federal and state levels should focus on designing incentives to recruit and retain staff in this high-need setting.
— Journal of the American Geriatrics Society, June 30, 2022
Study: Lower Turnover Linked to Higher Quality of Care at Nursing Homes
They found that average total nursing staff annual turnover rates were 53.4% among 1-star nursing homes, while it was 40.7% for 5-star facilities. Data also showed a consistent relationship between higher turnover and lower probability of having higher star ratings across all domains. “Compared to facilities with low total nurse staff turnover rates, nursing homes with high total nurse staff turnover rates were 16 percentage points more likely to have one-star rating, 10.5 percentage points more likely to have two stars, but 20.3 percentage points less likely to have five stars, after adjusting for other factors that may affect their star ratings,” researchers wrote.
— McKnight’s Long-Term Care News, May 9, 2022
Staffing laws, unionization can improve nurse retention, new research shows
The number of nurses considering leaving their jobs over the next year could be higher than previous studies suggest, according to new research from the Illinois Economic Policy Institute and the Project for Middle Class Renewal at the University of Illinois at Urbana-Champaign.
— Healthcare Dive, June 23, 2022
Nursing home staff turnover up 25 percent from last year: survey
The national nursing home staff turnover rate for all employees is up 25% from last year. That’s according to findings included in the 45th annual Nursing Home Salary & Benefits Report released Thursday by Hospital & Healthcare Compensation Service.
The average national turnover rate across executive-level positions and those in dining services, environmental services, marketing and therapy was 29.17%, according to the report. The national average turnover among registered nurses, licensed practical nurses and certified nursing assistants was 38.68%.
An upward trend in turnover among direct care workers was met with a slight drop in the average number of RNs, LPNs and CNAs per facility as reported by participants.
— McKnight’s, August 1, 2022
