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Organizational Characteristics Associated With Staff Turnover in Nursing Homes

Correspondence: Address correspondence to Nicholas G. Castle, PhD, Health Policy and Management, University of Pittsburgh, A649 Crabtree Hall, 130 DeSoto Street, Pittsburgh, PA 15261. E-mail: castleN{at}Pitt.edu

Purpose: The association between certified nurse aide, licensed practical nurse, and registered nurse turnover and the organizational characteristics of nursing homes are examined. Design and Methods: Hypotheses for eight organizational characteristics are examined (staffing levels, top management turnover, resident case mix, facility quality, ownership, chain membership, size, and Medicaid census), using Online Survey, Certification, and Reporting (known as OSCAR) data. Turnover information came from primary data collected from 854 facilities in six states (Missouri, Texas, Connecticut, New York, Pennsylvania, and New Jersey). Results: The 1-year turnover rates were 56.4%, 39.7%, and 35.8% for certified nurse aides, licensed practical nurses, and registered nurses, respectively. The results consistently show that, for all caregivers, lower staffing levels, lower quality, for-profit ownership, and higher bed size are associated with higher turnover. Some differences also are found for different levels of turnover, but there are few differences among types of nursing staff. Implications: Given that turnover rates are problematic, this study gives us a better understanding of the phenomenon and at the same time helps us further understand the wide variation that is known to exist between nursing homes, based on their organizational characteristics.

Key Words: Turnover • Quality indicators • Nursing homes • OSCAR • Long-term care staffing

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