The Gerontologist
 QUICK SEARCH:   [advanced]


This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Kash, B. A.
Right arrow Articles by Hawes, C.
Right arrow Search for Related Content
Right arrow PubMed Citation
Right arrow Articles by Kash, B. A.
Right arrow Articles by Hawes, C.
The Gerontologist 46:609-619 (2006)
© 2006 The Gerontological Society of America

Effect of Staff Turnover on Staffing: A Closer Look at Registered Nurses, Licensed Vocational Nurses, and Certified Nursing Assistants

Bita A. Kash, MBA1, Nicholas G. Castle, PhD2, George S. Naufal, BA3 and Catherine Hawes, PhD1

Correspondence: Address correspondence to Bita A. Kash, MBA, Department of Health Policy and Management, Texas A&M University Health Science Center, School of Rural Public Health, TAMU 1266, College Station, TX 77843. E-mail: bakash{at}

Purpose: We examined the effects of facility and market-level characteristics on staffing levels and turnover rates for direct care staff, and we examined the effect of staff turnover on staffing levels. Design and Methods: We analyzed cross-sectional data from 1,014 Texas nursing homes. Data were from the 2002 Texas Nursing Facility Medicaid Cost Report and the Area Resource File for 2003. After examining factors associated with staff turnover, we tested the significance and impact of staff turnover on staffing levels for registered nurses (RNs), licensed vocational nurses (LVNs) and certified nursing assistants (CNAs). Results: All three staff types showed strong dependency on resources, such as reimbursement rates and facility payor mix. The ratio of contracted to employed nursing staff as well as RN turnover increased LVN turnover rates. CNA turnover was reduced by higher administrative expenditures and higher CNA wages. Turnover rates significantly reduced staffing levels for RNs and CNAs. LVN staffing levels were not affected by LVN turnover but were influenced by market factors such as availability of LVNs in the county and women in the labor force. Implications: Staffing levels are not always associated with staff turnover. We conclude that staff turnover is a predictor of RN and CNA staffing levels but that LVN staffing levels are associated with market factors rather than turnover. Therefore, it is important to focus on management initiatives that help reduce CNA and RN turnover and ultimately result in higher nurse staffing levels in nursing homes.

Key Words: Nursing homes • Nurse staffing • Staff turnover

This article has been cited by other articles:

Home page
Journal of Applied GerontologyHome page
N. G. Castle
Nursing Home Caregiver Staffing Levels and Quality of Care: A Literature Review
Journal of Applied Gerontology, August 1, 2008; 27(4): 375 - 405.
[Abstract] [PDF]

Home page
GerontologistHome page
C. E. Bishop, D. B. Weinberg, W. Leutz, A. Dossa, S. G. Pfefferle, and R. M. Zincavage
Nursing Assistants' Job Commitment: Effect of Nursing Home Organizational Factors and Impact on Resident Well-Being
Gerontologist, July 1, 2008; 48(suppl_1): 36 - 45.
[Abstract] [Full Text] [PDF]

Home page
J. Gerontol. B Psychol. Sci. Soc. Sci.Home page
S. C. Stearns and L. P. D'Arcy
Staying the Course: Facility and Profession Retention Among Nursing Assistants in Nursing Homes
J. Gerontol. B. Psychol. Sci. Soc. Sci., May 1, 2008; 63(3): S113 - S121.
[Abstract] [Full Text] [PDF]

All GSA journals Journals of Gerontology Series A: Biological Sciences and Medical Sciences Journals of Gerontology Series B: Psychological Sciences and Social Sciences
Copyright © 2006 by The Gerontological Society of America.