Two studies examining the relationship between turnover of nursing staff and quality problems in nursing homes have found adverse outcomes.
The studies, both published in December, were based on data from the 2004 National Nursing Home Survey, which generated a sample of 1,174 nursing homes representing more than 16,000 nursing homes in the U.S.
The first study, Are Nursing Home Survey Deficiencies Higher in Facilities with Greater Staff Turnover, was published in the Journal of the American Medical Directors Association. In that study, Nancy B. Lerner, RN, DNP, CDONA, an assistant professor at the University of Maryland School of Nursing in Baltimore and colleagues, including University of Maryland professor Alison M. Trinkoff, RN, ScD, MPH, BSN, FAAN, found that turnover for both licensed nurses and certified nursing assistants was associated with quality problems as measured by deficiencies considered to be closely related to nursing care.
In the second study, Turnover Staffing, Skill Mix, and Resident Outcomes in a National Sample of U.S. Nursing Homes, published in the Journal of Nursing Administration, they found adverse resident outcomes, such as pressure ulcers and pain, are related to high turnover among certified nursing assistants. The study found that even after controlling for factors including skill mix, bed size and ownership nursing homes with high CNA turnover had significantly higher odds of pressure ulcers, pain and urinary tract infections.
Changes are needed to improve the retention of care providers and reduce staff vacancies in nursing homes to ensure high quality of care for older Americans, Lerner states. Further the study by Lerner and colleagues suggests the need for continued research using deficiencies as a measure of quality in addition to the quality indicators used by others.