title: Front line workers in long-term care: the effect of educational interventions and stabilization of staffing ratios on turnover and absenteeism.
abstract: OBJECTIVE
  Front line workers in long-term care play a crucial role in helping residents achieve their highest possible functional level. High turnover (rates in excess of 100% are common) and absenteeism threaten the ability of long-term care providers to meet this goal. The purpose of this study was to determine the effect of a formalized certified nursing assistant (CNA) education program and stabilization of staffing ratios on turnover and absenteeism.
  
  
  METHODS
  This study was a 12-month prospective, nonrandomized trial involving two long-term care facilities providing traditional intermediate and skilled care serving as study sites and a similar facility serving as a control. For historical comparisons, each facility served as its own control using data from the year before the interventions.
  
  
  METHODS
  An in-house educational program based on the State of North Carolina core curriculum for CNAs was instituted in each study site. During the study period, efforts were made to achieve stable staffing ratios of 1 CNA:8 residents for days, 1:10 for evenings, and 1:15 for nights. Traditional quality of care indicators and resident/surrogate satisfaction were tracked during the study period.
  
  
  RESULTS
  Both study facilities showed a decline in turnover, with the decline reaching statistically significant levels at Facility B (134% to 41%, P = 0.0001). Absenteeism rates did not change significantly during the study period. Resident/surrogate satisfaction with nursing care was improved significantly at Facility B (P = 0.02).
  
  
  CONCLUSIONS
  A formal education program in conjunction with stabilization of staffing ratios can result in lower turnover rates for CNA's and improved resident/surrogate satisfaction.
authors.affiliation: Thoms Rehabilitation Hospital.
authors.forename: M A
authors.initials: MA
authors.lastname: Noel
authors.forename: G L
authors.initials: GL
authors.lastname: Pearce
authors.forename: R
authors.initials: R
authors.lastname: Metcalf