title: Effect of staff turnover on staffing: A closer look at registered nurses, licensed vocational nurses, and certified nursing assistants.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Health Policy and Management, Texas A&M University Health Science Center, School of Rural Public Health, TAMU 1266, College Station, TX 77843, USA. bakash@srph.tamhsc.edu
authors.forename: Bita A
authors.initials: BA
authors.lastname: Kash
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Castle
authors.forename: George S
authors.initials: GS
authors.lastname: Naufal
authors.forename: Catherine
authors.initials: C
authors.lastname: Hawes
mesh_terms: D003430:Cross-Sectional Studies; D006707:Homes for the Aged; D006801:Humans; D009726:Nurses / Q000600:supply & distribution; D009735:Nursing Homes; D009740:Nursing Staff; D010563:Personnel Turnover; D014481:United States