Registered nurse retention strategies in nursing homes: a two-factor perspective.
BACKGROUND
As the American population ages and the proportion of individuals over the age of 65 expands, the demand for high-quality nursing home care will increase. However, nursing workforce instability threatens care quality and sustainability in this sector. Despite increasing attention to nursing home staff turnover, far less is known about registered nurse (RN) retention.


OBJECTIVE
In this study, the relationships between retention strategies, employee benefits, features of the practice environment, and RN retention were explored. Further, the utility of Herzberg's two-factor theory of motivation as a framework for nursing home retention studies was evaluated.


METHODS
This study was a secondary analysis of the nationally representative 2004 National Nursing Home Survey. The final sample of 1,174 participating nursing homes were either certified by Medicare or Medicaid or licensed by state agencies. We used a weighted multinomial logistic regression using an incremental approach to model the relationships.


RESULTS
Although most nursing homes offered some combination of retention programs, the majority of strategies did not have a significant association with the level of RN retention reported by facilities. Director of nursing tenure and other extrinsic factors had the strongest association with RN retention in adjusted analyses.


CONCLUSIONS
To improve RN retention, organizations may benefit greatly from stabilizing nursing home leadership, especially the director of nursing position. Second, managers of facilities with poor retention may consider adding career ladders for advancement, awarding attendance, and improving employee benefits. As a behavioral outcome of motivation and satisfaction, retention was not explained as expected using Herzberg's two-factor theory.
Trajectories of Chronic Illness and Care System Postdoctoral Program, School of Nursing, Duke University Medical Center, Durham, NC, USA. tena.huntmck@duke.edu
Selina R
SR
Hunt
Janice C
JC
Probst
Kathlyn S
KS
Haddock
Robert
R
Moran
Samuel L
SL
Baker
Ruth A
RA
Anderson
Kirsten
K
Corazzini
D001291:Attitude of Health Personnel; D006801:Humans; D007407:Interviews as Topic; D007588:Job Satisfaction; D007857:Leadership; D016015:Logistic Models; D009726:Nurses / Q000600:supply & distribution; D009735:Nursing Homes; D009740:Nursing Staff / Q000193:education / Q000706:statistics & numerical data / Q000600:supply & distribution*; D010558:Personnel Loyalty; D010560:Personnel Selection / Q000706:statistics & numerical data; D036301:Qualitative Research; D012456:Salaries and Fringe Benefits; D013192:Staff Development / Q000379:methods*; D011795:Surveys and Questionnaires; D014481:United States; D000078329:Workforce; D017132:Workplace / Q000523:psychology