Turnover, staffing, skill mix, and resident outcomes in a national sample of US nursing homes.
OBJECTIVE
The authors examined the relationship of staff turnover to selected nursing home quality outcomes, in the context of staffing and skill mix.


BACKGROUND
Staff turnover is a serious concern in nursing homes as it has been found to adversely affect care. When employee turnover is minimized, better care quality is more likely in nursing homes.


METHODS
Data from the National Nursing Home Survey, a nationally representative sample of US nursing homes, were linked to Nursing Home Compare quality outcomes and analyzed using logistic regression.


RESULTS
Nursing homes with high certified nursing assistant turnover had significantly higher odds of pressure ulcers, pain, and urinary tract infections even after controlling for staffing, skill mix, bed size, and ownership. Nurse turnover was associated with twice the odds of pressure ulcers, although this was attenuated when staffing was controlled.


CONCLUSIONS
This study suggests turnover may be more important in explaining nursing home (NH) outcomes than staffing and skill mix and should therefore be given greater emphasis.
Author Affiliations: Professor (Drs Trinkoff and Storr), Assistant Professor (Dr Lerner), Associate Professor (Dr Johantgen), and PhD candidate (Ms Gartrell), School of Nursing, University of Maryland, Baltimore Maryland; Assistant Professor (Dr Han), Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea.
Alison M
AM
Trinkoff
Kihye
K
Han
Carla L
CL
Storr
Nancy
N
Lerner
Meg
M
Johantgen
Kyungsook
K
Gartrell
D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D006707:Homes for the Aged; D006801:Humans; D009735:Nursing Homes; D009740:Nursing Staff / Q000706:statistics & numerical data*; D010561:Personnel Staffing and Scheduling / Q000706:statistics & numerical data*; D010563:Personnel Turnover / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D014481:United States; D000078329:Workforce