The role of organizational culture in retaining nursing workforce.
OBJECTIVE
We examined how organizational culture in nursing homes affects staff turnover, because culture is a first step to creating satisfactory work environments.


METHODS
Nursing home administrators were asked in 2009 to report on facility culture and staff turnover. We received responses from 419 of 1,056 administrators contacted. Respondents reported the strength of cultural values using scales from a Competing Values Framework and percent of staff leaving annually for Registered Nurse (RN), Licensed Practice Nurse (LPN), and nursing aide (NA) staff. We estimated negative binomial models predicting turnover.


RESULTS
Turnover rates are lower than found in past but remain significantly higher among NAs than among RNs or LPNs. Facilities with stronger market values had increased turnover among RNs and LPNs, and among NAs when turnover was adjusted for facilities with few staff. Facilities emphasizing hierarchical internal processes had lower RN turnover. Group and developmental values focusing on staff and innovation only lowered LPN turnover. Finally, effects on NA turnover become insignificant when turnover was adjusted if voluntary turnover was reported.


CONCLUSIONS
Organizational culture had differential effects on the turnover of RN, LPN, and NA staff that should be addressed in developing culture-change strategies. More flexible organizational culture values were important for LPN staff only, whereas unexpectedly, greater emphasis on rigid internal rules helped facilities retain RNs. Facilities with a stronger focus on customer needs had higher turnover among all staff.
Department of Health Management and Policy, University of Michigan School of Public Health, Institute of Gerontology, University of Michigan Medical School, Ann Arbor. janebh@umich.edu.
Jane
J
Banaszak-Holl
Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania.
Nicholas G
NG
Castle
Providigm, LLC, Denver, Colorado.
Michael K
MK
Lin
Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor.
Nijika
N
Shrivastwa
Department of Management and Organizations, University of Michigan Ross Business School, Ann Arbor.
Gretchen
G
Spreitzer
D005260:Female; D006707:Homes for the Aged / Q000458:organization & administration*; D006801:Humans; D009726:Nurses; D009735:Nursing Homes / Q000458:organization & administration*; D009740:Nursing Staff / Q000600:supply & distribution*; D015279:Organizational Culture; D010563:Personnel Turnover; D011795:Surveys and Questionnaires; D014481:United States
Long-term care; Nursing staff turnover; Organizational culture