Turnover of direct care workers in nursing homes: Do management practices matter?

High rates of turnover among nursing home (NH) workers seriously threaten residents' quality of care. It has been suggested that certain aspects of the work environment, in particular teamwork, may be effective in reducing turnover. However, there has been no empirical evidence to support this hypothesis.

We examined the relationship between managerial practices, including presence of teams, and staff turnover. Mail surveys of NH administrators (n=338) were conducted in 188 NYS facilities. Survey items included: presence of teams, unions, skill-mix, workloads, other job characteristics and managerial practices. Facility characteristics and market control variables were also included. We used a mixed linear regression model, with robust standard errors, to assess the association between management practices, teams and turnover of nursing assistants (CNAs), practical (LPNs) and registered nurses (RNs).

The 1-year turnover rates were 38.7%, 31.0%, and 32.5% for CNAs, LPNs, RNs. Controlling for all other characteristics, presence of teams was associated with a significant reduction (-0.1641) in RN turnover, but with an increased (0.1022) CNA turnover. RN turnover was lower in facilities where RNs (-0.1218) and CNAs (-0.3009) were unionized. However, unionized LPNs significantly increased (0.2652) RN turnover. Union presence had no impact on turnover of LPNs and CNAs. Other variables associated with turnover will be discussed.

In support of the hypothesis that teamwork contributes to lower NH turnover, the results are mixed. Other factors related to how work is structured and organized in nursing homes, are shown to impact turnover. The implications for retaining nursing home workers are discussed.