Do Management Practices Affect Nursing Home Staff Turnover?

High worker turnover threatens the quality of care in nursing homes. It has been suggested that presence of teams among frontline staff may reduce turnover. We test this hypothesis empirically.

Mail surveys of administrators (ADM) and directors of nursing (DON) were conducted in New York facilities. Survey items included information on: turnover; teams; unions; skill-mix; workloads; job design, and management characteristics. Facility and market control characteristics were also included.

The analytical sample is based on 119 facilities (63%), which provided the information on turnover. The dependent variables were turnover of registered nurses (RNs), licensed practical nurses (LPNs), and certified nursing assistants (CNAs).

Mixed linear regression models with robust standard errors, clustered at local market level to account for the potential correlation between observations in same markets were used.

Annual turnover rates were: 38.1%, 31.0%, and 32.5% for CNAs, LPNs and RNs, respectively. Turnover is significantly associated with presence of unions, workload and turnover within each group. The results are mixed for the hypothesis that presence of frontline teams contributes to lower turnover in nursing homes. Presence of formal teams is significantly (p=0.000) associated with lower turnover among RNs, but not among the LPNs or the CNAs.

The results demonstrate a complex set of relationships between turnover and management practice. Team presence appears to lower turnover among the professionals, but not among paraprofessionals. This raises questions about how teams are organized and the extent to which hierarchies between supervisory and non-supervisory positions continue to persist within teams.