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Kennedy KA. The Effect of Nurse Aide Retention on Ohio's Nursing Home Resident Care Experience Scores: A Facility-Level Analysis. J Appl Gerontol 2023; 42:37-48. [PMID: 36066924 DOI: 10.1177/07334648221124918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
This study examined whether certified nurse aide (CNA) retention was positively related to nursing home (NH) resident care experiences at the organizational-level. The 2017 Ohio Biennial Survey of Long-Term Care Facilities and the 2017 Ohio Nursing Home Resident Satisfaction Survey provided the key variables. Quartiles of CNA retention (0-48%, 49-60%, 61-72%, 73-100%) were created from the analysis sample (N = 667). Regression analyses clustered NHs within counties and controlled for structural characteristics, financial resources, empowered managers, resilience, quality of work-life, resident, and community characteristics. NHs in Quartile 3 of CNA retention had higher environment scores by 1.36 percentage points compared to Quartile 1 (p < .05). NHs in Quartile 4 had lower facility culture scores by 1.31 percentage points than NHs in Quartiles 1-3 (p < .05); this pattern repeated when Quartiles 3 and 4 were compared on other outcomes. Future research should explore NHs with very high CNA retention to improve understanding of the measure.
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Affiliation(s)
- Katherine A Kennedy
- Advanced Health Fellow in Health Services Research & Development, Center for Innovation in Long-Term Services & Supports, 20100Providence VA Medical Center, Providence, RI, USA
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An Interprofessional Communication Training Program to Improve Nurses’ Ability to Communicate With Stroke Patients With Communication Disorders. Rehabil Nurs 2018; 43:E25-E34. [DOI: 10.1097/rnj.0000000000000041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kim Y, Han K. Longitudinal associations of nursing staff turnover with patient outcomes in long-term care hospitals in Korea. J Nurs Manag 2018; 26:518-524. [DOI: 10.1111/jonm.12576] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Yoonseo Kim
- Chung-Ang University Graduate School Department of Nursing; Seoul Korea
| | - Kihye Han
- Chung-Ang University Red Cross College of Nursing; Seoul Korea
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Cluster Randomized Controlled Trial of An Aged Care Specific Leadership and Management Program to Improve Work Environment, Staff Turnover, and Care Quality. J Am Med Dir Assoc 2015; 16:629.e19-28. [DOI: 10.1016/j.jamda.2015.04.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 03/12/2015] [Accepted: 04/08/2015] [Indexed: 11/16/2022]
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Trinkoff AM, Lerner NB, Storr CL, Han K, Johantgen ME, Gartrell K. Leadership education, certification and resident outcomes in US nursing homes: cross-sectional secondary data analysis. Int J Nurs Stud 2014; 52:334-44. [PMID: 25458802 DOI: 10.1016/j.ijnurstu.2014.10.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 09/16/2014] [Accepted: 10/03/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Leadership is a key consideration in improving nursing home care quality. Previous research found nursing homes with more credentialed leaders had lower rates of care deficiencies than nursing homes with less credentialed leaders. Evidence that nursing home administrator (NHA) and director of nursing (DON) education and certification is related to resident outcomes is limited. OBJECTIVES To examine associations of education and certification among NHAs and DONs with resident outcomes. DESIGN Cross-sectional secondary data analysis. SETTINGS This study used National Nursing Home Survey data on leadership education and certification and Nursing Home Compare quality outcomes (e.g. pain, catheter use). PARTICIPANTS 1142 nursing homes in the survey which represented 16628 nursing homes in the US. METHODS Leadership education and certification were assessed separately for NHAs and DONs. Nursing home resident outcomes were measured using facility-level nursing home quality indicator rates selected from the Minimum Data Set. Facility-level quality indicators were regressed onto leadership variables in models that also held constant facility size and ownership status. RESULTS Nursing homes led by NHAs with both Master's degrees or higher and certification had significantly better outcomes for pain. Nursing homes led by DONs with Bachelor's degrees or higher plus certification also had significantly lower pain and catheter use. Whereas pressure ulcer rates were higher in facilities led by DONs with more education. CONCLUSIONS Selected outcomes for nursing home residents might be improved by increasing the education and certification requirements for NHAs and DONs. Additional research is needed to clarify these relationships.
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Affiliation(s)
| | - Nancy B Lerner
- School of Nursing, University of Maryland, Baltimore, MD, USA
| | - Carla L Storr
- School of Nursing, University of Maryland, Baltimore, MD, USA
| | - Kihye Han
- Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea
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Turnover, Staffing, Skill Mix, and Resident Outcomes in a National Sample of US Nursing Homes. J Nurs Adm 2013; 43:630-6. [DOI: 10.1097/nna.0000000000000004] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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McGilton KS, Sorin-Peters R, Sidani S, Boscart V, Fox M, Rochon E. Patient-centred communication intervention study to evaluate nurse-patient interactions in complex continuing care. BMC Geriatr 2012; 12:61. [PMID: 23050517 PMCID: PMC3538737 DOI: 10.1186/1471-2318-12-61] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 10/05/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Communication impairment is a frequent consequence of stroke. Patients who cannot articulate their needs respond with frustration and agitation, resulting in poor optimization of post-stroke functions. A key component of patient-centred care is the ability of staff to communicate in a way that allows them to understand the patient's needs. We developed a patient-centred communication intervention targeting registered and unregulated nursing staff caring for complex continuing care patients with communication impairments post stroke. Research objectives include 1) examining the effects of the intervention on patients' quality of life, depression, satisfaction with care, and agitation; and (2) examining the extent to which the intervention improves staff's attitudes and knowledge in caring for patients with communication impairments. The intervention builds on a previous pilot study. METHODS/DESIGN A quasi-experimental repeated measures non-equivalent control group design in a complex continuing care facility is being used. Patients with a communication impairment post-stroke admitted to the facility are eligible to participate. All staff nurses are eligible. Baseline data are collected from staff and patients. Follow-up will occur at 1 and 3 months post-intervention. Subject recruitment and data collection from 60 patients and 30 staff will take approximately 36 months. The Patient-Centred Communication Intervention consists of three components: (1) development of an individualized patient communication care plan; (2) a one-day workshop focused on communication and behavioural management strategies for nursing staff; and (3) a staff support system. The intervention takes comprehensive patient assessments into account to inform the development of communication and behavioural strategies specifically tailored to each patient. DISCUSSION The Patient-Centred Communication Intervention will provide staff with strategies to facilitate interactions with patients and to minimize agitation associated with considerable stress. The improvement of these interactions will lead to a reduction of agitation, which has the additional significance of increasing patients' well-being, quality of life, and satisfaction with care. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT01654029.
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Affiliation(s)
- Katherine S McGilton
- Department of Research, Toronto Rehabilitation Institute-UHN, E.W, Bickle Centre for Complex Continuing Care, 130 Dunn Avenue, Toronto, Ontario, M6K 2R7, Canada
- L. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, Ontario, M5T 1P8, Canada
| | - Riva Sorin-Peters
- Private Practice, Speech-Language Pathology, Thornhill, Ontario, L4J 5J2, Canada
| | - Souraya Sidani
- Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria Street, Toronto, Ontario, M5B 2K3, Canada
| | - Veronique Boscart
- School of Health & Life Sciences and Community Services, Conestoga College Institute of Technology and Advanced Learning, 299 Doon Valley Drive, Kitchener, Ontario, N2G 4M4, Canada
| | - Mary Fox
- School of Nursing, York University, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada
| | - Elizabeth Rochon
- Department of Speech-Language Pathology, University of Toronto, 160-500 University Avenue, Toronto, Ontario, M5G 1V7, Canada
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Nakanishi M, Imai H. Job role quality and intention to leave current facility and to leave profession of direct care workers in Japanese residential facilities for elderly. Arch Gerontol Geriatr 2012; 54:102-8. [PMID: 21227517 DOI: 10.1016/j.archger.2010.12.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 12/14/2010] [Accepted: 12/15/2010] [Indexed: 11/28/2022]
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Tyler DA, Shield RR, Rosenthal M, Miller SC, Wetle T, Clark MA. How valid are the responses to nursing home survey questions? Some issues and concerns. THE GERONTOLOGIST 2011; 51:201-11. [PMID: 21078827 PMCID: PMC3058131 DOI: 10.1093/geront/gnq095] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2010] [Accepted: 10/14/2010] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Although surveys are usually piloted before fielding, cognitive-based testing of surveys is not standard practice in nursing home (NH) research. Many terms used in the literature do not have standard definitions and may be interpreted differently by researchers, respondents, and policy makers. The purpose of this study was to ensure that survey respondents understood questions as intended, determine whether the Nursing Home Administrator (NHA) or the Director of Nursing (DON) was better able to answer questions on certain topics, and to inform the answer choices provided for questions. METHODS Using existing survey questions and input from experts, we developed surveys to be administered to DONs and NHAs. Cognitive-based interviews were conducted with 45 participants. We took detailed notes during all interviews, and 2 researchers independently coded these notes for key themes. RESULTS Many terms and concepts routinely used by NH researchers and policy makers, such as "direct-care workers" and "palliative care," were not uniformly interpreted by those managing NHs. For example, respondents' definitions of direct-care workers ranged from nursing assistants to broader categories of clinical and other staff members, including nurses, activities staff, and social workers. We also found NHAs and DONs, at times, did not possess or have access to information the researchers expected them to. IMPLICATIONS Our results may help explain discrepant findings across NH studies. They also underscore the necessity of cognitive-based testing for survey development and have important implications for policy decisions.
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Affiliation(s)
- Denise A Tyler
- Department of Community Health, Center for Gerontology and Health Care Research, Brown University, Box G-S121-6, Providence, RI 02912, USA.
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Dill JS, Cagle J. Caregiving in a patient's place of residence: turnover of direct care workers in home care and hospice agencies. J Aging Health 2010; 22:713-33. [PMID: 20584968 DOI: 10.1177/0898264310373390] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE High turnover and staff shortages among home care and hospice workers may compromise the quality and availability of in-home care. This study explores turnover rates of direct care workers for home care and hospice agencies. METHODS OLS (ordinary least square) regression models are run using organizational data from 93 home care agencies and 29 hospice agencies in North Carolina. RESULTS Home care agencies have higher total turnover rates than hospice agencies, but profit status may be an important covariate. Higher unemployment rates are associated with lower voluntary turnover. Agencies that do not offer health benefits experience higher involuntary turnover. CONCLUSION Differences in turnover between hospice and home health agencies suggest that organizational characteristics of hospice care contribute to lower turnover rates. However, the variation in turnover rates is not fully explained by the proposed multivariate models. Future research should explore individual and structural-level variables that affect voluntary and involuntary turnover in these settings.
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Probst JC, Baek JD, Laditka SB. Characteristics and recruitment paths of certified nursing assistants in rural and urban nursing homes. J Rural Health 2009; 25:267-75. [PMID: 19566612 DOI: 10.1111/j.1748-0361.2009.00229.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
CONTEXT Most nursing home care is provided by certified nursing assistants (CNAs), but little is known about rural CNAs. PURPOSE To develop a representative geographic profile of the CNA workforce, focusing on paths leading to present job. METHODS Cross-sectional analysis of data from the 2004 National Nursing Assistant Survey (NNAS), a nationally representative survey of 3,017 CNAs; analysis was restricted to 2,897 currently working CNAs. Location was categorized as metropolitan, micropolitan, or neither (other rural county). Demographics included age, sex, race, education, income, and years at present job. Analyses were weighted to reflect the complex sampling design. FINDINGS CNAs in micropolitan and other rural nursing homes were more likely to be white and US citizens than were urban CNAs. Rural or micropolitan CNAs were more likely to note "job close to home" as a reason for becoming a CNA than were urban CNAs (70.8%, 66.3%, and 43.6%, respectively; P < .001). Over half of CNAs (52.2%) entered the field from a different job category. CNAs in micropolitan and small rural counties were more likely than urban CNAs to report being trained at a nursing facility (61.4%, 65.4%, 52.5%; P < .001) rather than community college or other site. Informal means (family and friends) were the most common recruitment path. CONCLUSIONS Career-changers (individuals entering the CNA role from another job) represent a major recruitment target. The prevalence of informal networks in CNA recruitment history suggests that nursing homes seeking to become "employers of choice" will be advantaged when recruiting.
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Affiliation(s)
- Janice C Probst
- South Carolina Rural Health Research Center, Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Drive, Suite 204, Columbia, SC 29210, USA.
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Abstract
Given high rates of turnover among direct care workers in long-term care settings, it is important to identify factors affecting organizational-level turnover rates. In this study, the authors examine the impact of a workforce intervention program (Workforce Improvement for Nursing Assistants: Supporting Training, Education, and Payment for Upgrading Performance [WIN A STEP UP]) on turnover rates of direct care workers in nursing homes. Using data collected yearly between 2002 and 2006 from 405 nursing homes in North Carolina, the authors employ random effects modeling to predict a dichotomous outcome of “above-average” versus “below-average” turnover. Results indicate that nursing homes participating in the WIN A STEP UP program are 15% more likely to have below-average turnover than are nonparticipating nursing homes. Organizational factors such as ownership type and Medicaid participation also influenced turnover, whereas labor market factors had no independent effects. The results suggest that workforce development projects that increase the training of direct care workers and provide associated rewards show some potential to lower turnover rates of the direct care workforce.
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