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Mazzilli S, Scardina G, Collini F, Forni S, Gianolio G, Bisceglia L, Lopalco PL, Chieti A, Onder G, Vanacore N, Bonaccorsi G, Gemmi F, Tavoschi L. Hospital admission and mortality rates for non-Covid diseases among residents of the long-term care facilities before and during the pandemic: a cohort study in two Italian regions. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2023:1-13. [PMID: 37361287 PMCID: PMC10185456 DOI: 10.1007/s10389-023-01925-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 04/28/2023] [Indexed: 06/28/2023]
Abstract
Aim Long-term-care facility residents are a vulnerable population who experienced reduced healthcare access during the pandemic. This study aimed to assess the indirect impact of the COVID-19 pandemic, in terms of hospitalisation and mortality rates, among this population in two Italian Regions, Tuscany and Apulia, during 2020 in comparison with the pre-pandemic period. Subject and methods We conducted a retrospective cohort study on people residing in long-term-care facilities from 1 January 2018 to 31 December 2020 (baseline period: 1 January 2018-8 March 2020; pandemic period: and 9 March-31 December 2020). Hospitalisation rates were stratified by sex and major disease groups. Standardised weekly rates were estimated with a Poisson regression model. Only for Tuscany, mortality risk at 30 days after hospitalisation was calculated with the Kaplan-Meier estimator. Mortality risk ratios were calculated using Cox proportional regression models. Results Nineteen thousand two hundred and fifty individuals spent at least 7 days in a long-term-care facility during the study period. The overall mean non-Covid hospital admission rate per 100 000 residents/week was 144.1 and 116.2 during the baseline and pandemic periods, with a decrease to 99.7 and 77.3 during the first (March-May) and second lockdown (November-December). Hospitalisation rates decreased for all major disease groups. Thirty-day mortality risk ratios for non-Covid conditions increased during the pandemic period (1.2, 1.1 to 1.4) compared with baseline. Conclusion The pandemic resulted in worse non-COVID-related health outcomes for long-term-care facilities' residents. There is a need to prioritise these facilities in national pandemic preparedness plans and to ensure their full integration in national surveillance systems. Supplementary information The online version contains supplementary material available at 10.1007/s10389-023-01925-1.
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Affiliation(s)
- Sara Mazzilli
- Scuola Normale Superiore, Pisa, Italy
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Giuditta Scardina
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Francesca Collini
- Quality and Equity Unit, Regional Health Agency of Tuscany, Florence, Italy
| | - Silvia Forni
- Quality and Equity Unit, Regional Health Agency of Tuscany, Florence, Italy
| | - Giulio Gianolio
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Lucia Bisceglia
- Strategic Regional Health and Social Agency of Puglia (AReSS Puglia), Bari, Italy
| | - Pier Luigi Lopalco
- Department of Biological and Environmental Sciences and Technology, University of Salento, Lecce, Italy
| | - Antonio Chieti
- Strategic Regional Health and Social Agency of Puglia (AReSS Puglia), Bari, Italy
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, National Institute of Health, Rome, Italy
| | - Nicola Vanacore
- National Centre for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | | | - Fabrizio Gemmi
- Quality and Equity Unit, Regional Health Agency of Tuscany, Florence, Italy
| | - Lara Tavoschi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Andreyeva E, David G, Griese E, Stansbury Ward C, Candon M. Nursing turnover in a large, rural health system. J Rural Health 2023; 39:246-250. [PMID: 35848792 DOI: 10.1111/jrh.12694] [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: 02/01/2023]
Abstract
PURPOSE Nursing turnover is a leading cause of inefficiency in health care delivery. Few studies have examined turnover among nurses who work in rural areas. METHODS We accessed human resources data that tracked hiring and terminations from a large health system operating in South Dakota, North Dakota, and Minnesota between January 2016 and December 2017. Our study sample included 7,634 registered nurses, 1,765 of whom worked in a rural community. Within the health system, there were 27 affiliated hospitals, 17 of which were designated critical access hospitals. We estimated nursing turnover rates overall and stratified turnover rates by available demographic and occupational characteristics, including whether the nurse worked in a community with an affiliated acute care hospital or critical access hospital. FINDINGS Overall, 19% of nurses left their position between January 2016 and December 2017. Turnover rates were associated with state, nurse gender and age, and occupational tenure, but were similar in urban and rural areas. Of note, turnover rates were significantly higher in communities without an affiliated acute care hospital or critical access hospital. CONCLUSION Between 2016 and 2017, nearly 1 in 5 nurses working in this health system left their position. Turnover rates differed based on nurse demographics and selected occupational characteristics, including tenure. We also found higher turnover rates among nurses who worked in communities without an affiliated hospital, which points to a potential but unexplored benefit of hospitals in rural areas.
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Affiliation(s)
- Elena Andreyeva
- Department of Health Policy and Management, Texas A&M University, College Station, Texas, USA
| | - Guy David
- Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | - Molly Candon
- Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Mukamel DB, Saliba D, Ladd H, Konetzka RT. Daily Variation in Nursing Home Staffing and Its Association With Quality Measures. JAMA Netw Open 2022; 5:e222051. [PMID: 35285921 PMCID: PMC9907340 DOI: 10.1001/jamanetworkopen.2022.2051] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
IMPORTANCE Average staffing measures are a focus of nursing homes' quality assessments and reporting. They may, however, mask daily variation in staffing, additional information that could be important for understanding nursing home quality and relative ranking. OBJECTIVE To examine daily variation in staffing, its association with quality, and whether daily variation provides information regarding quality ranking of nursing homes over and above the information provided by average staffing levels. DESIGN, SETTING, AND PARTICIPANTS This quality improvement study included registered nurses (RNs) and certified nurse aide (CNAs) at 13 339 certified nursing homes throughout the United States during 2017 to 2018. Retrospective analyses of the Payroll-Based Journal, Medicare Cost Reports, and Nursing Home Care Compare were conducted. Data were analyzed from January 2017 to December 2018. MAIN OUTCOMES AND MEASURES Three measures of daily variation, ie, coefficient of variation (COV), total outlier days (TOD), and low outlier days (LOD), were calculated for RNs and CNAs. The association between these measures and quality rankings and other facility characteristics were evaluated. RESULTS A total of 13 339 nursing homes were included in this study, with 9476 (71%) for-profit facilities. The mean (SD) hours-per-resident-day were 0.41 (0.29) for RNs and 2.16 (0.49) for CNAs, and a mean (SD) 55% (26%) of residents were Medicaid beneficiaries. Outcome measures were as follows: mean (SD) COV, 0.5 (0.6) for RNs and 0.1 (0.1) for CNAs; mean (SD) TOD, 220 (69) for RNs and 44 (45) for CNAs; and mean (SD) LOD, 116 (45) for RNs and 22 (24) for CNAs. All 3 variation measures, for both RNs and CNAs, were significantly associated with both the 5-Star Quality Measures (COV among RNs, -0.014 [95% CI, -0.021 to -0.007]; P < .001; COV among CNAs: -0.004 [95% CI, -0.006 to -0.003]; P < .001; TOD among RNs, -3.79 [95% CI, -4.59 to -2.99]; P < .001; TOD among CNAs, -2.52 [95% CI, -3.08 to -1.96]; P < .001; LOD among RNs, -2.46 [95% CI, -3.03 to -1.88]; P < .001; LOD among CNAs, -1.29 [95% CI, -1.58 to -0.99]; P < .001) and the 5-Star Survey rankings (COV among RNs,-0.026 [95% CI, -0.033 to -0.019]; P < .001; COV among CNAs: -0.006 [95% CI, -0.007 to -0.004]; P < .001; TOD among RNs, -5.10 [95% CI, -5.97 to -4.23]; P < .001; TOD among CNAs, -4.16 [95% CI, -4.77 to -3.55]; P < .001; LOD among RNs, -3.04 [95% CI, -3.65 to -2.44]; P < .001; LOD among CNAs, -1.97 [95% CI, -2.29 to -1.65]; P < .001) published in Nursing Home Care Compare. Low κ values, ranging from 0.23 to 0.63, indicated that the variation measures add information about ranking to the information provided by average staffing measure. CONCLUSIONS AND RELEVANCE These findings highlight the importance of reporting daily variation in staffing to improve understanding of the relationship between staffing and quality. They suggest that 2 facilities with the same average staffing achieve different quality of resident care and survey ratings in association with on the day-to-day variation in staffing. Measures of daily staffing may enhance the value of Nursing Home Care Compare for nursing homes and others engaged in quality improvement and consumers searching for high quality nursing homes.
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Affiliation(s)
- Dana B. Mukamel
- Department of Medicine, Division of General Internal Medicine, University of California, Irvine
| | - Debra Saliba
- UCLA Borun Center at David Geffen School of Medicine, Los Angeles, California
- Veterans Administration GRECC, Los Angeles, California
- RAND Health, Santa Monica, California
| | - Heather Ladd
- Department of Medicine, Division of General Internal Medicine, University of California, Irvine
| | - R. Tamara Konetzka
- Department of Public Health Sciences, The University of Chicago, Chicago, Illinois
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Sharma H, Xu L. Association between wages and nursing staff turnover in Iowa nursing homes. Innov Aging 2022; 6:igac004. [PMID: 35770065 PMCID: PMC9233199 DOI: 10.1093/geroni/igac004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Objectives
Nursing staff turnover is a substantial concern for nursing homes that care for millions of older individuals, especially during the COVID-19 pandemic. Low pay is considered as one of the key reasons for high turnover. However, we do not know whether increasing wages can lead to lower turnover. In this study, we fill this gap in our understanding by analyzing the relationship between wages and nursing staff turnover.
Research Design and Methods
We obtained data on hourly wages (Medicare Cost Reports), turnover (Iowa Department of Human Services), and nursing home and resident characteristics (Nursing Home Compare and LTCFocus) from 2013 to 2017. We summarized the characteristics of nursing homes as well as turnover trends over time. Next, we used pooled OLS and facility fixed effects regressions to examine the relationship between wages and turnover adjusting for nursing home and resident characteristics.
Results
Among the 396 nursing homes in Iowa, average hourly wage was $27.0 for registered nurse (RNs), $21.6 for licensed practical nurses (LPNs), and $14.1 for certified nurse aides (CNAs) during 2013 to 2017. Average turnover rates were increasing over time for all staff types and in 2017, turnover rates were 46.0% for RNs, 44.4% for LPNs, and 64.7% for CNAs. In both pooled OLS and facility fixed effects regressions, higher wages were associated with lower turnover of CNAs but not LPNs or RNs. The magnitude of the effect of wages on turnover for CNAs was lower in facility fixed effects regressions.
Discussion and Implications
We found significant relationship between hourly wages and turnover for CNAs but not for LPNs or RNs. Focusing on higher wages alone may not lead to lower turnover of all types of nursing staff in nursing homes. We should also focus on non-wage factors related to turnover.
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Affiliation(s)
- Hari Sharma
- Department of Health Management and Policy, College of Public Health, The University of Iowa, Iowa City, Iowa, USA
| | - Lili Xu
- Department of Health Management and Policy, College of Public Health, The University of Iowa, Iowa City, Iowa, USA
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Zarska A, Avgar AC, Sterling MR. Relationship Between Working Conditions, Worker Outcomes, and Patient Care: A Theoretical Model for Frontline Health Care Workers. Am J Med Qual 2021; 36:429-440. [PMID: 34310376 PMCID: PMC10570923 DOI: 10.1097/01.jmq.0000735508.08292.73] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite the integral role that frontline health care workers play in providing care to older adults and those with chronic conditions and disabilities, few studies have examined the relationships between the working conditions endured by this workforce, the quality of the care they deliver, and the outcomes of patients for whom they care. Thus, the authors: (1) developed a novel conceptual framework that highlights these relationships and (2) performed a comprehensive search and analysis of the literature (PubMed, AgeLine, Cumulative Index to Nursing and Allied Health Literature (CINAHL), JSTOR, Scopus, Web of Science) to assess the relationships proposed in the framework. A total of 31 studies were included. The results suggest that working conditions affect workers themselves, the care they deliver, and their patients' outcomes. Additional studies, as well as policy solutions, are needed to address the issues faced by this workforce in order to improve health care delivery.
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Affiliation(s)
- Aleksandra Zarska
- Cornell University, School of Industrial and Labor Relations, Ithaca, NY Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
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Towers AM, Smith N, Allan S, Vadean F, Collins G, Rand S, Bostock J, Ramsbottom H, Forder J, Lanza S, Cassell J. Care home residents’ quality of life and its association with CQC ratings and workforce issues: the MiCareHQ mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background
Care home staff have a critical bearing on quality. The staff employed, the training they receive and how well they identify and manage residents’ needs are likely to influence outcomes. The Care Act 2014 (Great Britain. The Care Act 2014. London: The Stationery Office; 2014) requires services to improve ‘well-being’, but many residents cannot self-report and are at risk of exclusion from giving their views. The Adult Social Care Outcomes Toolkit enables social care-related quality of life to be measured using a mixed-methods approach. There is currently no equivalent way of measuring aspects of residents’ health-related quality of life. We developed new tools for measuring pain, anxiety and depression using a mixed-methods approach. We also explored the relationship between care home quality, residents’ outcomes, and the skill mix and employment conditions of the workforce who support them.
Objectives
The objectives were to develop and test measures of pain, anxiety and depression for residents unable to self-report; to assess the extent to which regulator quality ratings reflect residents’ care-related quality of life; and to assess the relationship between aspects of the staffing of care homes and the quality of care homes.
Design
This was a mixed-methods study.
Setting
The setting was care homes for older adults in England.
Participants
Care home residents participated.
Results
Three measures of pain, anxiety and low mood were developed and tested, using a mixed-methods approach, with 182 care home residents in 20 care homes (nursing and residential). Psychometric testing found that the measures had good construct validity. The mixed-methods approach was both feasible and necessary with this population, as the majority of residents could not self-report. Using a combined data set (n = 475 residents in 54 homes) from this study and the Measuring Outcomes in Care Homes study (Towers AM, Palmer S, Smith N, Collins G, Allan S. A cross-sectional study exploring the relationship between regulator quality ratings and care home residents’ quality of life in England. Health Qual Life Outcomes 2019;17:22) we found a significant positive association between residents’ social care-related quality of life and regulator (i.e. Care Quality Commission) quality ratings. Multivariate regression revealed that homes rated ‘good/outstanding’ are associated with a 12% improvement in mean current social care-related quality of life among residents who have higher levels of dependency. Secondary data analysis of a large, national sample of care homes over time assessed the impact of staffing and employment conditions on Care Quality Commission quality ratings. Higher wages and a higher prevalence of training in both dementia and dignity-/person-centred care were positively associated with care quality, whereas high staff turnover and job vacancy rates had a significant negative association. A 10% increase in the average care worker wage increased the likelihood of a ‘good/outstanding’ rating by 7%.
Limitations
No care homes rated as inadequate were recruited to the study.
Conclusions
The most dependent residents gain the most from homes rated ‘good/outstanding’. However, measuring the needs and outcomes of these residents is challenging, as many cannot self-report. A mixed-methods approach can reduce methodological exclusion and an over-reliance on proxies. Improving working conditions and reducing staff turnover may be associated with better outcomes for residents.
Future work
Further work is required to explore the relationship between pain, anxiety and low mood and other indicators of care homes quality and to examine the relationship between wages, training and social care outcomes.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 19. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ann-Marie Towers
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Nick Smith
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | - Stephen Allan
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | - Florin Vadean
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | - Grace Collins
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | - Stacey Rand
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | | | | | - Julien Forder
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
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Seow H, Dutta P, Johnson MJ, McMillan K, Guthrie DM, Costa AP, Currow DC. Prevalence and Risk Factors of Breathlessness Across Canada: A National Retrospective Cohort Study in Home Care and Nursing Home Populations. J Pain Symptom Manage 2021; 62:346-354.e1. [PMID: 33276042 DOI: 10.1016/j.jpainsymman.2020.11.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 11/21/2022]
Abstract
CONTEXT Breathlessness is a symptom associated with poor clinical outcomes and prognosis. Little is known about its long-term trends and associations with social factors including decline in social activities and caregiver distress. OBJECTIVES To describe factors associated with the prevalence of clinician-reported breathlessness across Canada among cohorts receiving home care or nursing home care. METHODS A retrospective observational cohort study of cross-sectional intake assessment data from Canadian interRAI Home Care and Nursing Home data sets. In each data set, we examined covariates associated with the presence of clinician-reported breathlessness using multivariate regression. RESULTS Between 2007 and 2018, we identified 1,317,117 and 469,709 individuals from the home care and nursing home data sets, respectively. Over two-thirds were aged >75 and over 60% were women. Breathlessness was present at intake in 26.0% of the home care and 8.2% of the nursing home cohorts. Between 2007 and 2018, prevalence of breathlessness increased by 10% for the home care cohort, while remaining relatively constant in nursing homes. Covariates associated with increased odds of having clinician-reported breathlessness at intake in both cohorts were moderate-severe impairment with activities of daily living, being male, older age, high pain scores, signs of depression, and decline in social activities. In the home care cohort, the presence of breathlessness was associated with a greater odds of caregiver distress (odds ratio = 1.19, 95% CI: 1.18-1.20). CONCLUSION The prevalence of clinician-reported breathlessness is higher in home care than in nursing home populations, the former having risen by 10% over the decade. Prevalence of breathlessness is associated with decline in social activities and caregiver distress. Enhanced supports may be required to meet increasing patient need in the community.
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Affiliation(s)
- Hsien Seow
- McMaster University, Hamilton, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
| | | | | | | | | | - Andrew P Costa
- McMaster University, Hamilton, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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Expert nurse response to workforce recommendations made by the coronavirus commission for safety and quality in nursing homes. Nurs Outlook 2021; 69:735-743. [PMID: 33993987 PMCID: PMC8020094 DOI: 10.1016/j.outlook.2021.03.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 11/21/2022]
Abstract
COVID-19 has exposed the longstanding internal problems in nursing homes and the weak structures and policies that are meant to protect residents. The Centers for Medicare and Medicaid Services convened the Coronavirus Commission for Safety and Quality in NHs in April, 2020 to address this situation by recommending steps to improve infection prevention and control, safety procedures, and the quality of life of residents in nursing homes. The authors of this paper respond to the Final Report of the Commission and put forth additional recommendations to federal policymakers for meaningful nursing home reform: 1) ensuring 24/7 registered nurse (RN) coverage and adequate compensation to maintain total staffing levels that are based on residents’ care needs; 2) ensuring RNs have geriatric nursing and leadership competencies; 3) increasing efforts to recruit and retain the NH workforce, particularly RNs; and 4) supporting care delivery models that strengthen the role of the RN for quality resident-centered care.
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Temkin-Greener H, Cen X, Li Y. Nursing Home Staff Turnover and Perceived Patient Safety Culture: Results from a National Survey. THE GERONTOLOGIST 2021; 60:1303-1311. [PMID: 32211874 DOI: 10.1093/geront/gnaa015] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We examined the association between turnover of registered nurses (RNs) and certified nurse assistants (CNAs) and perceived patient safety culture (PSC) in nursing homes (NHs). RESEARCH DESIGN AND METHODS In 2017, we conducted PSC survey using the Agency for Healthcare Research and Quality- developed and -validated instrument for NHs. A random sample of 2,254 U.S. NHs was identified. Administrators, directors of nursing (DONs), and nurse unit leaders served as respondents. Responses were obtained for 818 facilities from 1,447 individuals. The instrument contained 42 items relating to 12 PSC domains and turnover rates. PSC domains were based on five-point Likert scale items. A positive response was defined as "agree" or "strongly agree" (4-5 on the Likert scale). For CNAs low turnover was defined as <35%, and for RNs <15%. Facility-level and market-competition characteristics were included. Bivariate comparisons employed analysis of variance and chi-square tests. In multivariable models, we fit separate linear regressions for the average positive PSC score and for each of the 12 PSC domains, including turnover rates, NH, and market factors. RESULTS In NHs with low turnover, the overall PSC scores were 4.04% (RNs) and 6.28% (CNAs) higher than in NHs with high turnover. Teamwork, staffing, and training/skills were associated with CNA but not RN turnover. DISCUSSION AND IMPLICATIONS The effect of turnover on PSC depends on who leaves and to a lesser extent on the organizational characteristics. In NHs, improvements in PSC may depend on the ability to retain a well-trained and skilled nursing staff.
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Affiliation(s)
| | - Xi Cen
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, New York
| | - Yue Li
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, New York
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Patient Characteristics Are Not Associated With Documentation of Weight and Heart Failure Related Sign and Symptom Assessment in Skilled Nursing Facilities. J Am Med Dir Assoc 2020; 22:1265-1270.e1. [PMID: 33071159 DOI: 10.1016/j.jamda.2020.08.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 08/13/2020] [Accepted: 08/24/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Monitoring body weight and signs and symptoms related to heart failure (HF) can alert clinicians to a patient's worsening condition but the degree to which these practices are performed in skilled nursing facilities (SNFs) is unknown. This study analyzed the frequency of these monitoring practices in SNFs and explored associated factors at both the patient and SNF level. DESIGN An observational study of data from the usual care arm of the SNF Connect Trial, a randomized cluster trial of a HF disease management intervention. The data extracted from charts were combined with publicly available facility data. A linear regression model was estimated to evaluate the frequency of HF disease management conditional on patient and facility covariates. SETTING Data from 28 SNFs in Colorado. PARTICIPANTS Patients discharged from hospital to SNFs with a primary or secondary diagnosis of HF. MEASUREMENTS Patient-level covariates included demographics, New York Heart Association class, type of HF, and Charlson comorbidity index. Facility-level covariates were from Nursing Home Compare. RESULTS The sample (n = 320) was majority female (66%), white (93%), with mean age 80 ± 10 years and a Charlson comorbidity index of 3.2 ± 1.5. Seventy percent had HF with preserved ejection fraction, mean ejection fraction of 50 ± 16% and 40% with a New York Heart Association class III-IV. On average, patients were weighed 40% of their days in the SNF and had documentation of at least 1 HF-related sign or symptom 70% of their days in the SNF. Patient-level factors were not associated with frequency of documenting weight and assessments of HF-related signs/symptoms. Health Inspection Star Rating was positively associated with weight monitoring (P < .05) but not associated with symptom assessment. CONCLUSIONS AND IMPLICATIONS Patient-level factors are not meaningfully associated with the documentation of weight tracking or sign/symptom assessment. Monitoring weight was instead associated with the Health Inspection Star Rating.
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Kossek EE, Rosokha LM, Leana C. Work Schedule Patching in Health Care: Exploring Implementation Approaches. WORK AND OCCUPATIONS 2020; 47:228-261. [PMID: 34840412 PMCID: PMC8623715 DOI: 10.1177/0730888419841101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The authors propose a typology of "work schedule patching," the ongoing adjustments made to plug scheduling holes after employers post schedules. Patching occurs due to changes in employer work demands, or employee nonwork demands necessitating scheduling adjustments, which are reactive or proactive. Using qualitative data from eight health-care facilities, the authors identified three narratives justifying schedule patching implementation approaches (share-the-pain, work-life-needs, and reverse-status-rotation) with variation in formalization and improvisation. Exploratory analysis showed a suggestive link between improvised work-life scheduling and lower pressure ulcers. This article advances theory on balancing the "service triangle" of scheduling in-service economies including health care.
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Pélissier C, Charbotel B, Fassier JB, Fort E, Fontana L. Nurses' Occupational and Medical Risks Factors of Leaving the Profession in Nursing Homes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15091850. [PMID: 30150568 PMCID: PMC6163261 DOI: 10.3390/ijerph15091850] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 08/17/2018] [Accepted: 08/23/2018] [Indexed: 12/18/2022]
Abstract
This study aimed to evaluate the association between intention to leave work, and working conditions and health status among female care-staff in nursing homes. A multicenter cross-sectional study included female care-staff in 105 nursing homes for the elderly. We used validated questionnaires to assess occupational, psychosocial and medical data in a multicenter transverse study. Univariate analysis on chi² test was performed with stratification according to job (nurse, nursing assistant), and variables found to be significant on each dimension were included on multivariate models. 1428 nursing assistants and 342 registered nurses were included. 391 nursing assistants and 85 registered nurses intended to leave their work with the elderly. The registered nurses' intention to leave was associated with deteriorated care-team or residents relations, and with perceived elevated hardship due to the proximity of residents' death. The nursing assistants' intention to leave was associated with deteriorated management relation, with job insecurity and elevated hardship due to the residents' intellectual deterioration. Impaired physical or psychological health status also correlated with this intention. Policy to reduce voluntary turnover of care-staff in nursing homes for the elderly could be based on multifactorial management, acting on work organization and reducing psychosocial stress.
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Affiliation(s)
- Carole Pélissier
- Unité Mixte de Recherche Épidémiologique et de Surveillance Transport Travail Environnement (UMRESTTE, UMR_T9405), Institut français des sciences et technologies des transports, de l'aménagement et des réseaux (IFSTTAR), Université de Lyon, Université Lyon 1, Université de St Etienne, 42055 Saint-Etienne, France.
- Service de Santé au Travail et Pathologies Professionnelles, CHU de Saint-Etienne, 42055 Saint-Etienne, France.
| | - Barbara Charbotel
- Unité Mixte de Recherche Épidémiologique et de Surveillance Transport Travail Environnement (UMRESTTE, UMR_T9405), Institut français des sciences et technologies des transports, de l'aménagement et des réseaux (IFSTTAR), Université de Lyon, Université Lyon 1, F-69373 Lyon, France.
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service de Pathologies Professionnelles, F-69495 Pierre Bénite, France.
| | - Jean Baptiste Fassier
- Unité Mixte de Recherche Épidémiologique et de Surveillance Transport Travail Environnement (UMRESTTE, UMR_T9405), Institut français des sciences et technologies des transports, de l'aménagement et des réseaux (IFSTTAR), Université de Lyon, Université Lyon 1, F-69373 Lyon, France.
- Hospices Civils de Lyon, Service de Médecine et Santé au Travail, 69002 Lyon, France.
| | - Emmanuel Fort
- Unité Mixte de Recherche Épidémiologique et de Surveillance Transport Travail Environnement (UMRESTTE, UMR_T9405), Institut français des sciences et technologies des transports, de l'aménagement et des réseaux (IFSTTAR), Université de Lyon, Université Lyon 1, F-69373 Lyon, France.
| | - Luc Fontana
- Unité Mixte de Recherche Épidémiologique et de Surveillance Transport Travail Environnement (UMRESTTE, UMR_T9405), Institut français des sciences et technologies des transports, de l'aménagement et des réseaux (IFSTTAR), Université de Lyon, Université Lyon 1, Université de St Etienne, 42055 Saint-Etienne, France.
- Service de Santé au Travail et Pathologies Professionnelles, CHU de Saint-Etienne, 42055 Saint-Etienne, France.
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Tappen RM, Wolf DG, Rahemi Z, Engstrom G, Rojido C, Shutes JM, Ouslander JG. Barriers and Facilitators to Implementing a Change Initiative in Long-Term Care Using the INTERACT® Quality Improvement Program. Health Care Manag (Frederick) 2018; 36:219-230. [PMID: 28650872 PMCID: PMC5533173 DOI: 10.1097/hcm.0000000000000168] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Implementation of major organizational change initiatives presents a challenge for long-term care leadership. Implementation of the INTERACT® (Interventions to Reduce Acute Care Transfers) quality improvement program, designed to improve the management of acute changes in condition and reduce unnecessary emergency department visits and hospitalizations of nursing home residents, serves as an example to illustrate the facilitators and barriers to major change in long-term care. As part of a larger study of the impact of INTERACT® on rates of emergency department visits and hospitalizations, staff of 71 nursing homes were called monthly to follow-up on their progress and discuss successful facilitating strategies and any challenges and barriers they encountered during the yearlong implementation period. Themes related to barriers and facilitators were identified. Six major barriers to implementation were identified: the magnitude and complexity of the change (35%), instability of facility leadership (27%), competing demands (40%), stakeholder resistance (49%), scarce resources (86%), and technical problems (31%). Six facilitating strategies were also reported: organization-wide involvement (68%), leadership support (41%), use of administrative authority (14%), adequate training (66%), persistence and oversight on the part of the champion (73%), and unfolding positive results (14%). Successful introduction of a complex change such as the INTERACT® quality improvement program in a long-term care facility requires attention to the facilitators and barriers identified in this report from those at the frontline.
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Affiliation(s)
- Ruth M Tappen
- Author Affiliations: Christine E. Lynn College of Nursing (Dr Tappen and Ms Rahemi), and Charles E. Schmidt College of Medicine (Drs Engstrom, Rojido, and Ouslander, and Ms Shutes), Florida Atlantic University, Boca Raton; Health Services Administration, School of Professional and Career Education, Barry University (Dr Wolf), Miami Shores, Florida; and School of Nursing and Midwifery, Kashan University of Medical Sciences and Health Services (Ms Rahemi), Kashan, Isfahan, Iran
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Cheval B, Cullati S, Pihl-Thingvad J, Mongin D, Von Arx M, Chopard P, Courvoisier DS. Impact of CAre-related Regret Upon Sleep (ICARUS) cohort study: protocol of a 3-year multicentre, international, prospective cohort study of novice healthcare professionals. BMJ Open 2018; 8:e022172. [PMID: 29588326 PMCID: PMC5875595 DOI: 10.1136/bmjopen-2018-022172] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 02/09/2018] [Accepted: 02/13/2018] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Healthcare professionals are particularly at risk of developing numerous physical and psychological health problems. The experiences of emotional burden associated with providing healthcare, notably care-related regret, have been associated with these health problems, but only using cross-sectional data so far. Evidence of a causal impact of regret has not been assessed. The Impact of CAre-related Regret Upon Sleep (ICARUS) study is the first prospective and international cohort study established to examine how newly practising healthcare professionals adapt to their challenging job by assessing the impact of care-related regret on sleep and job quitting. METHOD AND ANALYSIS The ICARUS cohort study will include newly practising healthcare professionals working in acute care hospitals and clinics recruited between May 2017 and November 2019. Data collection, which will begin as soon as the participant starts working with patients, will consist of a 1-year weekly assessment using a secure web survey. Follow-up data will be collected at 6, 12, 18 and 24 months after the end of the first year. We will collect detailed information on the experience of care-related regret (ie, highest regret intensity, accumulation of regrets and coping strategies related to regrets), sleep problems and job quitting. Moreover, quality of life, health status and burnout will be assessed during the follow-up. Several confounders factors, including sociodemographic characteristics, personality, night shifts and work environment characteristics, will be assessed. ETHICS AND DISSEMINATION The study was approved by the Ethics Committee of Geneva Canton, Switzerland (CCER2016-02041), the Ethics Committee of London South Bank University (HSCSEP/17/06) and the University Research Ethics Committee of Bedfordshire (UREC106). Other study centres deemed local ethical approval unnecessary since the main ethics committee (Geneva) had already accepted the project. Results will be published in relevant scientific journals and be disseminated in international conferences. Fully anonymised data and questionnaires will be freely accessible to everyone (scientists and general public).
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Affiliation(s)
- Boris Cheval
- Quality of Care Service, University Hospital of Geneva, Geneva, Switzerland
- Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Geneva, Switzerland
| | - Stéphane Cullati
- Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Geneva, Switzerland
- Swiss NCCR “Lives: Overcoming Vulnerability: Life Course Perspectives”, University of Geneva, Geneva, Denmark
| | - Jesper Pihl-Thingvad
- Department of Occupational and Environmental Medicine, Odense University Hospital, Odense, Denmark
- National Center of Psychotraumatology, University of Southern Denmark, Odense, Denmark
| | - Denis Mongin
- Quality of Care Service, University Hospital of Geneva, Geneva, Switzerland
- Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Geneva, Switzerland
| | - Martina Von Arx
- Swiss NCCR “Lives: Overcoming Vulnerability: Life Course Perspectives”, University of Geneva, Geneva, Denmark
- Institute of Demography and Socioeconomics, University of Geneva, Geneva, Switzerland
| | - Pierre Chopard
- Quality of Care Service, University Hospital of Geneva, Geneva, Switzerland
- Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Geneva, Switzerland
| | - Delphine S Courvoisier
- Quality of Care Service, University Hospital of Geneva, Geneva, Switzerland
- Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Geneva, Switzerland
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Cheung ENM, Benjamin S, Heckman G, Ho JMW, Lee L, Sinha SK, Costa AP. Clinical characteristics associated with the onset of delirium among long-term nursing home residents. BMC Geriatr 2018; 18:39. [PMID: 29394886 PMCID: PMC5797375 DOI: 10.1186/s12877-018-0733-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 01/25/2018] [Indexed: 01/28/2023] Open
Abstract
Background Nursing home residents are frail, have multiple medical comorbidities, and are at high risk for delirium. Most of the existing evidence base on delirium is derived from studies in the acute in-patient population. We examine the association between clinical characteristics and medication use with the incidence of delirium during the nursing home stay. Methods This is a retrospective cohort study of 1571 residents from 12 nursing homes operated by a single care provider in Ontario, Canada. Residents were over the age of 55 and admitted between February 2010 and December 2015 with no baseline delirium and a minimum stay of 180 days. Residents with moderate or worse cognitive impairment at baseline were excluded. The baseline and follow-up characteristics of residents were collected from the Resident Assessment Instrument-Minimal Data Set 2.0 completed at admission and repeated quarterly until death or discharge. Multivariate logistic regression was used to identify characteristics and medication use associated with the onset of delirium. Results The incidence of delirium was 40.4% over the nursing home stay (mean LOS: 32 months). A diagnosis of dementia (OR: 2.54, p < .001), the presence of pain (OR: 1.64, p < .001), and the use of antipsychotics (OR: 1.87, p < .001) were significantly associated with the onset of delirium. Compared to residents who did not develop delirium, residents who developed a delirium had a greater increase in the use of antipsychotics and antidepressants over the nursing home stay. Conclusions Dementia, the presence of pain, and the use of antipsychotics were associated with the onset of delirium. Pain monitoring and treatment may be important to decrease delirium in nursing homes. Future studies are necessary to examine the prescribing patterns in nursing homes and their association with delirium. Electronic supplementary material The online version of this article (10.1186/s12877-018-0733-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Evelyn Ning Man Cheung
- Department of Medicine, McMaster University, IHB/HSC-McMaster 3016, Victoria 10B St. S., Kitchener, ON, N2G 1C5, Canada.
| | - Sophiya Benjamin
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - George Heckman
- Schlegel Research Institute for Aging, Waterloo, ON, Canada.,School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Joanne Man-Wai Ho
- Department of Medicine, McMaster University, IHB/HSC-McMaster 3016, Victoria 10B St. S., Kitchener, ON, N2G 1C5, Canada.,Schlegel Research Institute for Aging, Waterloo, ON, Canada.,Big Data and Geriatric Models of Care, McMaster University, Hamilton, ON, Canada
| | - Linda Lee
- Big Data and Geriatric Models of Care, McMaster University, Hamilton, ON, Canada.,Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Andrew P Costa
- Department of Medicine, McMaster University, IHB/HSC-McMaster 3016, Victoria 10B St. S., Kitchener, ON, N2G 1C5, Canada.,Schlegel Research Institute for Aging, Waterloo, ON, Canada.,Big Data and Geriatric Models of Care, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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Gilster SD, Boltz M, Dalessandro JL. Long-Term Care Workforce Issues: Practice Principles for Quality Dementia Care. THE GERONTOLOGIST 2018; 58:S103-S113. [DOI: 10.1093/geront/gnx174] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Indexed: 11/14/2022] Open
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Norton SA, Ladwig S, Caprio TV, Quill TE, Temkin-Greener H. Staff Experiences Forming and Sustaining Palliative Care Teams in Nursing Homes. THE GERONTOLOGIST 2018; 58:e218-e225. [DOI: 10.1093/geront/gnx201] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Indexed: 01/25/2023] Open
Affiliation(s)
| | - Susan Ladwig
- Department of Medicine, University of Rochester School of Medicine and Dentistry, New York
| | - Thomas V Caprio
- Department of Medicine, University of Rochester School of Medicine and Dentistry, New York
| | - Timothy E Quill
- Department of Medicine, University of Rochester School of Medicine and Dentistry, New York
| | - Helena Temkin-Greener
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, New York
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Zhang Y, Punnett L, Gore R. Predictors of Nursing Staff Voluntary Termination in Nursing Homes: A Case-Control Study. J Appl Gerontol 2017; 38:1518-1536. [DOI: 10.1177/0733464817724043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Workforce instability in the long-term care sector has raised wide attention about nursing staff turnover. Most attention has been devoted to understanding the relationship between facility’s characteristics and organizational turnover. This case-control study examined the contribution of work characteristics to individual staff turnover. Surveys were collected with nursing staff in 18 for-profit nursing homes on up to five occasions between 2006 and 2012. A list of nursing staff voluntarily terminating jobs was provided by the company. Cases and controls (628 of each) were selected from survey respondents by matching on age, job category, and survey occasion. Multiple predictor conditional logistic regression models showed that evening shift work (hazards ratio [HR] = 2.00, p < .01) and shift length > 8 hr (HR = 1.42, p < .05) were contributing factors to voluntary termination. This study provides different perspectives of nursing staff voluntary termination in nursing homes. Future qualitative research would be valuable to explore and understand nursing staff turnover in the health care industry.
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Abstract
High levels of staff turnover of certified nursing assistants (CNAs) are costly and disruptive to patient care. A variety of factors contribute to a 36% turnover rate of CNAs nationwide (2015 Staffing Report, 2015). According to Stone and Wiener, high rates of turnover and staff vacancies have multilayered consequences; patient care suffers, cost of constantly replacing workers soars, and worker job dissatisfaction increases. This study examined the CNAs' beliefs about job satisfaction as an approach to prevent job turnover and retain high achieving staff in one acute care hospital in a south eastern region. The goal was to determine how CNAs define job satisfaction, evaluate their understanding of and gauge interest in the career options presented at information sessions as well as listen to their ideas on how they believe are the best approaches to achieve job satisfaction for the CNAs at this facility. A qualitative key informant design was used to interview a purposive sample of 9 nursing assistants who were currently employed at the hospital for at least 6 months and who attended a brief information session. Individual 20-minute face-to-face interviews of consented participants were recorded, transcribed, and coded for themes using constant comparative analysis. Four major categories emerged from the interviews: CNA views of job satisfaction, clinical ladder option, support services option, and what CNAs want.
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Ruiz PBDO, Perroca MG, Jericó MDC. [Cost of nursing turnover in a Teaching Hospital]. Rev Esc Enferm USP 2016; 50:104-11. [PMID: 27007427 DOI: 10.1590/s0080-623420160000100014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 12/29/2015] [Indexed: 05/29/2023] Open
Abstract
OBJECTIVE To map the sub processes related to turnover of nursing staff and to investigate and measure the nursing turnover cost. METHOD This is a descriptive-exploratory study, classified as case study, conducted in a teaching hospital in the southeastern, Brazil, in the period from May to November 2013. The population was composed by the nursing staff, using Nursing Turnover Cost Calculation Methodology. RESULTS The total cost of turnover was R$314.605,62, and ranged from R$2.221,42 to R$3.073,23 per employee. The costs of pre-hire totaled R$101.004,60 (32,1%), and the hiring process consumed R$92.743,60 (91.8%) The costs of post-hire totaled R$213.601,02 (67,9%), for the sub process decreased productivity, R$199.982,40 (93.6%). CONCLUSION The study identified the importance of managing the cost of staff turnover and the financial impact of the cost of the employee termination, which represented three times the average salary of the nursing staff.
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Affiliation(s)
| | - Marcia Galan Perroca
- Departamento de Enfermagem Especializada, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | - Marli de Carvalho Jericó
- Departamento de Enfermagem Especializada, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
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Economic evaluation of registered nurse tenure on nursing home resident outcomes. Appl Nurs Res 2016; 29:89-95. [PMID: 26856495 DOI: 10.1016/j.apnr.2015.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 04/20/2015] [Accepted: 05/09/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE Little is known about the economic implications of nursing home (NH) registered nurse (RN) tenure on resident outcomes. This study evaluated the cost-effectiveness of two nurse workforce scenarios focusing on RN tenure (high versus low), and the associated transfers from NH to the hospital. METHODS A decision tree was constructed to compare the incremental costs and effects of RN tenure scenarios on NH resident transfers to the hospital under two NH staffing scenarios: high versus low levels of RN tenure. Three outcomes were modeled: 1) dollars per hospitalization avoided, 2) dollars per hospitalization and death avoided, and 3) dollars per death avoided. RESULTS The total costs of care for the low tenure scenario were $34,108 per month compared to the high tenure scenario at $29,442 per month. Effectiveness of the high tenure was greater across all 3 outcomes (incremental effectiveness ranged from 0.925 to 0.974 depending on outcome), indicating that high tenure was the dominant strategy (that is less costly and more effective). CONCLUSIONS Higher RN tenure was a dominant strategy across the 3 outcomes. This was a fairly robust finding despite the variations in the model and uncertainty in the input parameters. Aligning quality outcomes with cost effectiveness is imperative to driving the direction of health policy in the United States. Better prevention of hospitalizations by having an experienced RN workforce will not only improve resident quality of care but will allow NHs to realize the value of retaining a skilled workforce.
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Kennerly S, Heggestad ED, Myers H, Yap TL. Using the Nursing Culture Assessment Tool (NCAT) in Long-Term Care: An Update on Psychometrics and Scoring Standardization. Healthcare (Basel) 2015; 3:637-47. [PMID: 27417786 PMCID: PMC4939571 DOI: 10.3390/healthcare3030637] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 07/08/2015] [Accepted: 07/21/2015] [Indexed: 11/16/2022] Open
Abstract
An effective workforce performing within the context of a positive cultural environment is central to a healthcare organization's ability to achieve quality outcomes. The Nursing Culture Assessment Tool (NCAT) provides nurses with a valid and reliable tool that captures the general aspects of nursing culture. This study extends earlier work confirming the tool's construct validity and dimensionality by standardizing the scoring approach and establishing norm-referenced scoring. Scoring standardization provides a reliable point of comparison for NCAT users. NCAT assessments support nursing's ability to evaluate nursing culture, use results to shape the culture into one that supports change, and advance nursing's best practices and care outcomes. Registered nurses, licensed practical nurses, and certified nursing assistants from 54 long-term care facilities in Kentucky, Nevada, North Carolina, and Oregon were surveyed. Confirmatory factor analysis yielded six first order factors forming the NCAT's subscales (Expectations, Behaviors, Teamwork, Communication, Satisfaction, Commitment) (Comparative Fit Index 0.93) and a second order factor-The Total Culture Score. Aggregated facility level comparisons of observed group variance with expected random variance using rwg(J) statistics is presented. Normative scores and cumulative rank percentages and how the NCAT can be used in implementing planned change are provided.
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Affiliation(s)
- Susan Kennerly
- School of Nursing, University of North Carolina at Charlotte, Charlotte, NC 28223, USA.
| | - Eric D Heggestad
- Department of Psychology and Organizational Science, University of North Carolina at Charlotte, Charlotte, NC 28223, USA.
| | - Haley Myers
- Department of Organizational Science, University of North Carolina at Charlotte, Charlotte, NC 28223, USA.
| | - Tracey L Yap
- School of Nursing, Duke University, Durham, NC 27710, USA.
- Center for the Study of Aging and Human Development, Duke University, Durham, NC 27710, USA.
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Chen IH, Brown R, Bowers BJ, Chang WY. Work-to-family conflict as a mediator of the relationship between job satisfaction and turnover intention. J Adv Nurs 2015; 71:2350-63. [PMID: 26043649 DOI: 10.1111/jan.12706] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2015] [Indexed: 12/11/2022]
Abstract
AIMS To investigate the mediating effect of work-to-family conflict on the relationship between job satisfaction and turnover intention among licensed nurses in long-term care settings. BACKGROUND The considerable research on turnover in long-term care has primarily focused on the impact of job satisfaction on turnover intention. Given the well-documented high turnover rate in nursing home staffing, dissatisfaction is expected to continue. Alternatives (e.g. reduction in work-to-family conflict) for reducing turnover under the circumstance of job dissatisfaction have not been investigated extensively. DESIGN A cross-sectional mailed survey. METHODS A convenience sample comprising 200 nurses from 25 private nursing homes in Central Taiwan was created. Data were collected from nurses about their level of turnover intention, job satisfaction and work-to-family conflict in 2012. A composite indicator structural equation model was used to examine the mediation model of this study. RESULTS Overall, 186 nurses (93%) returned the completed questionnaires. Consistent with published research from other countries, turnover intention in our study was significantly and negatively associated with job satisfaction and significantly and positively associated with work-to-family conflict. In addition, job dissatisfaction indirectly influenced turnover intention through high work-to-family conflict. CONCLUSION Findings from this study indicate the importance of work-to-family conflict to nurse turnover. While work setting has a strong, well-documented influence on job satisfaction, limiting job satisfaction efforts to work setting improvements may not yield the hoped-for results unless work-to-family conflict is also considered and addressed.
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Affiliation(s)
- I-Hui Chen
- Department of Nursing, Asia University, Taichung City, Taiwan
| | - Roger Brown
- Schools of Nursing, University of Wisconsin-Madison, Wisconsin, USA
| | - Barbara J Bowers
- Schools of Nursing, University of Wisconsin-Madison, Wisconsin, USA
| | - Wen-Yin Chang
- Graduate Institute of Nursing, College of Nursing, Taipei Medical University, Taiwan
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Kim Y, Lee JY, Kang H. [Impact of nurse, nurses' aid staffing and turnover rate on inpatient health outcomes in long term care hospitals]. J Korean Acad Nurs 2014; 44:21-30. [PMID: 24637283 DOI: 10.4040/jkan.2014.44.1.21] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE This study was conducted to explore the impact of registered nurse/nurses' aid (RN/NA) staffing and turnover rate on inpatient health outcomes in long term care hospitals. METHODS A secondary analysis was done of national data from the Health Insurance Review and Assessment Services including evaluation of long term care hospitals in October-December 2010 and hospital general characteristics in July-September 2010. Final analysis of data from 610 hospitals included RN/NA staffing, turnover rate of nursing staff and 5 patient health outcome indicators. RESULTS Finding showed that, when variables of organization and community level were controlled, patients per RN was a significant indicator of decline in ADL for patients with dementia, and new pressure ulcer development in the high risk group and worsening of pressure ulcers. Patients per NA was a significant indicator for new pressure ulcer development in the low risk group. Turnover rate was not significant for any variable. CONCLUSION To maintain and improve patient health outcomes of ADL and pressure ulcers, policies should be developed to increase the staffing level of RN. Studies are also needed to examine causal relation of NA staffing level, RN staffing level and patient health outcomes with consideration of the details of nursing practice.
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Affiliation(s)
- Yunmi Kim
- College of Nursing, Eulji University, Sungnam, Korea
| | - Ji Yun Lee
- Department of Nursing, Kangwon National University, Chuncheon, Korea.
| | - Hyuncheol Kang
- Department of Informational Statistics, Hoseo University, Asan, Korea
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Abstract
BACKGROUND Exit interviews are widely used in healthcare organisations to identify reasons for staff attrition, yet their usefulness in limiting turnover is unclear. OBJECTIVES To determine the effectiveness of various exit interview strategies in decreasing turnover rates amongst healthcare professionals. SEARCH METHODS We searched the Cochrane EPOC Group Specialised Register; Cochrane Central Register of Controlled Trials (CENTRAL), Issue 11, 2012; MEDLINE, Ovid (1950- ); EMBASE, Ovid (1947- ); CINAHL, EbscoHost (1980- ), and PsycINFO, OVID (1806-) between October 31 and November 6, 2012. We also screened the reference lists of included studies and relevant reviews; and searched trial registries for planned and on-going studies. We did not restrict searches by language or publication date. SELECTION CRITERIA Randomised controlled trials, controlled clinical trials, controlled before-after studies and interrupted time series studies comparing turnover rates between healthcare professionals who had undergone one form of exit interview with another form of exit interview or with no interview. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. MAIN RESULTS The original search identified 1560 citations, of which we considered 19 potentially relevant. The two authors independently reviewed the abstracts of these studies and retrieved the full texts of eight studies. We excluded all eight following independent assessment; they were either interviews, commentaries on how to do an exit interview or descriptive studies about reasons for leaving. We found no studies that matched our inclusion criteria. For this first update, we screened 2220 citations and identified no new studies. AUTHORS' CONCLUSIONS Evidence about the effectiveness of exit interviews to reduce turnover is currently not available. However, exit interviews may provide useful information about the work environment which, in turn, may be useful in the development of interventions to reduce turnover.
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Affiliation(s)
- Joan Webster
- Royal Brisbane and Women's HospitalCentre for Clinical NursingLevel 2, Building 34Butterfield StreetBrisbaneQueenslandAustralia4029
| | - Anndrea Flint
- Royal Brisbane and Women's HospitalGrantley Stable Neonatal UnitLevel 2, Building 34BrisbaneQueenslandAustralia4029
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Duffield CM, Roche MA, Homer C, Buchan J, Dimitrelis S. A comparative review of nurse turnover rates and costs across countries. J Adv Nurs 2014; 70:2703-12. [DOI: 10.1111/jan.12483] [Citation(s) in RCA: 198] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Christine M. Duffield
- Centre for Health Services Management; Faculty of Health; University of Technology; Sydney New South Wales Australia
- Clinical Nursing and Midwifery Research Centre; School of Nursing and Midwifery; Edith Cowan University; Joondalup Perth Western Australia Australia
| | - Michael A. Roche
- Centre for Health Services Management; Faculty of Health; University of Technology; Sydney New South Wales Australia
| | - Caroline Homer
- Centre for Midwifery, Child and Family Health; Faculty of Health; University of Technology; Sydney New South Wales Australia
| | - James Buchan
- Centre for Health Services Management; Faculty of Health; University of Technology; Sydney New South Wales Australia
| | - Sofia Dimitrelis
- Centre for Health Services Management; Faculty of Health; University of Technology; Sydney New South Wales Australia
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Webster J, Flint A. Exit interviews to reduce turnover amongst healthcare professionals. Cochrane Database Syst Rev 2014:CD006620. [PMID: 24633500 DOI: 10.1002/14651858.cd006620.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Exit interviews are widely used in healthcare organisations to identify reasons for staff attrition, yet their usefulness in limiting turnover is unclear. OBJECTIVES To determine the effectiveness of various exit interview strategies in decreasing turnover rates amongst healthcare professionals. SEARCH METHODS We searched the Cochrane EPOC Group Specialised Register; Cochrane Central Register of Controlled Trials (CENTRAL), Issue 11, 2012; MEDLINE, Ovid (1950- ); EMBASE, Ovid (1947- ); CINAHL, EbscoHost (1980- ), and PsycINFO, OVID (1806-) between October 31 and November 6, 2012. We also screened the reference lists of included studies and relevant reviews; and searched trial registries for planned and on-going trials. We did not restrict searches by language or publication date. SELECTION CRITERIA Randomised controlled trials, controlled clinical trials, controlled before-after studies and interrupted time series studies comparing turnover rates between healthcare professionals who had undergone one form of exit interview with another form of exit interview or with no interview. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. MAIN RESULTS The original search identified 1560 citations, of which we considered 19 potentially relevant. The two authors independently reviewed the abstracts of these studies and retrieved the full texts of eight studies. We excluded all eight following independent assessment; they were either interviews, commentaries on how to do an exit interview or descriptive studies about reasons for leaving. We found no trials that matched our inclusion criteria. For this first update, we screened 2220 citations and identified no new trials. AUTHORS' CONCLUSIONS Evidence about the effectiveness of exit interviews to reduce turnover is currently not available. However, exit interviews may provide useful information about the work environment which, in turn, may be useful in the development of interventions to reduce turnover.
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Affiliation(s)
- Joan Webster
- NHMRC Centre of Research Excellence in Nursing, Royal Brisbane and Women's Hospital, Level 2, Building 34, Butterfield Street, Brisbane, Queensland, Australia, 4029
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Performance and turnover intentions: a social exchange perspective. JOURNAL OF MANAGERIAL PSYCHOLOGY 2013. [DOI: 10.1108/jmp-09-2011-0054] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
BACKGROUND Exit interviews are widely used in healthcare organisations to identify reasons for staff attrition, yet their usefulness in limiting turnover is unclear. OBJECTIVES To determine the effectiveness of various exit interview strategies in decreasing turnover rates amongst healthcare professionals. SEARCH METHODS We searched the Cochrane EPOC Group Specialised Register; Cochrane Central Register of Controlled Trials (CENTRAL), Issue 11, 2012; MEDLINE, Ovid (1950- ); EMBASE, Ovid (1947- ); CINAHL, EbscoHost (1980- ), and PsycINFO, OVID (1806-) between October 31 and November 6, 2012. We also screened the reference lists of included studies and relevant reviews; and searched trial registries for planned and on-going trials. We did not restrict searches by language or publication date. SELECTION CRITERIA Randomised controlled trials, controlled clinical trials, controlled before-after studies and interrupted time series studies comparing turnover rates between healthcare professionals who had undergone one form of exit interview with another form of exit interview or with no interview. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. MAIN RESULTS The original search identified 1560 citations, of which we considered 19 potentially relevant. The two authors independently reviewed the abstracts of these studies and retrieved the full texts of eight studies. We excluded all eight following independent assessment; they were either interviews, commentaries on how to do an exit interview or descriptive studies about reasons for leaving. We found no trials that matched our inclusion criteria. For this first update, we screened 2220 citations and identified no new trials. AUTHORS' CONCLUSIONS Evidence about the effectiveness of exit interviews to reduce turnover is currently not available. However, exit interviews may provide useful information about the work environment which, in turn, may be useful in the development of interventions to reduce turnover.
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Affiliation(s)
- Anndrea Flint
- Grantley Stable Neonatal Unit, Royal Brisbane and Women’s Hospital, Brisbane, Australia.
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Thomas KS, Mor V, Tyler DA, Hyer K. The relationships among licensed nurse turnover, retention, and rehospitalization of nursing home residents. THE GERONTOLOGIST 2012; 53:211-21. [PMID: 22936529 DOI: 10.1093/geront/gns082] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Individuals receiving postacute care in skilled nursing facilities often require complex, skilled care provided by licensed nurses. It is believed that a stable set of nursing personnel is more likely to deliver better care. The purpose of this study was to determine the relationships among licensed nurse retention, turnover, and a 30-day rehospitalization rate in nursing homes (NHs). DESIGN AND METHODS We combined two data sources: NH facility-level data (including characteristics of the facility, the market, and residents) and the Florida Nursing Home Staffing Reports (which provide staffing information for each NH) for 681 Florida NHs from 2002 to 2009. Using a two-way fixed effects model, we examined the relationships among licensed nurse turnover rates, retention rates, and 30-day rehospitalization rates. RESULTS Results indicate that an NH's licensed nurse retention rate is significantly associated with the 30-day rehospitalization rate (est. = -.02, p = .04) controlling for demographic characteristics of the patient population, residents' preferences for hospitalization, and the ownership characteristics of the NH. The NHs experiencing a 10% increase in their licensed nurse retention had a 0.2% lower rehospitalization rate, which equates to 2 fewer hospitalizations per NH annually. Licensed nurse turnover is not significantly related to the 30-day rehospitalization rate. IMPLICATIONS These findings highlight the need for NH administrators and policy makers to focus on licensed nurse retention, and future research should focus on the measures of staff retention for understanding the staffing/quality relationship.
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Affiliation(s)
- Kali S Thomas
- Center for Gerontology and Healthcare Research, Brown University, Box G-S121 (6), Providence, RI 02912, USA.
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Zhang Y, Punnett L, Gore R. Relationships Among Employees’ Working Conditions, Mental Health, and Intention to Leave in Nursing Homes. J Appl Gerontol 2012; 33:6-23. [DOI: 10.1177/0733464812443085] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Employee turnover is a large and expensive problem in the long-term care environment. Stated intention to leave is a reliable indicator of likely turnover, but actual predictors, especially for nursing assistants, have been incompletely investigated. This quantitative study identifies the relationships among employees’ working conditions, mental health, and intention to leave. Self-administered questionnaires were collected with 1,589 employees in 18 for-profit nursing homes. A working condition index for the number of beneficial job features was constructed. Poisson regression modeling found that employees who reported four positive features were 77% less likely to state strong intention to leave (PR = 0.23, p < .001). The strength of relationship between working conditions and intention to leave was slightly mediated by employee mental health. Effective workplace intervention programs must address work organization features to reduce employee intention to leave. Healthy workplaces should build better interpersonal relationships, show respect for employee work, and involve employees in decision-making processes.
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Affiliation(s)
- Yuan Zhang
- University of Massachusetts Lowell, Lowell, MA, USA
| | | | - Rebecca Gore
- University of Massachusetts Lowell, Lowell, MA, USA
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Levy C, Hutt E, Pointer L. Site of Death Among Veterans Living in Veterans Affairs Nursing Homes. J Am Med Dir Assoc 2012; 13:199-201. [DOI: 10.1016/j.jamda.2011.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 07/25/2011] [Accepted: 08/03/2011] [Indexed: 11/16/2022]
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Choi J, Johantgen M. The importance of supervision in retention of CNAs. Res Nurs Health 2012; 35:187-99. [PMID: 22262015 DOI: 10.1002/nur.21461] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2011] [Indexed: 11/06/2022]
Abstract
Certified nursing assistants (CNAs) provide the majority of direct care in nursing homes, yet recruiting and retaining CNAs has been difficult. Retaining CNAs is important because it has been linked to the better quality of resident care in nursing homes. In this study, the investigators examined the relationships of work-related and personal factors to CNA job satisfaction and intent to leave. Linked data from the 2004 National Nursing Home Survey and the 2004 National Nursing Assistant Survey were analyzed using multilevel logistic regression. Personal factors such as age, education, and job history, were related to intent to leave but not to job satisfaction. Supportive supervision was a significant predictor of both job satisfaction and intent to leave.
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Affiliation(s)
- JiSun Choi
- National Database of Nursing Quality Indicators, University of Kansas Medical Center, School of Nursing, Kansas City, Kansas 66160, USA
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Abstract
BACKGROUND Exit interviews are widely used in healthcare organisations to identify reasons for staff attrition, yet their usefulness in limiting turnover is unclear. OBJECTIVES To determine the effectiveness of various exit interview strategies in decreasing turnover rates amongst healthcare professionals. SEARCH STRATEGY We used a comprehensive search strategy including an electronic search of the following databases: DARE, CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC (search date: 7 September 2010) and EPOC Specialised Register (search date: 30 September 2009). We also screened the reference lists of included studies and relevant reviews. SELECTION CRITERIA Randomised controlled trials, controlled clinical trials, controlled before and after studies and interrupted time series studies comparing turnover rates between healthcare professionals who had undergone one form of exit interview with another form of exit interview or with no interview. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. MAIN RESULTS The search identified 1560 citations of which we considered 19 potentially relevant. The two authors independently reviewed the abstracts of these studies and retrieved the full texts of eight studies. We excluded all eight following independent assessment. They were either interviews, commentaries on how to do an exit interview or descriptive studies about reasons for leaving. We found no trials that matched our inclusion criteria. AUTHORS' CONCLUSIONS Evidence about the effectiveness of exit interviews to reduce turnover is currently not available. However, exit interviews may provide useful information about the work environment which, in turn, may be useful in the development of interventions to reduce turnover.
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Affiliation(s)
- Anndrea Flint
- Centre for Clinical Nursing, Level 2, Royal Women's Hospital, Butterfield St, Herston, Brisbane, Queensland, Australia, 4029
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Li Y, Harrington C, Spector WD, Mukamel DB. State regulatory enforcement and nursing home termination from the medicare and medicaid programs. Health Serv Res 2010; 45:1796-814. [PMID: 20819106 DOI: 10.1111/j.1475-6773.2010.01164.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Nursing homes certified by the Medicare and/or Medicaid program are subject to federally mandated and state-enforced quality and safety standards. We examined the relationship between state quality enforcement and nursing home terminations from the two programs. STUDY DESIGN Using data from a survey of state licensure and certification agencies and other secondary databases, we performed bivariate and multivariate analyses on the strength of state quality regulation in 2005, and nursing home voluntary terminations (decisions made by the facility) or involuntary terminations (imposed by the state) in 2006-2007. PRINCIPAL FINDINGS Involuntary terminations were rarely imposed by state regulators, while voluntary terminations were relatively more common (2.16 percent in 2006-2007) and varied considerably across states. After controlling for facility, market, and state covariates, nursing homes in states implementing stronger quality enforcement were more likely to voluntarily terminate from the Medicare and Medicaid programs (odds ratio = 1.53, p = .018). CONCLUSIONS Although involuntary nursing home terminations occurred rarely in most states, nursing homes in states with stronger quality regulations tend to voluntarily exit the publicly financed market. Because of the consequences of voluntary terminations on patient care and access, state regulators need to consider the effects of increased enforcement on both enhanced quality and the costs of termination.
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Affiliation(s)
- Yue Li
- Department of Internal Medicine, University of Iowa & Iowa City VA Medical Center, SE610 GH, 200 Hawkins Dr, Iowa City, IA 52242, USA.
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Reflecting on turnover costs in nursing homes. Med Care 2009; 47:1037-8. [PMID: 19820611 DOI: 10.1097/mlr.0b013e3181ae558a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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