Staff turnover and quality of care in nursing homes
Staff turnover and quality of care in nursing homes
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DOI：
10.1097/01.mlr.0000163661.67170.b9
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发表时间：
2005-06-01
期刊：
影响因子：
3
通讯作者：
Engberg, J
中科院分区：
文献类型：
--
作者：
Castle, NG;Engberg, J
目的：研究护理院护士助理(NA)、执业护士(LPN)和注册护士(RN)的流动率与护理质量指标的关系。设计和方法：护理质量指标包括身体束缚使用率、导管使用率、宫缩发生率、压疮发生率、精神活性药物使用率和护理缺陷认证调查。此外，我们使用了一个结合了这些指标的质量指数。营业额信息来自从4个州的354家工厂收集的主要数据，其他信息来自2003年的在线调查、认证和报告数据。流失率分为低、中、高3类，分别定义为0%~20%、21%~50%和50%以上。结果：本研究确定的NAS和LPN的1年平均流失率较高，分别为85.8%和55.4%。多变量分析表明，质量的下降与RN流动率的增加有关，特别是从低到中等流失率的增加，与NA和LPN流动率的增加，特别是从中到高流失率的增加。横截面的研究结果只能显示出关联性，然而，文献中很少有实证研究显示这种关联性。
Purpose: In this work, the association between nurse aide (NA) plus licensed practical nurse (LPN) and registered nurse (RN) turnover and quality indicators in nursing homes is examined.Design and Methods: Indicators of care quality used are the rates of physical restraint use, catheter use, contractures, pressure ulcers, psychoactive drug use, and certification survey quality of care deficiencies. In addition, we used a quality index combining these indicators. Turnover information came from primary data collected from 354 facilities in 4 states and other information came from the 2003 Online Survey, Certification and Reporting data. The turnover rates were grouped into 3 categories, low, medium, and high, defined as 0% to 20%, 21% to 50%, and greater than 50% turnover, respectively.Results: The average 1-year turnover rates identified in this study were high at 85.8% for NAs and LPNs and 55.4% for RNs. Multivariate analysis shows that decreases in quality are associated with increases in RN turnover, especially increases from low-to-moderate levels of turnover, and with increases in NA and LPN turnover, especially increases from moderate-to-high levels of turnover.Implications: These findings are significant because the belief that staff turnover influences quality is pervasive. The cross-sectional results are only able to show associations, nonetheless, few empirical studies in the literature have shown this relationship.