The Influence of Staff Turnover on Quality

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DESCRIPTION (provided by applicant): The belief that staff turnover influences quality is pervasive. Indeed, staff turnover in nursing homes is often used as a quality indicator. However, based on empirical studies in the literature this may be premature, as the association between turnover and quality is generally inconclusive. Some further research in this area is clearly warranted. Results from turnover studies set in other industries have also shown that some staff turnover is beneficial, and it is higher levels of turnover that negatively influence performance. Clearly, if turnover does influence quality in different directions depending on the level observed, then by using one linear measure of turnover the effects may be masked. Some further research in this area in nursing homes is also clearly warranted. In this initiative, we propose to use data previously collected from 2,127 nursing facilities and examine the association between staff turnover and quality. The caregiving labor force consists primarily of nurse aides (NAs) who provide 80 to 90% of resident care, but also includes licensed practical nurses (LPNs), and registered nurses (RNs). These are the staff we examine. The information on staff turnover was collected as part of an ongoing study investigating the accuracy of turnover reporting by nursing homes. We propose to use five well-accepted indicators of care quality in nursing homes. These are the rates of physical restraint use, urethral catheterization, pressure ulcers, psychoactive medication use, and persistent pain. We believe that by: (1) examining different levels of turnover; (2) using our precise measure of turnover; and (3) using the Minimum Data Set (MDS) resident-level data on quality and case mix - this proposed study represents a considerable improvement over prior works. Thus, using previously collected primary data matched to secondary data sources, such as the MDS, we propose to examine: (1) Association between caregiver turnover (RNs, LPNs, and NAs) and quality indicators in nursing homes; (2) Contribution of different caregivers (RNs, LPNs, and NAs) to the association between turnover and quality indicators; (3) Whether some level of turnover is positively associated with quality indicators and at what point turnover is negatively associated with quality indicators.