Improving the Well-being of Nursing Home Workers An Examination of Non-nurse Staff Turnover and Quality in Nursing Homes

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Project Summary: Nursing homes are considered one of the most dangerous workplaces in the United States, and the Occupational Safety and Health Administration (OSHA) has emphasized on both inspections and collaborative efforts to improve worker safety in nursing homes. Dangerous work environment can lead to high turnover of workers. In addition, high turnover of staff has potentially adverse consequences for more than a million residents who depend on nursing home workers for their daily needs including bathing, eating, and toileting. Despite the recognition by OSHA on high injury risk and the adverse implication of high turnover on resident quality of care, nursing home worker welfare and safety has not been given enough attention by policymakers and researchers. Although a few recent studies have highlighted the issue of high turnover of nurse staff in nursing homes, the turnover of other essential workers such as dietary and housekeeping staff that earn very low wages has not been examined. We do not yet have a national database of turnover rates for different staff types in nursing homes but some states such as Iowa require nursing homes to report turnover rates for different staff types. In 2015, turnover rates were 61% for dietary staff and 42% for housekeeping staff in Iowa nursing homes. There is limited evidence on the trends and organizational factors associated with high turnover of non-nurse staff in nursing homes. Moreover, the value of lowering staff turnover to improve resident welfare is not understood well. Despite the substantial role played by non-nurse staff on patient care in nursing homes, to our knowledge, no studies have examined non-nurse staff turnover or its impact on nursing home quality. To this end, we have three specific aims: 1) To examine trends in non-nurse staff turnover, overall, and stratified by staff types, 2) To identify risk factors for non-nurse staff turnover, and 3) To estimate the impact of turnover of different staff types on outcomes such as hospitalization rates, falls, pressure ulcers, citations for nutritional issues, and infections. Our findings have the potential to affect national and state policies on the collection of staff turnover data and efforts to lower staff turnover by providing rigorous estimates on the potential causes and consequences of staff turnover in nursing homes. This proposal fits within the Healthcare and Social Assistance sector area under NORA (NAICS code: 62) and focuses on the subsector of nursing and residential care facilities (NAICS code: 623). It addresses several priority goals for strategic goal 7 (7.12A- 7.12D; 7.2A-7.2C) within the NORA priorities. Our study examines how work organization affects both worker and patient safety. Our study also focuses on low-wage occupations such as dietary staff, therapists, housekeeping, and maintenance staff. The manuscripts and presentations from this innovative project will inform state and national policymakers about factors driving staff turnover in nursing homes and are critical to improve Research to Practice (r2p) efforts in the Healthy Work Design and Well-Being (HWD).