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

项目摘要： 养老院被认为是美国最危险的工作场所之一， 职业安全与健康管理局（OSHA）强调检查和合作 努力改善养老院工人的安全。危险的工作环境可能导致高流动性的 工人此外，工作人员更替率高，可能对100多万人产生不利影响 依靠疗养院工作人员满足日常需求的居民，包括洗澡、吃饭和散步。 尽管OSHA承认高伤害风险和高营业额对居民的不利影响， 护理质量、护理之家工作人员的福利和安全没有得到决策者的足够重视 和研究人员。尽管最近的一些研究强调了护士人员流动率高的问题， 养老院，其他基本工作人员的流动，如饮食和家政人员，收入非常高， 低工资没有得到审查。我们还没有关于不同工作人员更替率的全国数据库 类型的养老院，但一些国家，如爱荷华州要求养老院报告周转率， 不同的员工类型。2015年，爱荷华州的餐饮人员和家政人员的流动率分别为61%和42 养老院关于与高风险相关的趋势和组织因素的证据有限。 养老院非护理人员的更替率。此外，降低员工流动率对改善居民生活的价值 福利没有得到很好的理解。尽管非护理人员在护理中对病人护理发挥了重要作用， 家庭，据我们所知，没有研究探讨非护士人员流动或其对养老院的影响 质量.为此，我们有三个具体目标：1）研究非护士人员流动的趋势，总体上， 按工作人员类型分层，2）确定非护士人员流动的风险因素，3）估计 不同工作人员类型对结果的更替率，如住院率、福尔斯、压疮、 营养问题和感染。我们的研究结果有可能影响国家和州的政策， 收集工作人员更替数据，并努力通过对工作人员更替率进行严格估计， 养老院员工流动的潜在原因和后果。该提案适用于医疗保健 诺拉（NAICS代码：62）下的社会和社会援助部门领域，重点是护理分部门 和住宿护理设施（NAICS代码：623）。它涉及战略目标7（7.12A-7.12B）的几个优先目标。 7.12D; 7.2A-7.2C）。我们的研究探讨了工作组织如何影响工人和 和患者安全。我们的研究还关注低工资职业，如饮食工作人员，治疗师， 家政和维修人员。这个创新项目的手稿和演示文稿将 向州和国家决策者通报养老院工作人员流动的因素， 改善健康工作设计和福祉（HWD）的研究实践（R2 P）工作。

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).