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Reducing turnover of registered nurses and certified nursing assistants will help maintain nursing home staffing levels

Nursing homes have historically suffered from high staff turnover rates. Some research suggests this has adverse effects on both staffing levels and resident outcomes. A new study found that high turnover rates of registered nurses (RNs) and certified nursing assistants (CNAs) significantly reduced RN and CNA staffing levels. However, licensed vocational nurse (LVN) staffing levels were not affected by LVN turnover, but were influenced by market factors such as availability of LVNs in the county and women in the labor force.

Nursing homes should focus on management initiatives that reduce RN and CNA turnover and ultimately result in higher nurse staffing levels, suggests Bita A. Kash, M.B.A., of Texas A&M University. She and colleagues analyzed data on 1,014 Texas nursing homes from the 2002 Texas Nursing Facility Medicaid Cost Report as well as market data from the 2003 Area Resource File.

They calculated an average staffing level of 0.25 RN hours, 0.86 LVN hours, and 2.12 CNA hours, totaling 3.23 hours of direct care per resident day at the Texas nursing homes. Staff turnover rates were relatively high at 133 percent for RNs, 108 percent for LVNs, and 160 percent for CNAs. All three types of nursing staff levels were lower with for-profit ownership, higher percentage of Medicaid days, and higher wages. Higher occupancy rates were associated with lower RN and LVN staffing, but with higher CNA staffing levels. Higher reimbursement rates were associated with higher staffing levels for all three types of staff, confirming the resource dependency of staffing decisions. The study was supported by the Agency for Healthcare Research and Quality (HS16229).

See "Effect of staff turnover on staffing: A closer look at registered nurses, licensed vocational nurses, and certified nursing assistants," by Ms. Kash, Nicholas G. Castle, Ph.D., George S. Naufal, B.A., and Catherine Hawes, Ph.D., in the October 2006 Gerontologist 46(5), pp. 609-619.

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