When nurses leave nursing homes, patient care suffers even more than suspected
Nurse turnover in nursing homes is very high—nationally, more than 50 percent of nurses are replaced within one year. In some nursing homes, the entire nursing staff can change within one year. Common sense suggests that when nurses stay put, patients benefit. Yet most research to date fails to answer the question of how high job turnover in nursing homes affects the quality of patient care.
Most studies of the effects of nursing home staff turnover fail to account for unobserved factors, such as poor administrative management, that accompany turnover and affect quality. To control for these unobserved variables, Yaa Aksoa Antwi of Indiana University and John R. Bowblis of Miami University examined how the unemployment rate correlated with quality of care in a sample of California nursing homes between 2005 and 2011. Unemployment varied widely during the period and likely affected nurse turnover in nursing homes—with nurses less likely to change jobs when unemployment was high. Their work appears in a recent Upjohn Institute working paper.
The researchers found that previous studies significantly underestimated the effect of turnover on quality. They also found suggestive evidence that turnover may increase mortality in nursing home patients, though their findings did not reach statistical significance.
Given the likelihood that most current research has underestimated the effect of nursing home staff turnover on quality of care, policymakers may wish to pay even greater attention to creating mechanisms to reduce staff turnover. This is especially important since nursing home nurses were more likely to stay put during the Great Recession but may now be looking to move as the economy picks up.