Staff Turnover Linked to Poor Patient Outcomes in LTCs

Two recent studies suggest that preventing staff turnover should be given greater emphasis in long-term care facilities (LTCs), Advanced Healthcare Network for Nurses reports. The studies examined the relationship between turnover of nursing staff and quality of care for nursing homes residents and found negative outcomes for patients in facilities with high turnover.

Published in December 2013, both studies were based on data from the 2004 National Nursing Home Survey. The first, "Are Nursing Home Survey Deficiencies Higher in Facilities with Greater Staff Turnover," found that turnover for both licensed nurses and certified nursing assistants (CNAs) were associated with problems in quality of care, qualify of life, and resident behavior deficiencies. The second study, "Turnover Staffing, Skill Mix, and Resident Outcomes in a National Sample of U.S. Nursing Homes," found a relationship between high turnover among CNAs and adverse patient outcomes such as pressure ulcers, urinary tract infections, and pain.

An INQRI study led by Robin Newhouse and Laura Morlock, published in the May 2013 issue of Medical Care, underscores the importance of nurse staffing in providing quality care. The researchers tested in 23 rural hospitals a quality collaborative intervention to improve care for heart failure patients. At the end of the study, the researchers found no quantitative difference between the intervention and control groups on implementation of the key measures. They did find that hospitals with lower turnover in nurse staffing implemented more of the measures. The researchers assert that the study speaks to the central role of nurses in quality improvement.

INQRI also looked at patient outcomes in LTCs in The Res-Care-AL Intervention Study.  Researchers, led by Barbara Resnick and Sheryl Zimmerman, conducted a randomized controlled trial to test Function Focused Care – Assisted Living, an intervention designed to maintain and improve function, physical activity, muscle strength, psychosocial outcomes, and decrease adverse events (pain, falls, and hospitalizations) among assisted living residents.