What are Predictors of Nursing Assistant Retention in Long-Term Care Communities?

By Richard Shank

It is well known that staff turnover rates impact the business and health care performance of long-term care settings and other health care contexts. A recent study examined patterns and predictors of staff retention among nursing assistants in these settings.

As is similar with other health care disciplines, fluctuations in both the nursing assistant staffing levels and in turnover of nursing assistants at-large have a direct impact on the quality of care provided. Long-term care settings facing even a modest level of turnover run the risk of degrading both the staff-resident relationships and staff’s knowledge of residents’ medical and social history—both of which help drive high-quality care. Furthermore, turnover levels increase staffing costs which takes away from the material resources that could be allocated for care.

This study suggested that differentiating between the two types of staff retention—staff turnover within a community and turnover within the discipline at-large—helps to better understand retention patterns. Staff turnover is the type of turnover that occurs due to the working conditions of the community, leading the employee to seek out another employer within the profession. Turnover on a more general level occurs because of issues related to the conditions of the nursing assistant profession which drives the employee to leave the discipline entirely. This distinction will help long-term care administrators focus on issues that they can control within their workplace and help them pinpoint structural reform issues to promote within the broader nursing assistant discipline.

Using data from the 2004 National Nursing Assistant Survey, the researchers examined factors that are associated with a nursing assistant’s decision to leave a particular facility, as well as factors that determine whether a nursing assistant leaves the discipline completely. Not surprisingly, the researchers discovered that substantially different factors led to each type of turnover.

First, facility retention can be explained by factors more directly related to the working conditions within the community (e.g., supervisor quality, training/safety, and benefits). On the other hand, retention within the discipline is more heavily influenced by the broader labor market conditions for nursing assistants (e.g., pay, education, credentials, etc.).

These findings suggest that staff retention strategies can benefit from a two-pronged approach. Focusing solely on community level reform might prove beneficial to individual settings in the short-run. However, this type of reform will not slow profession-wide retention issues. Despite being limited in their capacity, long-term care administrators can best promote retention by associating training and benefits to the professionalization of their nursing staff, while at the same time managing workplace-related factors that impact facility turnover.

Source: Sally C. Stearns and Laura P. D’Arey. 2008. Staying the course: Facility and profession retention among nursing assistants in nursing homes. The Journals of Gerontology Series B: Psychological and Social Sciences 63: S113-S121.

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