Is Higher Nurse Aide Retention Associated with Fewer Nursing Home Allegations and Complaints?

Consumer voices are often left out from assessments of nursing home (NH) quality. For this reason, consumer allegations and complaints against nursing homes were studied in relation to facility rates of nurse aide retention. Analyses involved means and frequencies, correlations, ANOVAs with Tukey correction to examine the independent and dependent variables (N=690). Four quartiles of retention were created. In the final models, medium, high, and extremely high retention facilities are compared to the low retention facilities. Negative binomial regressions were estimated on total, substantiated, and unsubstantiated counts of allegations and complaints. All regressions controlled for the same characteristics, including nurse aide empowerment, consistent assignment, administrator turnover, director of nursing turnover, average age of residents, and percent female. The correlation between retention and the dependent variables was negative and statistically significant (r=-0.11, p<.01). The ANOVAs showed that high retention NHs (61-72%) received significantly fewer allegations than low (0-48%) and medium (49-60%) retention NHs; they also received fewer unsubstantiated allegations, and fewer complaints, both substantiated and unsubstantiated. After controlling for other variables, each retention group was significantly related to having fewer allegations and complaints compared to the low retention NHs. Notably, high retention NHs received between 29 and 35% fewer allegations and complaints of all types. Unexpectedly, extremely high retention NHs had more allegations, complaints, and unsubstantiated allegations than high retention NHs. Policy and practice have a role to promote nurse aide retention, improve job quality, and ensure adequate support for this critical, in-demand workforce.

The Role of Schedule Volatility in Home Health Nursing Turnover

Despite considerable research on nursing turnover, few studies have considered turnover among nurses working in home health care. Using novel administrative data from one of the largest home health care organizations in the United States, this study examined turnover among home health nurses, focusing on the role of schedule volatility. We estimated separation rates among full-time and part-time registered nurses and licensed practical nurses and used daily visit logs to estimate schedule volatility, which was defined as the coefficient of variation of the number of daily visits in the prior four weeks. Between 2016 and 2019, the average annual separation rate of home health nurses was over 30%, with most separations occurring voluntarily. Schedule volatility and turnover were positively associated for full-time nurses, but not for part-time nurses. These results suggest that reducing schedule volatility for full-time nurses could mitigate nursing turnover in home health care.

Turnover among foreign nurses in Saudi Arabia

Background: Globally, nursing turnover has become a contemporary concern that significantly influences the financial proficiency of healthcare systems. Not only costs, but healthcare accessibility and quality also reverberate the consequence of the phenomenon.Design and methods: The study explores the factors that attribute to turnover among foreign registered nurses working in Saudi Arabia. A quantitative-based cross-sectional descriptive study design that uses survey data to make statistical inferences about foreign nurse turnover in Saudi Arabia, was conducted to ascertain factors influencing the termination of foreign nurses working with the Ministry of Health (MOH) hospitals.Results: Factors influencing turnover were categorized into 9 dimensions, professional growth and development, leadership style, management, wage and benefits, workload, interpersonal relationship, housing facilities and services, hospital facilities and intent to stay and turn-over intention, of which the professional growth (4.1±0.7) and development had the highest mean agreement scores (4.0±1.1), whereas housing (2.3±1.3) and hospital facilities (2.1±1.0) showed the lowest mean scores. Conclusions: Wage benefits and workload factors were found to be the most significant causes of expatriate nursing turnover, closely followed by inadequate housing and hospital facilities. Recommendations from nursing staff on how to improve retention were also noted.

Understanding Nursing Turnover: The Case of Home Health Care

Only a few studies of nursing turnover have examined post-acute home health care. This study examines factors that are associated with home health licensed nurse turnover using linked employee-level and patient-level data from one of the five largest home health companies in the US. The data include variables from human resources and payroll systems, visit logs, discharge records, physical and mental health assessments, care plans, and patient encounters and is organized at the employee-day level. We measured turnover using human resources data, including measures of voluntary and involuntary job separation, and from exit interviews that allow classification of whether turnover was associated with agency-related factors (e.g., pay, schedule, supervisor, coworkers) versus personal factors (e.g., family needs, relocation). In bivariate and multivariate analyses, explanatory variables included nurse demographics, patient population characteristics, and the degree to which nurses can delegate tasks to home care aides. We found a downward trend in turnover for licensed nurses between 2016 and 2019. Attrition in the first year was 34% for full-time nurses and 45% for part-time nurses, most of it occurring in the first 180 days of employment. The rate of voluntary turnover was nearly four times as great as involuntary turnover. We found that agency factors accounted for 26% of monthly turnover on average, while personal factors accounted for 74%. In states in which licensed nurses could delegate more tasks to home care aides, turnover rates were slightly higher than in states with little delegation.

Resolving Intractable Conflicts Through Third-Party Facilitation: A 14-Year Study

Intractable conflicts between two individuals within an organization can be particularly detrimental, exerting ripple effects that affect other individuals, entire units, or the organization as a whole. This study extends previous research on third-party consultation interventions by exploring trust and other variables that facilitate intractable conflict resolution, while examining several outcomes over time. Data for this 14-year study in an operating room came from self-reports by the participants, behavioral observations by hospital administrators, and hospital records. Results include statistically significant improvement in trust measures, individual and group effectiveness, increased availability of surgical supplies and equipment, reduced physician abuse of scheduling privileges, decreased verbal abuse of nurses by physicians, the elimination of nursing turnover, and a decision by the surgeons to not build an outpatient surgical center. From a methodological standpoint, our quasi-experimental design using longitudinal panel data provide strong evidence for the effectiveness of organization development interventions on intractable conflicts, including not only how resolutions and positive outcomes occur but also how they can endure over time.

Evidence-Based Management

This chapter outlines the case for “evidence-based management” then adopts a critical perspective. To do so, it focuses on a recurring feature of evidence-based writings: the management-as-medicine motif (MAMM). Advocates draw on MAMM in two ways. First, they promote the same model of knowledge production as in medicine, e.g. championing ‘systematic reviews’. Second, they rely on comparisons between management and medicine as professional practices. Identified here are consequent problems and a ‘systematic review’ is considered in the Cochrane Database of Systematic Reviews. This concerns a management phenomenon: nursing turnover and there are now five versions of the review. Bizarrely, these never actually review any evidence and the different versions are incompatible. This shows how the protocols of ‘systematic’ reviews do not necessarily lead to superior evidence, instead they can disguise inaccuracies and inconsistencies. It also exemplifies problems with MAMM.