Abstract
Objectives
We examined the relationship between nursing assistant (NA) retention and a measure
capturing nursing home leadership and staff empowerment.
Design
Cross-sectional study using nationally representative survey data.
Setting and Participants
Data from the Nursing Home Culture Change 2016-2017 Survey with nursing home administrator
respondents (N = 1386) were merged with facility-level indicators.
Methods
The leadership and staff empowerment practice score is an index derived from responses
to 23 survey items and categorized as low, medium, and high. Multinomial logistic
regression weighted for sample design and to address culture-change selection bias
identified factors associated with 4 categories of 1-year NA retention: 0% to 50%,
51% to 75%, 76% to 90%, and 91% to 100%.
Results
In an adjusted model, greater leadership and staff empowerment levels were consistently
associated with high (76%-90% and 91%-100%) relative to low (0%-50%) NA retention.
Occupancy rate, chain status, licensed practical nurse and certified nursing assistant
hours per day per resident, nursing home administrator turnover, and the presence
of a union were also significantly associated with higher categories of retention
(vs low retention).
Conclusions and Implications
Modifiable leadership and staff empowerment practices are associated with NA retention.
Associations are most significant when examining the highest practice scores and retention
categories. Nursing homes seeking to improve NA retention might look to leadership
and staff empowerment practice changes common to culture change.
Keywords
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Article info
Publication history
Published online: March 17, 2020
Footnotes
Funding: This work was supported by the National Institute on Aging (grant number NIA R01 AG048940-01A1). Berridge was supported by the Agency for Healthcare Research and Quality, National Research Service Award (T32HS-000011).
The authors declare no conflicts of interest.
Identification
Copyright
© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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