Is Resident Hospitalization Related to Nurse Turnover & Retention?

Nursing home (NH) residents have high rates of hospitalization and rehospitalization, with around one quarter of hospitalized NH residents being readmitted to the hospital within 30 days. Research suggests that many of the rehospitalizations may be avoided with appropriate follow-up care. An article in the most recent issue of The Gerontologist examines whether rates of rehospitalization of NH residents are related to the employment stability of NH licensed nursing staff, who play an important role in preventing rehospitalization by monitoring and assessing resident health and overseeing the administration of care.

Much research has looked at the effects of staff turnover in NHs, finding that high rates of turnover are associated with a range of negative outcomes, such as decline in resident functional ability, infections, and hospitalizations. Less attention has been paid to the possible positive effects of long-term retention of staff. Nurses and other staff who are long-tenured at a given facility have experience and facility-specific knowledge and training, are more familiar with the population of residents, and can help ease the transition of new staff into the specific environment.

It is likely, then, that both turnover and retention may be associated with rates of hospitalization. It is also useful to assess turnover and retention as separate measures rather than just choosing one variable to represent nursing workforce stability, given that high rates of turnover may result from turnover at the same position (or a small set of positions) at any given NH, and may co-exist with high retention rates in other positions at the same NH.

Researchers examined data from 681 Florida NHs, including measures of turnover and retention (assessed by the proportion of licensed nurses who had been employed onsite for at least one year) for licensed nurses, 30-day rehospitalization rate, and various control variables that are known to be associated with hospitalization risk (such as resident demographic characteristics, resident advance care directives, and ownership characteristics of the NH).

Within this sample, higher retention rate in licensed nurses was related to a slightly lower rate of rehospitalization, while turnover had no effect on rehospitalization. Methodologically, this suggests the usefulness of studying retention (in terms of long employee tenure) and turnover as distinct workforce phenomena. In terms of policy and operational implications, these findings suggest that licensed nursing staff retention may be an effective way to reduce the overall economic and quality-of-life costs of rehospitalization.

Thomas KS, Mor V, Tyler DA, et al. The relationships among licensed nurse turnover, retention, and rehospitalization of nursing home residents. The Gerontologist (2013); 53(2): 211–221.

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