Want to Slow Nursing Assistant Turnover? Change Your Culture.

High staff turnover in nursing homes is costly and linked to lower quality of care. In a study that won a 2020 Bronze Innovative Research on Aging Award, researchers investigated the association between nursing assistant retention and elements of the work environment, nursing home leadership, and staff empowerment.

The study’s authors used data from the second wave (2016–2017) of the Nursing Home Culture Change Survey. This national study on culture change implementation surveyed a stratified, random sample of US nursing homes. Nursing home administrators completed the survey. Nursing assistant retention was assessed by asking for the percent of nursing assistants employed today who had worked at the nursing home for at least 12 months. The researchers combined responses to 13 survey items from 1,407 nursing homes to create a measure of staff empowerment and combined another 10 items to measure leadership. The staff empowerment measure included questions that assess nursing assistant involvement in care planning, independence, and practices that show their role is valued. Leadership items included those related to two-way communication, staff involvement in decision-making, staff education and training, respect for workers, positive relationships between leadership and staff, and coaching.

The results showed that higher levels of staff empowerment and leadership were linked to high retention rates. More specifically, nursing homes with medium and high leadership and staff empowerment scores were significantly more likely than facilities with low scores to have higher nursing assistant retention (76% to 90% and 91% to 100%), as opposed to lower retention (0 to 50%). The study also uncovered some interesting findings related to other nursing home characteristics. For example, the presence of a nursing assistant union was associated with nursing assistant retention rates in the highest category (91% to 100%) as compared to the lowest retention category (0% to 50%).

The study findings highlight the potential of leadership and staff empowerment practices in addressing workforce stability. Including nursing assistants in quality improvement teams, rewarding extra training and education, and encouraging shared decision-making are examples of practices that could contribute to culture change.



Berridge C, Lima J, Schwartz M, Bishop C, Miller SC. Leadership, staff empowerment, and the retention of nursing assistants: Findings from a survey of US nursing homes. Journal of the American Medical Directors Association, (2020); Mar 16.

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