Leadership,Staff Empowerment,and the Retention of Nursing Assistants: Findings From a Survey of U.S. Nursing Homes |
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| Affiliation: | 1. University of Washington School of Social Work, Seattle, WA;2. Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, RI;3. Brandeis University, Heller School for Social Policy and Management, Waltham, MA;1. Department of Internal Medicine, Division of Endocrinology and Metabolism, Eastern Virginia Medical School, Norfolk, VA;2. Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, VA;3. School of Health Professions, Eastern Virginia Medical School, Norfolk, VA;4. School of Physical Therapy and Athletic Training, Old Dominion University, Norfolk, VA;5. Human Movement Sciences Department, Old Dominion University, Norfolk, VA;6. Department of Internal Medicine, National Taiwan University Hospital, Yun Lin Branch, Taiwan;7. Department of Psychology, Old Dominion University, Norfolk, VA;1. Department of Medicine and Geriatrics, Careggi Hospital and University of Florence, Florence, Italy;2. Centro di Valutazione e Ricerca Gerontologica, Chair of Geriatrics, University of Modena and Reggio Emilia, Modena, Italy;3. SCDU Geriatria e Malattie Metaboliche dell''Osso, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy;4. Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy;5. Department of Health Sciences, University of Milano Bicocca and Acute Geriatric Unit, San Gerardo Hospital, Monza, Italy;6. Medicine and Geriatric Unit, Spedali Civili of Brescia, Brescia, Italy;7. Geriatric Department, SS. Trinità Hospital, Cagliari, Italy;8. S. Maria di Ca'' Foncello Hospital, Treviso, Italy;9. Geriatric Unit, Santa Chiara Hospital, Trento, Italy;10. Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy;11. S. Jacopo Hospital, Azienda USL 3, Pistoia, Italy;12. Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy;1. Videbimus Clinic Research Center, Tokyo, Japan;2. Department of Primary Care and Population Health, University College London, London, United Kingdom;3. Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan;4. Center for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Japan;1. Centre on Aging and Mobility, University Hospital Zurich, Waid City Hospital, and University of Zurich, Zurich, Switzerland;2. Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA;3. Department of Geriatrics, University Hospital Zurich, Zurich, Switzerland;4. University Clinic for Acute Geriatric Care, Waid City Hospital, Zurich, Switzerland |
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| Abstract: | ObjectivesWe examined the relationship between nursing assistant (NA) retention and a measure capturing nursing home leadership and staff empowerment.DesignCross-sectional study using nationally representative survey data.Setting and ParticipantsData from the Nursing Home Culture Change 2016-2017 Survey with nursing home administrator respondents (N = 1386) were merged with facility-level indicators.MethodsThe 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%.ResultsIn 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 ImplicationsModifiable 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. |
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| Keywords: | Culture change staffing turnover nursing home leadership staff empowerment |
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