Association between nursing home staff turnover and infection control citations

Loomer, Lacey; Grabowski, David C.; Yu, Huizi; Gandhi, Ashvin

doi:10.1111/1475-6773.13877

Cited by 35 publications

(29 citation statements)

References 45 publications

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“…Nursing homes are required to submit daily employee-level staffing information based on auditable payroll and contract data to the PBJ, including unique employee identifiers (allowing individual staff members to be tracked over time), staff type, employment arrangement (salary or contract), and hours worked. 6 , 7 , 16 While the data cover a broad range of staff types, we restricted this analysis to nursing staff (RNs, LPNs, and CNAs) because these staff provide the majority of direct care for patients, and facilities may have deliberately reduced or deferred the use of other staff (eg, therapists, administrative staff) during outbreaks. These staff care for both short-stay and long-stay patients at nursing homes.…”

Section: Methodsmentioning

confidence: 99%

“…The nursing home industry has long been plagued by concerns about the adequacy and turnover of its staffing, 4 , 5 , 6 , 7 and anecdotal reports indicate that COVID-19 has placed immense additional strain on the industry’s workforce. 8 Staff have been at substantial risk of contracting COVID-19, in part owing to persistent personal protective equipment shortages and inadequate COVID-19 testing.…”

Section: Introductionmentioning

confidence: 99%

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Staffing Patterns in US Nursing Homes During COVID-19 Outbreaks

et al. 2022

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IMPORTANCEStaff absences and departures at nursing homes may put residents at risk and present operational challenges. OBJECTIVE To quantify changes in nursing home facility staffing during and after a severe COVID-19 outbreak. DESIGN, SETTING, AND PARTICIPANTSIn this cohort study, daily staffing payroll data were used to construct weekly measures of facility staffing, absences, departures, and use of overtime and contract staff among US nursing homes experiencing a severe COVID-19 outbreak that started between June 14, 2020, and January 1, 2021. Facility outbreaks were identified using COVID-19 case data. An event-study design with facility and week fixed effects was used to investigate the association of severe outbreaks with staffing measures.EXPOSURES Weeks since the beginning of a severe COVID-19 outbreak (4 weeks prior to 16 weeks after). MAIN OUTCOMES AND MEASURESTotal weekly staffing hours, staff counts, staff absences, departures, new hires, overtime and contract staff hours measured for all nursing staff and separately by staff type (registered nurses, licensed practical nurses, certified nursing assistants), facility selfreported staff shortages, and resident deaths. RESULTSOf the included 2967 nursing homes experiencing severe COVID-19 outbreaks, severe outbreaks were associated with a statistically significant drop in nursing staffing levels owing to elevated absences and departures. Four weeks after an outbreak's start, around when average new cases peaked, staffing hours were 2.6% (95% CI, 2.1%-3.2%) of the mean below preoutbreak levels, despite facilities taking substantial measures to bolster staffing through increased hiring and the use of contract staff and overtime. Because these measures were mostly temporary, staffing declined further in later weeks; 16 weeks after an outbreak's start, staffing hours were 5.5% (95% CI, 4.5%-6.5%) of the mean below preoutbreak levels. Staffing declines were greatest among certified nursing assistants, primarily owing to smaller increases in new hires of this staff type compared with licensed practical nurses and registered nurses. CONCLUSIONS AND RELEVANCEIn this cohort study of nursing homes experiencing severe COVID-19 outbreaks, facilities experienced considerable staffing challenges during and after outbreaks. These results suggest the need for policy action to ensure facilities' abilities to maintain adequate staffing levels during and after infectious disease outbreaks.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Staffing Patterns in US Nursing Homes During COVID-19 Outbreaks

et al. 2022

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“…Of the 29 studies examining registered nurse staffing, 19 reported higher levels of this staff grade and compliance were positively associated (15, 36, 47-49, 56-58, 79, 88, 90, 93, 113, 120, 138, 153-156) , nine reported a null association (16,52,61,65,92,96,124,126,157) and one reported a negative association. (87) Likewise, total nurse staffing levels (all grades of nurse staff) and compliance were positively associated in eleven studies (36,45,51,54,87,110,111,128,153,156,158) , with two finding a negative association (49,111) and three a null association. (37,72,84) The results are similar for nurse aides/care assistants: 15 studies reported higher levels these staff and compliance were positively associated (15,35,37,48,49,51,54,56,58,79,90,126,128,138,154,156) , nine reported a null association (16,…”

Section: Other: Staffingmentioning

confidence: 96%

Determinants of regulatory compliance in health and social care services: a systematic review using the Consolidated Framework for Implementation Research

Dunbar

Keyes

Browne

2022

Preprint

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Background The delivery of high quality care is a fundamental goal for health systems worldwide. One policy tool to ensure quality is the regulation of minimum standards by an independent public authority. This systematic review seeks to identify determinants of compliance with such regulation in health and social care services. Methods Systematic searches were carried out on five electronic databases and grey literature sources. Quantitative, qualitative and mixed methods studies were eligible for inclusion. Titles and abstracts were screened by two reviewers independently. Determinants were identified from the included studies, extracted and allocated to constructs in the Consolidated Framework for Implementation Research (CFIR). The quality of included studies was appraised by two independent reviewers. The results were synthesised in a narrative review using the constructs of the CFIR as grouping themes. Results The search yielded 7,500 articles for screening, of which 157 were included. Most studies were quantitative designs in nursing home settings and were conducted in the United States. We found the following structural characteristics and compliance to be positively associated: smaller facilities (as measured by bed capacity); higher nurse-staffing levels; and lower staff turnover. A facility’s geographic location and compliance was also associated. We make no findings in respect of process determinants as qualitative studies were sparse, limiting investigation of the processes underlying regulatory compliance. Conclusion The literature in this field has focused to date on the structural attributes of compliant providers, perhaps because these are easier to measure, and has neglected more complex processes around the implementation of regulatory standards. A number of gaps, particularly in terms of qualitative work focused on the mechanisms involved in implementing regulations, are evident in the literature and further research in this area is needed to provide a clearer picture.

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“…Nurse turnover deteriorates the activities of daily living, worsens existing pressure ulcers, or causes the development of new pressure ulcers, and increases 30-day hospitalization rates, medical errors, and the possibilities of receiving infection control citations in the United States and South Korea [ 8 , 9 , 10 , 11 ]. In addition, high nurse turnover rates considerably increase costs.…”

Section: Introductionmentioning

confidence: 99%

Factors Affecting Turnover Intention among New Graduate Nurses: Focusing on Job Stress and Sleep Disturbance

Heo

Hwang

et al. 2022

Healthcare

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Despite the high prevalence of nurses’ turnover and the turnover intention of new nurses, there are insufficient studies examining turnover intention at the time when job orientation is completed and independent nursing commences. Thus, this study examined turnover intention levels and identified the factors affecting turnover intention of new Generation Z nurses, focusing on job stress and sleep disturbance, at the eighth week after completing job orientation. This was a cross-sectional descriptive correlational study. Using a convenient sampling method, 133 new nurses were recruited. Data were collected using a structured questionnaire consisting of demographic and occupational characteristics, job stress, sleep disturbance, and turnover intention. Descriptive statistics were computed to describe the sample and interest variables. Logistic regression analysis was performed to examine the association of job stress and sleep disturbance with turnover intention. Most nurses were women (91.7%) and approximately two-thirds worked in the surgical ward (n = 61, 45.9%). Turnover intention was 12.8%, average job stress was 40.11 ± 90.7, and average sleep disturbance was 42.39 ± 15.27. New graduate nurses’ turnover intention was associated with job stress (OR = 1.07, 95% CI = 1.02–1.12) and sleep disturbance (OR = 1.19, 95% CI = 1.05–1.35), and this model explained 47.7% of the variance. Study findings determine that job stress and sleep disturbance were significant predictors of turnover intention in new nurses at the eighth week after joining the hospital. Therefore, nursing administrators should focus on new nurses’ job stress and sleep disturbance, and provide them with timely assessment and management to reduce turnover intention.

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Association between nursing home staff turnover and infection control citations

Abstract: Objective: To describe the association between nursing home staff turnover and the presence and scope of infection control citations.

Cited by 35 publications

References 45 publications

Staffing Patterns in US Nursing Homes During COVID-19 Outbreaks

Staffing Patterns in US Nursing Homes During COVID-19 Outbreaks

Determinants of regulatory compliance in health and social care services: a systematic review using the Consolidated Framework for Implementation Research

Factors Affecting Turnover Intention among New Graduate Nurses: Focusing on Job Stress and Sleep Disturbance

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