How to Maintain 2024 CMS Rules on Nurse Aide Staffing: An Ecological Framework Explaining Turnover

• In Event: 50464 - Section on Sociological Practice and Public Sociology Roundtables

Abstract

ABSTRACT/DESCRIPTION

Aims: to (1) advance our knowledge of nurse aide (NA) intent to quit by identifying factors of importance at four levels found within the nursing home (NH; i.e., organization, work design, interpersonal, and personal levels) and (2) consider potential strategies for addressing the factors identified.

Background: The Centers for Medicare and Medicaid Services (CMM) have recently established minimum long-term care (LTC) staffing requirements. These standards and rules were established to improve quality and safety in nursing homes (NHs). However, they will put additional pressure on NHs throughout the country to hire and maintain NA staff. Unfortunately, current NA shortages are high, with 84 percent of NHs reporting moderate to high staffing shortages. Theories and research findings suggest the factors affecting turnover are at four levels within the nursing home: organizational, work design, interpersonal, and personal. The ecological framework allows for the inclusion of multiple theories at the varying levels that provide explanations for NA turnover. We are unaware of any research studies that have simultaneously considered factors at the four levels to identify relative effects.

Methods: A self-administered questionnaire was completed by 332 NAs within 11 nursing homes in the north Texas region. Most of the independent variables were based on an index of three or more statements with Chronbach’s alphas ranging from .716 to .889. Steps were taken to increase validity. Cluster-adjusted standard errors were used along with structure coefficients.

Results: tentative results identify at least six factors within the four levels significantly associated with NA turnover. The most highly associated characteristics appear to be burnout, effective work procedures, and adequate staffing (tentative findings are provided in table at end of extended description).

Authors

• Dale Elgert Yeatts, University of North Texas

• Ronald Kwon