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High rates of nursing staff turnovers have surprising benefit for facilities

High rates of nursing staff turnovers have been an issue in the long-term care industry for decades. Studies show, that for Certified Nurse Assistants (CNAs), the most common type of caregiver in long-term care, turnover can exceed 100%.

nursing-staff-turnovers-group-of-nursesFor other nursing home staff it isn’t much better. For RNs, Licensed Vocational Nurses turnover rates can be as much as 55% – 75%.

The cost to patients caused by a revolving door of front line staff isn’t hard to imagine, neither are costs to the facility.

What is surprising, is that high rates of turnover can generate significant cost savings for facilities, giving them little incentive to make the sort of improvements that retain staff – and improve continuity of care and overall health outcomes for patients.

“The fact that turnover has been a persistent phenomenon over many decades suggests that there are business or cost advantages to turnover,” wrote the authors of a National Institute of Health study report, “otherwise they would have taken steps that would have minimized costly turnover. The marginal cost savings associated with a 10 percentage point increase in turnover for an average facility was $167,063 or 2.9% of annual total costs.”

That means “A nursing home choosing between operating at the 25th percentile versus the 75th percentile of turnover, i.e. between 38% and 78%, would experience a cost saving of $668,252,” reports the National Institute of Health.

Such savings – or profits – may explain why, despite many policy initiatives to reduce them, long-term care facilities continue to have such high turnover rates.

The only other industry with comparable turnover rates is fast food. The difference, of course, is, fast food workers don’t impact the health and quality of life of patients with limited options the way nursing staff do.

But the issues that lead staff to leave at both are similar …

  • Low wages with little chance of increase
  • Lack of benefits
  • Inadequate training
  • Poor supervision
  • Lack of advancement opportunity
  • Feeling undervalued by bosses
  • Too few workers
  • Heavy workload
  • Lack of incentives

To be clear this is less a worker problem, than a patient problem.

“These high rates have persisted despite the large number of studies documenting an association with poor quality of care,” reported the NIH.

For long-term care patients, high rates of nursing staff turnovers …

  • Increase hospital readmission rates. A “10% increase in (staff) retention = 2 fewer hospital readmissions,” according to The Gerontological Society of America’s website.
  • Lead to higher rates of medication errors
  • Impact patients’ mental health due to repeated loss of personal relationships with those who leave and a general feeling of insecurity
  • Interrupt the continuity of care
  • Lead to higher number of facility accidents
  • Leave other staff to pick up the slack at the expense of patient care

General Medicine puts patient care ahead of everything else. Our Post-Hospitalists specialize in the care of patients in long-term care facilities. They hold regular onsite office hours that allow time for quality patient/doctor and patient/staff relationships to develop, which means fewer hospital readmissions and fewer staff turnovers.

Tom Prose