Kimberly Johnson, RHIA, CPC, CHC - Health Care Compliance ...

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Managing employee turnover in a shrinking workforce
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Furthermore, high rates of employee turnover can lead to chronic low
staffing levels that can result in declines in the quality and continuity of
care for residents, more adverse events for patients (e.g., medical errors),
higher patient mortality rates, and the need to close beds or defer
patients to other facilities. 8 Moreover, the cost related to high turnover
can affect the financial performance of organizations.
Cost of turnover
Staff turnover within the LTC industry continues to increase at a significant
rate. 6,7 National averages show the overall turnover rate ranges from
38% to 50% for LPNs, RNs, and administrators, and 66% for CNAs. 7
Turnover increases costs associated with recruitment and training as well
as affecting quality of care and customer satisfaction. For example, a
turnover rate of 45% among 2.6 million LTC workers costs about $4.1
billion per year. Furthermore, it can lead to inadequate staffing levels
which results in decreased continuity of care. 9,10,11
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In addition to influencing the financial health of providers and quality
of care that LTC residents receive, turnover affects the efficiency of
resource allocation within the Medicare and Medicaid programs.
Inadequate staffing levels are the primary reason for poor quality of care
in nursing homes. 9
Although many turnover costs are borne by providers, others are borne
directly or indirectly by direct care workers themselves, by consumers
and their families, and by the public sector. The exact costs are difficult
to measure, but the evidence suggests that the price paid by government
payers for turnover in LTC is approximately $2.5 billion. 10
How employee turnover impacts quality
In a qualitative study conducted by Mascio, 12 data from 251 caregivers
(i.e., RN, LPN, and nurse aides) were used to examine job satisfaction
scores of these caregivers and what characteristics of these caregivers are
associated with job satisfaction. The data were collected from two nursing
homes over a two-and-a-half year period with five periods of data
collection at six-month intervals. The Job Description Index was used to
collect job satisfaction data. Mascio concluded that there is a consistent
association between job satisfaction and the quality of resident care, even
affecting the mortality rate of the elder person. Furthermore, employees
who experience a higher job satisfaction proved to be better caregivers.
In this study, the residents felt well-cared for when employees had higher
job satisfaction. Based on these results, nursing home management
should take measures to improve employee satisfaction that will improve
the quality of care and help create a warm and loving environment for
residents. 12
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