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Staying the Course: Facility and Profession Retention Among Nursing Assistants in Nursing Homes

Department of Health Policy and Administration, University of North Carolina at Chapel Hill.

Address correspondence to Sally C. Stearns, PhD, University of North Carolina at Chapel Hill, Health Policy and Administration, CB#7411, McGavran-Greenberg, Chapel Hill, NC 27599-7411. E-mail: sally_stearns{at}unc.edu

Objectives. High turnover rates among nursing assistants (NAs) in nursing homes have costly implications for facility operation and quality, and low rates of NA profession retention can deplete the stock of experienced staff. This study assessed the extent to which the same factors are associated with NAs' intent to leave a particular job versus the NA profession.

Methods. We used data for 2,328 NAs from the 2004 National Nursing Assistant Survey to model (a) two measures of facility retention (whether NAs expected to leave their current job within 1 year and whether they were also searching for a new job); and (b) NA profession retention, measured by whether NAs did not expect their next job to be as an NA.

Results. Substantially different factors affected facility versus profession retention. Facility characteristics (including supervisor qualities, training/safety, and benefits) primarily affected facility retention, whereas NA profession retention was negatively associated with income and education.

Discussion. Facilities can implement specific actions to retain NAs, though such policies may have a limited effect on retention in the profession. Broader enhancements of career opportunities may be necessary for profession retention, though balance between retention and promotion may be important.

Key Words: Long-term care • Intent to leave • Staffing • Turnover