Employee benefits, stable leadership improve nurse retention in homes

Nursing homes (NHs) wanting to improve their rates of registered nurse (RN) retention should offer career-advancement opportunities and reward attendance, employee benefits such as health insurance, and develop long-tenured leaders, show the results of a US study.

Unearthing factors related to RN are critical to improving quality of care in NHs and preparing for future demand in aging populations, explain the researchers.

Their findings suggest that it is a combination of intrinsic motivators (such as tuition and conference reimbursement and attendance awards) plus extrinsic factors (including retirement benefits and paid sick days) that most benefit RN retention in the NH setting.

"Many nurses in NHs report satisfaction with work but dissatisfaction with work environment," say Selina Hunt (Duke University Medical Center, Durham, North Carolina) and co-investigators, who analyzed the results of the 2004 National Nursing Home Survey to generate their results.

Overall, the 1174 participating NHs had moderate RN, with more than 50% of nurses retained for more than 1 year. Fifty percent or less RNs employed for more than 1 year and 80% or more nurses employed for more than 1 year denoted low and high RN retention, respectively.

Employee-retention programs with paid tuition fees and career-promotion opportunities were more common among moderate- and high-retention than low-retention NHs, at 63.6% and 66.0% versus 54.2%, and 79.2% and 77.6% versus 70.9%, respectively.

Considering intrinsic factors alone, having attendance awards was the only significant factor related to RN, with NHs that offer these being 1.6 times more likely to fall in the moderate- versus low-retention category.

Combining intrinsic and extrinsic factors revealed that NHs with retirement benefits, paid sick days, and available parenteral nutrition services were more likely to fall into the moderate- versus the low-RN group.

One of the "most potent" factors that increased retention was high director of nursing tenure, with length of tenure more than three-times higher than the average at high-RN institutions compared with low-retention ones, observe Hunt and colleagues.

"Rapid turnover and hiring cycles in upper management may destabilize the workforce as changing policies stress nursing staff," they note, in Health Care Management Review.

"The findings of this study have broad implications for administrators, payers, policy makers, and consumers," they conclude.

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