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The nation is experiencing a crisis in the long-term health care of the aged. The financial burden on taxpayers, the restrictions and limitations imposed by third party payers, and the increasing number of nursing homes unable to pass state and federal accreditation surveys are critical concerns for health professionals. The nationwide shortage of professional licensed nurses is compounded by the high turnover rate of nursing assistants in the delivery of long-term care.
In the nursing home setting, the ratio of non-licensed to licensed staff is much higher than in the acute care setting. According to Waxman, approximately 90% of the actual personal care in nursing homes is provided by nonlicensed staff.1 He also reports a turnover rate of up to 75% for non-licensed staff. In Washington State, the mean turnover was 117% (range 20% to 500%) per year for non-licensed staff working in 74 skilled nursing homes.2
The high rate of turnover among nursing assistants directly affects both the financial expenditures of the facility and the quantity and quality of patient care provided. Reduction in efficiency of present staff while new staff are being oriented, overtime hours worked to cover staff shortages related to the turnover, higher costs of purchased services (agency personnel), and reduced efficiency of the agency personnel are additional factors affecting the longterm care industry.
The focus of current and proposed legislation is on education, training, and numbers of nursing assistants in nursing homes. The missing information is on the turnover rate of nursing assistants and the identification of factors related to that turnover. No studies were found in the literature that examined turnover from a theoretical perspective. This is important because theories guide practice and lead to the development of nursing science.
A review of the literature on turnover of nursing assistants working in nursing homes showed turnover to be 40% to 75%. The factors relating to job satisfaction and turnover are coordination of order and organization of the facility; management style; program clarity; relationship with supervisors and other nursing assistants; size of facility (turnover is highest in facilities with more than 100 beds); education; salaries higher than minimum wage; knowledge of patients; comprehensive orientation; and acceptance by peers.1,35 Salary was studied by some investigators but was not found to be...