Image of Sarah L. Krein, Ph.D., RN; Image credit: University of Michigan
Sarah L. Krein, Ph.D., RN; Image credit: University of Michigan

A people-oriented work environment with tangible staff supports is key to minimizing turnover and care disruptions in nursing homes. In fact, direct care providers say it’s often more important than compensation, according to a new study.

Researchers from the University of Michigan and the Department of Veterans Affairs at Ann Arbor Healthcare System interviewed direct care RNs, LPNs and CNAs, as well as residents’ family members about strategies for reducing staff attrition and its consequences.

Person- and resident-centered care has been a core nursing home concept for two decades, but the study results showed that staffing problems work against this ideal, lead author Sarah L. Krein, Ph.D., RN., reported. 

Although better wages were mentioned, it was not viewed by most participants as a primary factor to reduce turnover,” Krein said. “Rather, family members as well as direct care and administrative staff all identified the need for staff to feel appreciated and have the support they require as critical to decrease turnover and minimize disruptions in care delivery.”

“[W]hile some interviewees mentioned bonuses or incentives, it was generally in the context of staff recognition or appreciation rather than as additional compensation,” Klein added.

Direct care workers in the study talked about the importance of work environments in motivating staff to remain on the job. 

“I don’t think that a wage increase, too much, would affect the turnover,” one direct care worker said. “… I mean, higher pay could be a motivator for some, but I know most would rather prefer a better work environment.”

Another direct care worker pinpointed constant overwork and scattered support from senior care providers as an important issue:  “[If] you’re burning the candle at both ends because you’re always short-staffed … you don’t get any help from the nurse, then … and it’s just like that constantly, I mean, the money’s not worth it.”  

Administrative staff were on the same page as their direct care colleagues. As one administrator said: “So management plays a huge role in turnover, and it’s about having a rapport and, you know, respectful relationship amongst each other … So when you feel like that your boss has your back, you know, you’re more likely to stay where you’re at.”

Study respondents also offered ideas for alleviating the well-known consequence of high staff turnover rates: inconsistent care provision. New staff training and adequate training time is key to solving this problem, they said. 

New staff must get to know the resident as a person, including likes, dislikes and preferences, they said. Many family members recommended that facilities post signs in residents’ rooms to communicate preferences or specific care requirements to direct care providers, for example.

Full findings with additional suggestions from study participants were published in JAMDA.