Median turnover among nursing staff in skilled nursing hit 94% in 2017 and 2018, according to an analysis that included virtually all U.S. facilities.

Mean turnover was 141% among registered nurses, 129% for certified nursing aides and 114% among licensed practical nurses, according to a study in Health Affairs. Using Payroll-Based Journal data, researchers  found wide swings in turnover depending on state or quality indicators, such as overall star ratings and health inspections. One-star rated facilities had the highest median turnover for all nursing staff at 136%.

“Lower-quality facilities may induce staff to separate more frequently,” lead author Ashvin Gandhi, Ph.D., assistant professor at UCLA’s Anderson School of Management, told McKnight’s. “They may choose to leave facilities that are low-quality specifically for the reasons that make them low-quality.”

Total nursing staff turnover rates also were higher at facilities that were for-profit, chain-owned or predominantly reimbursed by Medicaid.

Gandhi and co-author David Grabowski, Ph.D, suggested states could reduce turnover through higher Medicaid reimbursement and targeted incentives. They called for public reporting of turnover rates to leverage better wages and generate better state funding.