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It's not about the money for long-term care nurses

Pay plays a relatively small role in a nurse's decision to stay at or leave a job in a nursing home, according to new research from Rice University, the University of Pittsburgh and Baylor College of Medicine. In a comprehensive study of certified nursing assistants, researchers found that attitudinal factors such as job satisfaction and emotional well-being are better predictors of turnover in long-term care facilities.

While previous studies have found high turnover rates -- between 23 and 36 percent -- in the long-term care industry, this new study found that only 5.8 percent of the workers left the industry and 8.4 percent switched to another facility within a year. "Many of the past studies mix full-time and part-time workers and tend to overestimate the turnover rate in the industry," said Vikas Mittal, co-author of the study and professor of marketing in Rice's Jones Graduate School of Business.

The study, to be published in an upcoming issue of The Gerontologist, gives nursing home administrators a better understanding of the work-related factors associated with staff turnover.

"As baby boomers age, it's critical for the U.S. to have a stable, long-term care workforce," Mittal said. "Staff turnover in this industry increases the financial burden of caring for elders and interferes with the quality of care. Through our study we see that to increase the retention of these workers, administrators should address low job satisfaction among employees and provide health insurance."

Mittal and his co-authors identified three distinct groups among the 620 certified nursing assistants they studied: stayers, who were in the same job for the same organization a year after they were first surveyed; switchers, who continued to work at least 30 hours per week as certified nursing assistants but for a different organization a year after they were first surveyed; and leavers, who were no longer in the direct-care industry or left the workforce entirely.

The study found that leavers were more likely than switchers to report physical health problems as their primary reason for leaving their jobs (65.6 percent versus 21.1 percent). Switchers were more likely than leavers to quit their jobs to pursue other opportunities (87.2 percent versus 63.3 percent).

Switchers were similar to stayers in terms of job factors, such as the amount of paid leave and health insurance they received, but differed from them in terms of key attitudinal factors and reported greater emotional distress, lower job satisfaction and less respect for their supervisor. The switchers reported positive outcomes -- lower emotional stress and greater job satisfaction after switching jobs -- even when switching resulted in lower pay. Job satisfaction remained unchanged for stayers.

"Although turnover is undesirable from the nursing home industry's perspective, it appears to benefit the individual workers," Mittal said. "Even leavers, who are less inclined to this work or physically unable to continue the work, find greater satisfaction."


Contact: David Ruth
Rice University

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