Question

Submit a summary of six of your articles on the discussion board. Discuss one strength and one weakness to each of these six articles on why the article may or may not provide sufficient evidence for your practice change

Answer 1

Employee Retention in the Texas Long Term Care Workforce.

1.McGilton, K. S., Boscart, V. M., Brown, M., & Bowers, B. (2014). Making tradeoffs between the reasons to leave and reasons to stay employed in long-term care homes: Perspectives of licensed nursing staff. International Journal Of Nursing Studies, 51(6), 917-926. doi:10.1016/j.ijnurstu.2013.10.015

BACKGROUND:

Turnover of licensed nursing staff in long-term care (LTC) settings (e.g., nursing homes) is a mounting concern and is associated with poor quality of care and low staff morale. Retention and turnover research in LTC have focused primarily on direct care workers (i.e., nurse aides) leaving the issues largely unexplored for licensed nursing staff (i.e., registered nurses and licensed practical nurses).

OBJECTIVE:

The main objective of this study was to understand the factors that influence nurses' intentions to remain employed at their current job.

DESIGN:

A qualitative descriptive study.

SETTINGS:

Seven nursing homes in Ontario, Canada.

PARTICIPANTS:

A convenience sample of forty-one licensed LTC nurses.

METHODS:

Data were collected through focus groups conducted at each of the participating nursing homes. Focus group discussions were transcribed verbatim. Directed content analysis was used to identify and develop themes.

RESULTS:

Work conditions were a salient element affecting nurses' intention to stay and included the impact of regulations on nurse role flexibility and professional judgment, an underfunded system contributing to insufficient resources and staffing, and a lack of supportive leadership. Factors promoting nurses' willingness to stay included the development of meaningful relationships with residents and staff and opportunities for learning and professional development. Nurses also considered personal and life circumstances (e.g., marital status and seniority) when discussing intention to stay.

CONCLUSIONS:

Nurses in this study weighed positive and negative work-related factors as well as personal circumstances to determine their intent to stay. Developing a more individualized approach to address the attrition of licensed nurses in LTC may be the most successful strategy for improving the retention of highly skilled staff in this sector.

*Strength: The main strength of the present study is to understand the factors that influence nurses' intentions to remain employed at their current job with a small sample

*Weakness: :The main weakness of the study is that the generalization shoud not be applicable

2. Nicholas G. Castle, Ph.D.; Measuring Staff Turnover in Nursing Homes. Gerontologist 2006; 46 (2): 210-219. doi: 10.1093/geront/46.2.210

Purpose:

In this study, the levels of staff turnover reported in the nursing home literature (1990–2003) are reviewed, as well as the definitions of turnover used in these prior studies. With the use of primary data collected from 354 facilities, the study addresses the various degrees of bias that result, depending on how staff turnover is defined in nursing homes.

Design and Methods:

Data came from a survey mailed to administrators of 526 nursing homes during March 2003. Facilities were located in four states: Missouri, Texas, Connecticut, and New Jersey. Three hundred and fifty-four responses were received, giving a response rate of 67%.

Results:

The 1-year turnover rates identified in these facilities were 119%, 89%, 87%, 57%, and 48%, for nurse aides, licensed practical nurses, registered nurses, administrators, and directors of nursing, respectively. However, findings show that the definition of turnover used could influence the relative difference between these reported rates by as much as 47%.

Implications:

As a result of measurement error, turnover rates may be misrepresented in prior studies. On the basis of the results of this investigation, several recommendations are made for future data-collection initiatives that will eliminate some of this measurement error.

*Strength: Understood how staff turnover is defined in nursing homes with more samples

*Weakness: The generalization of the findings

3.Tilden, V. P., Thompson, S. A., Gajewski, B. J., & Bott, M. J. (2012). End-of-Life Care in Nursing Homes: The High Cost of Staff Turnover. Nursing Economics, 30(3), 163-166.

Nursing home staff turnover results in high cost--both economic and personal--and has a negative impact on the quality of care provided to residents at the end of life. Reducing staff turnover in nursing homes would benefit both the cost to the U.S. health care system and, most importantly, the care residents receive in the vulnerable period leading to death. There is rising pressure on nursing homes to improve their palliative and end-of-life care practices and reduce transfers to the hospital for situations and conditions that can be safely managed on site. Nursing care staff deserve an investment in the specific training necessary for them to give the highest quality care to dying residents. This training should be multifaceted and include the physiological, psychological, spiritual, interpersonal, and cultural (including ethnic) aspects of dying. Empowerment with these necessary knowledge, skills, and attitudes will not only result in better care for residents but likely also will reduce the burnout and frustration staff experience in caring for residents near death.

*Strength: Understood the  rising pressure on nursing homes

*Weakness: The application is understood stood, and not given a clear explanation

4.Wendsche, J., Hacker, W., Wegge, J., Schrod, N., Roitzsch, K., Tomaschek, A., & Kliegel, M. (2014). Rest break organization in geriatric care and turnover: A multimethod cross-sectional study. International Journal Of Nursing Studies, 51(9), 1246-1257. doi :10.1016/j.ijnurstu.2014.01.006

BACKGROUND:

Various determinants of nurses' work motivation and turnover behavior have been examined in previous studies. In this research, we extend this work by investigating the impact of care setting (nursing homes vs. home care services) and the important role of rest break organization.

OBJECTIVES:

We aimed to identify direct and indirect linkages between geriatric care setting, rest break organization, and registered nurses' turnover assessed over a period of one year.

DESIGN:

We designed a multimethod cross-sectional study.

SETTING:

80 nursing units (n=45 nursing homes, n=35 home care) in 51 German geriatric care services employing 597 registered nurses.

METHODS:

We gathered documentary, interview, and observational data about the organization of rest breaks, registered nurses' turnover, and additional organizational characteristics (the type of ownership, location, nursing staff, clients, and client-to-staff-ratio).

RESULTS:

The findings show that the rest break system in geriatric nursing home units is more regularly as well as collectively organized and causes less unauthorized rest breaks than in home care units. Moreover, the feasibility of collective rest breaks was, as predicted, negatively associated with registered nurses' turnover and affected indirectly the relation between care setting and registered nurses' turnover. Care setting, however, had no direct impact on turnover. Furthermore, registered nurses' turnover was higher in for-profit care units than in public or non-profit units.

CONCLUSIONS:

This study reveals significant differences in rest break organization as a function of the geriatric care setting and highlights the role of collective rest breaks for nursing staff retention. Our study underlines the integration of organizational context variables and features of rest break organization for the analysis of nursing turnover.

*Strength: Understood direct and indirect linkages between geriatric care setting, rest break organization, and registered nurses' turnover.

* Weakness: Not given the idea regarding how to minimize staff turnover

5.Texas Center for Nursing Workforce Studies Long Term Care Nurse Staffing Study

Studies have shown that the Directors of Nursing (DONs) can have an impact on the quality of care in long term care settings. Facilities that reported having a DON with longer job tenure had a higher quality of care scores. So, it is important to further analyze DONs in long term care settings in Texas. This report provides information on DONs in Texas long term care nursing facilities, including salary, longevity, qualifications/experience, and reasons for DON turnover. Only 4 of 439 facilities reported having no DON at the time of data submission.

" Krause, M.R. (2012) Director of Nursing Current Job Tenure and Past Experience and Quality of Care in Nursing Homes. Health Care Manage Rev., 37, 98-108"

71.7% of facilities reported having a DON that held the position for less than 2 years and almost half of responding facilities currently had a DON who was at the facility less than a year. This is an issue that must be addressed because research has shown that quality of care is negatively impacted when long term care facilities employ a DON that does not have long tenure. Exhaustion/burnout was the most frequently reported reason for DON turnover. The proportion of DONs with a BSN has increased since the 2014 LCTNSS, but the number of DONs with an advanced degree remained similar to 2014 data. The median salary range for DONs has increased from $80,000 and $89,999 in 2014 to $90,000 and $99,999 in 2016.

Strength: Understood regarding the Directors of Nursing (DONs) impact on the quality of care in long term care settings.

Weakness: Regarding the solution not understood?

6. Bita A. Kash, George S. Naufal, Leslie Cortés, Christopher E. JohnsonExploring Factors Associated With Turnover Among Registered Nurse (RN) Supervisors in Nursing Homes, Journal of applied gerontology, June 4,2009,doi.org/10.1177/0733464809335243

Because most turnover studies focus on certified nursing assistants (CNAs), licensed vocational nurses (LVNs), and administrators, little is known about registered nurses’ (RNs) higher turnover. This study builds on the current body of knowledge about turnover among RN supervisors in nursing homes. The article discusses a survey of RN nurse supervisors administered in more than 1,000 nursing homes that were merged with the 2003 Texas Medicaid cost report and the area resource file. Two 2-stage models are developed to predict RN turnover rates. RNs’ intent to leave predicts RN turnover through job satisfaction, perceived empowerment, and education level. High LVN and CNA turnover and high Medicare census are associated with higher turnover. Implications are that participation in management decisions and perceived wage competitiveness is an important determinant of RN retention in nursing homes. Future research should focus on why RN supervisors with higher levels of education leave nursing homes.

Strength: Study builds on the current body of knowledge about turnover among RN supervisors in nursing homes.