Kash Bita A, Castle Nicholas G, Naufal George S, Hawes Catherine
Department of Health Policy and Management, Texas A&M University Health Science Center, School of Rural Public Health, TAMU 1266, College Station, TX 77843, USA.
Gerontologist. 2006 Oct;46(5):609-19. doi: 10.1093/geront/46.5.609.
We examined the effects of facility and market-level characteristics on staffing levels and turnover rates for direct care staff, and we examined the effect of staff turnover on staffing levels.
We analyzed cross-sectional data from 1,014 Texas nursing homes. Data were from the 2002 Texas Nursing Facility Medicaid Cost Report and the Area Resource File for 2003. After examining factors associated with staff turnover, we tested the significance and impact of staff turnover on staffing levels for registered nurses (RNs), licensed vocational nurses (LVNs) and certified nursing assistants (CNAs).
All three staff types showed strong dependency on resources, such as reimbursement rates and facility payor mix. The ratio of contracted to employed nursing staff as well as RN turnover increased LVN turnover rates. CNA turnover was reduced by higher administrative expenditures and higher CNA wages. Turnover rates significantly reduced staffing levels for RNs and CNAs. LVN staffing levels were not affected by LVN turnover but were influenced by market factors such as availability of LVNs in the county and women in the labor force.
Staffing levels are not always associated with staff turnover. We conclude that staff turnover is a predictor of RN and CNA staffing levels but that LVN staffing levels are associated with market factors rather than turnover. Therefore, it is important to focus on management initiatives that help reduce CNA and RN turnover and ultimately result in higher nurse staffing levels in nursing homes.
我们研究了机构和市场层面的特征对直接护理人员的人员配备水平和离职率的影响，并研究了人员流动对人员配备水平的影响。
我们分析了来自1014家得克萨斯州疗养院的横断面数据。数据来自2002年得克萨斯州护理机构医疗补助成本报告和2003年区域资源文件。在研究了与人员流动相关的因素后，我们测试了人员流动对注册护士（RN）、执业职业护士（LVN）和认证护理助理（CNA）的人员配备水平的显著性和影响。
所有三种类型的员工都表现出对资源的强烈依赖，如报销率和机构付款人组合。合同制与雇佣制护理人员的比例以及RN的离职率增加了LVN的离职率。较高的行政支出和较高的CNA工资降低了CNA的离职率。离职率显著降低了RN和CNA的人员配备水平。LVN的人员配备水平不受LVN离职率的影响，但受市场因素的影响，如该县LVN的可获得性和劳动力中的女性数量。
人员配备水平并不总是与人员流动相关。我们得出结论，人员流动是RN和CNA人员配备水平的一个预测指标，但LVN的人员配备水平与市场因素而非人员流动相关。因此，重要的是关注有助于减少CNA和RN离职率并最终提高疗养院护士人员配备水平的管理举措。
