Berridge Clara, Lima Julie, Schwartz Margot, Bishop Christine, Miller Susan C
University of Washington School of Social Work, Seattle, WA.
Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, RI.
J Am Med Dir Assoc. 2020 Sep;21(9):1254-1259.e2. doi: 10.1016/j.jamda.2020.01.109. Epub 2020 Mar 16.
We examined the relationship between nursing assistant (NA) retention and a measure capturing nursing home leadership and staff empowerment.
Cross-sectional study using nationally representative survey data.
Data from the Nursing Home Culture Change 2016-2017 Survey with nursing home administrator respondents (N = 1386) were merged with facility-level indicators.
The leadership and staff empowerment practice score is an index derived from responses to 23 survey items and categorized as low, medium, and high. Multinomial logistic regression weighted for sample design and to address culture-change selection bias identified factors associated with 4 categories of 1-year NA retention: 0% to 50%, 51% to 75%, 76% to 90%, and 91% to 100%.
In an adjusted model, greater leadership and staff empowerment levels were consistently associated with high (76%-90% and 91%-100%) relative to low (0%-50%) NA retention. Occupancy rate, chain status, licensed practical nurse and certified nursing assistant hours per day per resident, nursing home administrator turnover, and the presence of a union were also significantly associated with higher categories of retention (vs low retention).
Modifiable leadership and staff empowerment practices are associated with NA retention. Associations are most significant when examining the highest practice scores and retention categories. Nursing homes seeking to improve NA retention might look to leadership and staff empowerment practice changes common to culture change.
我们研究了护理助理（NA）留用情况与一项衡量养老院领导力和员工赋权的指标之间的关系。
使用具有全国代表性的调查数据进行横断面研究。
将2016 - 2017年养老院文化变革调查中养老院管理人员受访者的数据（N = 1386）与机构层面指标合并。
领导力和员工赋权实践得分是一个从对23个调查项目的回答中得出的指数，分为低、中、高三个类别。针对样本设计进行加权并解决文化变革选择偏差的多项逻辑回归确定了与1年NA留用的4个类别相关的因素：0%至50%、51%至75%、76%至90%以及91%至100%。
在一个调整模型中，相对于低（0% - 50%）NA留用率，更高的领导力和员工赋权水平始终与高（76% - 90%和91% - 100%）留用率相关。入住率、连锁状态、每位居民每天的执业护士和注册护理助理工作时长、养老院管理人员更替率以及工会的存在也与更高的留用类别（相对于低留用率）显著相关。
可改变的领导力和员工赋权实践与NA留用相关。在检查最高实践得分和留用类别时，关联最为显著。寻求提高NA留用率的养老院可能会考虑文化变革中常见的领导力和员工赋权实践变革。
