As the American population ages and the proportion of individuals over the age of 65 expands, the demand for high-quality nursing home care will increase. However, nursing workforce instability threatens care quality and sustainability in this sector. Despite increasing attention to nursing home staff turnover, far less is known about registered nurse (RN) retention.
In this study, the relationships between retention strategies, employee benefits, features of the practice environment, and RN retention were explored. Further, the utility of Herzberg’s two-factor theory of motivation as a framework for nursing home retention studies was evaluated.
This study was a secondary analysis of the nationally representative 2004 National Nursing Home Survey. The final sample of 1,174 participating nursing homes were either certified by Medicare or Medicaid or licensed by state agencies. We used a weighted multinomial logistic regression using an incremental approach to model the relationships.
Although most nursing homes offered some combination of retention programs, the majority of strategies did not have a significant association with the level of RN retention reported by facilities. Director of nursing tenure and other extrinsic factors had the strongest association with RN retention in adjusted analyses.
To improve RN retention, organizations may benefit greatly from stabilizing nursing home leadership, especially the director of nursing position. Second, managers of facilities with poor retention may consider adding career ladders for advancement, awarding attendance, and improving employee benefits. As a behavioral outcome of motivation and satisfaction, retention was not explained as expected using Herzberg’s two-factor theory.
Selina R. Hunt, PhD, APRN, BC, is Postdoctoral Research Associate, Trajectories of Chronic Illness and Care System Postdoctoral Program, School of Nursing, Duke University Medical Center, Durham, North Carolina. E-mail: firstname.lastname@example.org.
Janice C. Probst, PhD, is Director, South Carolina Rural Health Research Center, and Professor, Arnold School of Public Health, Department of Health Services Policy and Management, University of South Carolina, Columbia.
Kathlyn S. Haddock, PhD, RN, is Associate Chief of Staff–Research, WJB Dorn VA Medical Center, Columbia, South Carolina.
Robert Moran, PhD, is Clinical/Instructional Assistant Professor in Biostatistics, Health Services Research Core, University of South Carolina, Columbia.
Samuel L. Baker, PhD, is Associate Professor, Arnold School of Public Health, Department of Health Services Policy and Management, University of South Carolina, Columbia.
Ruth A. Anderson, PhD, RN, FAAN, is Virginia Stone Professor of Nursing, School of Nursing, and Senior Fellow, Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina.
Kirsten Corazzini, PhD, is Associate Professor, School of Nursing, and Senior Fellow, Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina.
Preparation of this manuscript was funded, in part, by the Duke University School of Nursing, Trajectories of Chronic Illness and Care Systems postdoctoral program. The study was approved by the institutional review board of the University of South Carolina.
The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.