Voluntary and involuntary nursing home staff turnover

The goal of this study was to identify nursing home characteristics that have differential associations to voluntary and involuntary turnover among formal caregivers (i.e., registered nurses, licensed practical nurses, and nurse aides). Primary data from 354 facilities from four states were merged with data from the 2004 Online Survey, Certification and Recording system. Multinomial logistic regression analyses were conducted to determine whether organizational characteristics were related to a greater probability of high or low levels of voluntary and involuntary turnover among formal caregivers. The analysis revealed that a higher ratio of nurses to beds, a smaller number of quality-of-care deficiencies, and a smaller proportion of residents using Medicaid were all associated with lower voluntary turnover but higher involuntary turnover. The findings indicate that controlling turnover is a complex process that may involve monitoring the organizational levels not only of voluntary separations but also of involuntary terminations.