A limited number of studies have linked a variety of empowerment approaches to job satisfaction, intent to stay, and lower turnover. Regarding CNA retention, Donoghue estimated an annual national rate of 62.5%.Įmpowerment-focused staffing practices have been proposed as a way to enhance CNA job satisfaction and stability. According to the American Health Care Association ( AHCA 2012) 2012 Quality Report, the 2010 turnover rate among CNAs in skilled nursing facilities was 42.6%. Castle and Engberg (2005) found an annual turnover rate of 85.8% based on 354 facilities in four states, whereas Donoghue (2010) found an annualized estimate from the National Nursing Home Survey of 74.5%. Study estimates of annual CNA turnover rates range widely ( Castle, 2006). Turnover is the percentage of staff who quit within a specific time frame (typically 1 year), whereas retention is the percentage who remain employed for that time ( Donoghue, 2010).
Staff stability is commonly measured as turnover, but can be measured in two ways. Explanations for a positive relationship between staff stability and quality center on the idea that staff will perform better when they are familiar with the needs of residents and when they have established relationships with both residents and colleagues ( Bowers & Nolet, 2011 Donoghue, 2010 Flesner, 2009). High turnover among CNAs has been linked to quality of care and resident behavior deficiencies, as well as poor end-of-life quality indicators ( Castle & Anderson, 2011 Lerner, Johantgen, Trinkoff, Storr, & Han, 2014 Tilden, Thompson, Gajewski, Buescher, & Bott, 2013). The long-standing interest in retention and turnover among certified nursing assistants (CNAs) in long-term care stems from projections for a dramatic increase in demand for workers ( Institute of Medicine, 2008) and the widely held belief that staff stability has positive impacts on quality of care in nursing homes ( Bowers & Nolet, 2011 Castle & Engberg, 2005). This research suggests that staffing empowerment practices on the whole are worthwhile from the CNA staffing stability perspective. Greater opportunities for CNA empowerment are associated with longer CNA retention. 001) and those with high empowerment scores had a 64% greater likelihood of having higher CNA retention (OR = 1.64 95% CI =, p < 001). Compared with the low empowerment category, nursing homes with scores in the medium category had a 44% greater likelihood of having higher CNA retention (odds ratio = 1.44 95% confidence interval =, p =. After adjustment for covariates, a greater staff empowerment practice score was positively associated with greater retention. Data from 2,034 nursing home administrators from a 2009/2010 national nursing home survey and ordered logistic regression were used. This article examines whether staff empowerment practices common to nursing home culture change are associated with certified nursing assistant (CNA) retention.
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