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DURHAM, N.C. -- The chronic staffing turnover common to many of the
nursing homes that serve more than 1.4 million elderly persons in the
United States is lower at nursing homes with stable nursing leadership,
according to a new study by researchers from the Duke University School
of Nursing.

The research published in the June 2004 issue of The
Gerontologist says nursing homes with good communication, a merit-based
work environment and adequate staffing have an edge in retaining nurses
at a time when many facilities are competing to fill these positions.

"Turnover
rates for staff in nursing homes can be as high as 200 percent in a
year," said registered nurse Ruth Anderson, Ph.D., lead author and
associate professor with the Duke University School of Nursing. "New
nurses have to be trained. Patients have to get to know them and there
is less time for the nursing staff to bond with the patients. Nurses
need their managers to create the right work environment so they can
feel comfortable at the facility and want to stay. Until we do that, we
are going to continue to have this instability that is such a problem
in the industry."

The study surveyed the staff of 164 nursing
homes in Texas. Staff included nursing home administrators, directors
of nursing, registered nurses, licensed vocational nurses (also known
as licensed practical nurses) and certified nursing assistants.

The
researchers found lower turnover rates for registered nurses and
licensed vocational nurses directly related to a longer tenure for the
director of nursing. For each year the director of nursing remained in
her position, RN turnover decreased by 16 percent and LVN turnover
decreased by 11 percent. The more time the director of nursing was on
staff, the more stable the nurses perceived their work environment.

"Having
a good director of nursing that the RN's can work with, can bounce
ideas off, is very critical," said Anderson. "If a director of nursing
leaves or is fired, that relationship is broken and has to be rebuilt.
Sometimes the nurses will leave the nursing home and follow the
director of nursing when she is hired somewhere else. It can cause a
major staffing shake-up."

A stable work environment was also
critical for nursing assistants, for whom a significant factor in
reducing turnover was the amount of time they were allowed to spend
with each resident.

"If they don't have the time to spend that
extra minute with the residents, they feel like they might be cheating
the resident," said Anderson. "They're always rushing in and out of the
room. That contributes to the high turnover."

The researchers
said another important factor in promoting stability is the number of
registered nurses on staff. Registered nurses want other nurses with
which to collaborate, and nursing assistants need the security of
having access to the clinical expertise of the registered nurses.

"Nurses
are leaving because they don't feel like they have the support they
need to take care of their patients. They also need to know that their
managers hear their concerns, so communication is key," said Kirsten
Corazzini, Ph.D., assistant professor, Duke University School of
Nursing. "Clear expectations from management are important, too. Nurses
need to know what is expected of them, and when they are able to reach
those goals, they need to be rewarded for that."

The researchers
stress that nursing home managers who seek to retain their nurses need
to give their directors of nursing a chance to learn from mistakes,
build a stable nursing staff and create a positive work environment.

"In
many nursing homes, if something happens, blame often lands squarely on
the shoulders of the director of nursing," said Anderson. "Many times
she is fired. Unfortunately, the lessons learned from those mistakes
are taken with that director of nursing when she goes somewhere else.
Directors of nursing need to be given the chance to learn and grow in
their jobs. If they can do that, the entire facility is a more stable
and productive place."

The survey contained closed-ended
questions about the employees' social and demographic backgrounds, and
their perceptions of management practices at their nursing home.
Information on wage competition, case mix, ownership, size, occupancy
and turnover was obtained from Texas Medicaid nursing facility cost
reports.

The research was funded by the National Institute of
Nursing Research and the Trajectories of Aging and Care Center at Duke
University Medical Center. Reuben R. McDaniel, professor in the McCombs
School of Business at the University of Texas at Austin, is a co-author
on the paper.