Formulating Social Policies under the Authoritarian Developmental State of the 1970s Korea (1997)

ABSTRACT In a study of 469 nursing homes, the authors found a relationship between labor market competition, ownership, profit margin, size, case mix, occupancy, skill mix, workload, administrative resources, and clinical resources and turnover. These organizational variables explained 22%, 9%, and 15% of variance in RN, LVN, and aide turnover, respectively, in a path regression model. In discriminant analysis, these variables explained 59% of variance in group membership for homes with the lowest versus highest turnover. The proportion of resources allocated to administrative functions and roles was the most important predictor of differences between homes with the best and worst turnover rates. INTRODUCTION Turnover remains a serious problem for nursing home managers even though much previous research has examined this problem.1 Estimates of nursing staff turnover ranged from 48% to 86% in nonprofit nursing homes compared to only 20% to 30% in non-profit hospitals and ranged from 72% to 118% in for-profit nursing homes compared to only 30% to 44% in for-profit hospitals (Serrow et al., 1993). This suggests that knowledge gained in previous research has not been successfully applied by managers in reducing turnover in nursing homes and that further research from a new perspective would be useful. Turnover captures managers' attention because it is related to organizational performance in areas of cost efficiency (Alexander, Bloom, and Nichols, 1994) certification violations (Burnfeind and O'Connor, 1992), and death rates (Halbur and Fears, 1986). Previous research has focused on employee characteristics as predictors of turnover. Garland, Oyabu, and Gipson (1988), for example, found that nurse aids (NAs) were more likely to stay if they had cared for an elderly relative, had a friend who was a NA. and their family had positive feelings about their job. Other researchers found that NAs were more likely to stay when they felt that their residents needed them, that they had input into care planning (Caudill and Patrick, 1984), or that they were part of a team (Monahan and McCarthy, 1992). Similarly, Cavanagh (1990) found that kinship responsibilities contributed to turnover rates among nurses in hospitals. Longer job tenure was also related to lower nursing turnover (Rublee, 1986; Caudill and Patrick, 1989; Bloom, Alexander, and Nichols, 1992). In attempting to reduce turnover, however, there is little managers can do to affect changes in employees' characteristics. Laws prevent discrimination in hiring (Carmichael, 1995) and the applicant pool for positions in nursing homes is limited. Thus, managers cannot easily use knowledge of personal characteristics to select employees who will be more stable on their jobs. In this study, therefore, the researchers explored a set of organization-level variables, that are under varying degrees of managerial control, for their relationship to turnover among registered nurses (RNs), licensed vocational nurses (LVNs), and nurse assistants (NAs) in nursing homes. The authors asked: 1) What are the direct, indirect, and total effects of selected organization-level variables on turnover rates of RNs, LVNs, and NAs in nursing homes? 2) How do the very best (lowest turnover rates) and very worst (highest turnover rates) performing nursing homes differ in terms of selected organizationlevel variables? Turnover is voluntary or involuntary. The authors use this definition of turnover because Alexander, Bloom, and Nichols (1994) in an organization-level study found that combined voluntary and involuntary turnover of RNs was positively related to hospital operating costs per patient day. This suggests that, as an organization-level problem for managers, overall turnover is of concern. MODEL OF VARIABLES AND TURNOVER The authors' model of nursing staff turnover focuses on organizational variables which reflect varying levels of managerial control as suggested by Park, Ofori-Dankwa, and Bishop (1994). …