QIOs to Help Reduce Staff Turnover in Nursing Homes National Commission Calls For Action On Staff Shortages

Washington , D.C. — Quality Improvement Organizations (QIOs) will begin working this summer to help reduce staff turnover in nursing homes across the country. QIOs will undertake this effort as part of a new three-year contract with the Centers for Medicare & Medicaid Services ( CMS ).

The contract calls for QIOs to cut nursing assistant turnover rates by at least 15% in over 2,000 nursing homes by late-2007. 

Reducing nursing home staff shortages is the focus of a report, “Act Now For Your Tomorrow,” released today by the National Commission on Nursing Workforce for Long-Term Care. The commission reported that on any given day there are almost 100,000 vacant nursing staff positions in long-term care facilities. Staff turnover in many facilities exceeds 50% annually. The diverse members of the Commission were brought together by the American Health Care Association, which represents thousands of long-term care facilities and has been a national leader in drawing attention to nurse staffing shortages.

“The high level of staff turnover in nursing homes is corrosive to personal relationships that are important to both nursing home residents and workers. Turnover directly detracts from the quality of health care for residents and raises the cost of providing care,” said David Schulke , Executive Vice President of the American Health Quality Association, which represents the national network of QIOs—private organizations that work in every state to improve the quality of care. 

“ Poor retention leads to understaffing and stressed-out nursing staff who must rush to provide very personal care to prevent pressure sores, feeding, bathing and assisting with toileting. It leads to caregivers who don’t know the residents, who are always strangers,” Schulke said. “Nurse aide turnover averages 71% per year.  Reducing nursing aide turnover by at least 15% over the next three years will save about $27,000 per home per year -- enough money to hire an additional nurse aide.  Or it could finance professional development training opportunities, as recommended in the Commission report.”

Helping Reduce Staff Turnover

Schulke spoke at a Washington news conference to release the report, which recommends state and local initiatives to help reduce the long-term care nursing shortage, but says that successful staff retention depends largely on “work by long-term care nursing leaders to improve their internal organization and operation.”

QIOs will work in a number of ways to help nursing home leaders succeed in creating working conditions that reduce turnover, Schulke said.

• QIOs will help nursing home management learn to measure staff and resident satisfaction data and turnover rates, and to routinely use these as organizational management techniques. 
• QIOs will help nursing home managers adopt the practice of assigning the same aides to the same residents every time they come to work—a critical step for improving care, strengthening caregiver-resident relationships, and reducing turnover.  Experts in the field estimate as few as 5% of nursing homes are using consistent assignment today; the current norm is to constantly rotate staff through different facility wards. 
• QIOs will help nursing home managers work with staff closest to the problems to help design solutions.  Experience has shown that nurses and nurse aides often come up with creative solutions that work, and that being part of the solution increases job satisfaction.
• QIOs will customize the training agenda in workshops and onsite interventions to focus on issues commonly cited by staff—from dissatisfaction with salary and schedules to issues of personal worth and fulfillment, such as having opportunities to learn and grow professionally, the freedom to work in non-hierarchical teams, and feeling valued, respected and informed by licensed nurses and management. 
• QIOs will encourage nursing home executives and clinical leaders to improve management practices to empower nurse aides and enhance their relationships with residents through consistent assignment, team-building, recognizing high performance by workers, and simple but meaningful steps like recognizing and honoring grief when a resident dies.

CMS  is also asking QIOs to make significant improvements in clinical care for nursing home residents—including significant reductions in numbers of residents with pressure ulcers and helping nursing homes improve patient assessments and other processes of care—a continuation of QIO efforts over the past three years.

Building On Prior Success

Schulke pointed out that during the last three years, QIOs have been major contributors to the national Nursing Home Quality Improvement initiative started and funded by CMS. Partnering with nursing homes, QIOs have taught best practices and provided assistance to help improve care as measured by standardized quality indicators.  This work has demonstrated some significant early results, announced by CMS last December, including nationwide gains in reducing the numbers of residents suffering from pain and residents who are physically restrained.

CMS data shows that the 2,500 nursing homes that worked more intensively with their QIOs have improved faster than the national trends.

The Rhode Island QIO, working on a pilot project with 10 multi-facility corporations, is currently conducting educational sessions with senior administrative leadership and direct care workers to implement ways to improve nurse satisfaction and reduce turnover.  This collaborative learning method stresses peer-to-peer education and information sharing on best practices, and it has already shown promising results that QIOs will build upon nationwide. 

The American Health Quality Association is dedicated to improving the safety and effectiveness of health care. AHQA represents the national network of Quality Improvement Organizations (QIOs) that work with hospitals, medical practices, health plans, long-term care facilities, home health agencies, and employers to encourage the spread of best clinical practices and improve systems of care delivery.