Why Staff Turnover Affects Quality of Care
High staff turnover rates at nursing homes, elderly care facilities, and similar medical facilities can have a major effect on the quality of care that their patients receive. If employees, especially nurses, quit voluntarily or are terminated too frequently, it can cascade into an avalanche of problems.
Let’s explore a few of the biggest reasons that a high turnover rate can have a negative impact on the quality of care in nursing homes.
Lack of Continuity Increases the Risk of Mistakes
In a medical context, continuity refers to an ongoing system of care provided to a patient, generally through the same nurse or group of nurses. Naturally, this also means that a patient at a high-turnover facility won’t enjoy this continuity if he or she has a different nurse every month.
Let’s say a 78-year-old male patient has been at this particular facility for nine months and was admitted after suffering a stroke. The stroke affected his vocal cords, and he’s lost the ability to speak. He also has an allergy to digitalis, which every other patient in the facility takes for their heart.
If the man has the same nurse for the entire year, the odds of him being given the wrong drug are practically zero, as that nurse will see him five days a week and remember his allergy. If he has a different nurse every six weeks, the odds of one of them forgetting, misreading his chart, or making a mistake will increase significantly, which could kill him.
Nurse-to-Patient Ratio Increases
Constant turnover means new nurses must be hired constantly to maintain the proper ratio of nurses to patients, but a nurse undergoing training who must be accompanied by another nurse at all times lowers the overall number of medical professionals who can help patients at any given time.
In addition to federal laws mandating “sufficient nursing staff”, each state has its own laws regarding the number of available nurses that must be available in care homes at any given time. Most nursing homes assign staff based on fulfilling the minimum requirements of these laws, which means they typically don’t carry extra nurses.
For example, let’s say that the state law requires a total of four nurses for every 10 patients. The administration hires exactly four nurses to meet the standard, but let’s say two of them quit. Two new nurses are immediately hired, but have to undergo training in pairs with the two existing nurses.
They meet the legal requirement of nurses per resident, but until the training period is over, they functionally only have two nurses on staff, as the new nurses must be observed and taught throughout their shifts. Residents can’t realistically receive the same standard of care with half as many nurses on staff.
Increased Risk of Complaints and Patient Abuse
A 2022 Study by the Center for Medicare & Medicaid Services revealed that the average nursing home has an annual turnover rate of 52%, meaning over half of the staff at any given nursing home will quit or be fired in any given year.
The study found that care facilities with rates higher than 52% were strongly correlated to higher rates of patient abuse and resident complaints that were later proven justified after an investigation. Having a high turnover rate doesn’t necessarily mean that patients are being abused, but the two are linked for obvious reasons.
It also revealed that, in addition to potentially resulting in patients’ deaths, high turnover is also correlated with worse patient outcomes in general. Patients in these facilities tend to experience falls more often, might not heal properly, and have lower ambulatory rates (i.e., not being able to walk) than those with better retention rates.
If one or more nurses are engaging in misconduct at a nursing home, they will likely eventually be discovered and fired during routine Medicare inspection visits. The good, honest nurses who aren’t abusive will probably not want to continue working for a company that allowed it to happen in the first place, thus creating even more turnover.
Many nursing home abuse lawyers find that these abuse hotspots tend to have recurring issues, like poor training, bad administrators, a lack of oversight, and broader institutional corruption, as opposed to one individual who simply chose to perform their nursing duties poorly.
Employee Stress and Burnout
Similarly, a high turnover rate is also connected to underpaid, overstressed nurses who likely feel burned out. Whether it’s the cause of the turnover or one of the effects, it also means that these nurses will likely have issues providing truly compassionate care and will be more prone to mistakes.
At most jobs, an employee making a simple mistake can cost their company thousands of dollars or take weeks to fix. In health services, especially nursing homes, a single mistake or oversight can kill a patient or resident. That’s why it’s such a stressful job and why it’s essential that the nursing staff’s morale must be as high as possible.
Benefits and pay must be as high as possible while still being able to keep the company in business, and systems that check for high stress levels or burnout should be in place, too.
Recap: Why Staff Turnover Affects Quality of Care
Nursing homes with excessive employee turnover are at risk for lower patient care quality due to the risk of stress and burnout, lack of continuity, and excessive nurse-to-patient ratios.
Employee turnover can be either the cause or the effect, but in either case, higher turnover is directly correlated with worse patient outcomes. Some turnover is unavoidable, and you can’t expect to keep every nurse for 30 years, but steps should be taken to make sure the rates are as low as possible.
Lower turnover rates lead to happier patients, a higher standard of care, and fewer resident complaints, as well as fewer lawsuits brought by nursing home abuse lawyers on behalf of patients and their families.
If you are a loved one of someone who may be getting abused or neglected in their nursing home, you may find My Nursing Home Abuse Guide a reliable source of information, tips, and more.
