“Sometimes it's not about the money... it's the way you treat people...”: A Qualitative Study of Nursing Home Staff Turnover

To better understand and compare resident family and nursing home staff experiences and perceptions of licensed and unlicensed direct care staff turnover. Descriptive qualitative design. Nursing home resident family members and direct care registered nurses (RNs), licensed practical nurses (LPNs), certified nursing assistants (CNAs), and administrative staff. We conducted semistructured interviews with family members and nursing home staff between September 2019 and July 2020. Using a rapid analysis approach, we compared family member, direct care RNs, LPNs, CNAs, and administrative staff experiences and perceptions related to staff turnover, ways to reduce turnover, and strategies for minimizing disruptions. We completed interviews with 17 family members, 25 direct care RNs, LPNs, and CNAs, and 6 administrative staff from 13 nursing homes primarily located in southeastern Michigan. Family members had mixed experiences with turnover, but commonly described the need for consistent, personalized care to ensure safe, high-quality resident care. Direct care RNs, LPNs, and CNAs expressed a similar viewpoint and frustration with not being able to provide the care they would like because of turnover or short staffing. Although better wages were mentioned, all groups also identified the importance of staff feeling appreciated and supported as critical for decreasing turnover. Adequate training and strategies to acclimate new staff to resident preferences were also noted as approaches for minimizing care disruptions during turnover. Our findings largely confirm those of others regarding potential contributing factors and consequences of staff turnover. However, our findings also provide a clear message about important areas on which to focus. This includes identifying ways to effectively provide consistent, person-centered care for residents in the context of staffing inconsistencies and the need for a more people-oriented work environment for nursing home staff to reduce turnover and minimize disruptions in resident care.