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Top Nurse-Management Staffing Collapse and Care Quality in Nursing Homes

Top Nurse-Management Staffing Collapse and Care Quality in Nursing Homes Director of nursing turnover is linked to staff turnover and poor quality of care in nursing homes; however the mechanisms of these relationships are unknown. Using a complexity science framework, we examined how nurse management turnover impacts system capacity to produce high quality care. This study is a longitudinal case analysis of a nursing home (n = 97 staff) with 400% director of nursing turnover during the study time period. Data included 100 interviews, observations and documents collected over 9 months and were analyzed using immersion and content analysis. Turnover events at all staff levels were nonlinear, socially mediated and contributed to dramatic care deficits. Federal mandated, quality assurance mechanisms failed to ensure resident safety. High multilevel turnover should be elevated to a sentinel event for regulators. Suggestions to magnify positive emergence in extreme conditions and to improve quality are provided. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Applied Gerontology SAGE

Top Nurse-Management Staffing Collapse and Care Quality in Nursing Homes

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References (40)

Publisher
SAGE
Copyright
© The Author(s) 2012
ISSN
0733-4648
eISSN
1552-4523
DOI
10.1177/0733464812455096
pmid
24652943
Publisher site
See Article on Publisher Site

Abstract

Director of nursing turnover is linked to staff turnover and poor quality of care in nursing homes; however the mechanisms of these relationships are unknown. Using a complexity science framework, we examined how nurse management turnover impacts system capacity to produce high quality care. This study is a longitudinal case analysis of a nursing home (n = 97 staff) with 400% director of nursing turnover during the study time period. Data included 100 interviews, observations and documents collected over 9 months and were analyzed using immersion and content analysis. Turnover events at all staff levels were nonlinear, socially mediated and contributed to dramatic care deficits. Federal mandated, quality assurance mechanisms failed to ensure resident safety. High multilevel turnover should be elevated to a sentinel event for regulators. Suggestions to magnify positive emergence in extreme conditions and to improve quality are provided.

Journal

Journal of Applied GerontologySAGE

Published: Feb 1, 2014

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