Myths, Evidence About Employee Turnover

Abstract

DR. TELLIS-NAYAK is a vice president at My InnerView, which promotes an evidence-based approach to quality in long-term care. He has a doctorate in sociology from Michigan State University. As a professor, researcher, and consultant, he has taught medical sociology and gerontology. DR. TELLIS-NAYAK bears responsibility for references to research and other literature cited in this series. References pertaining to specific data drawn from the archives of My InnerView are proprietary and may not be used in any fashion without the written authorization of My InnerView. Millions saw the apple fall, but Newton asked why; and mankind took a giant step forward. Most of us cruise through life well prepared to answer life's questions but with little ability to question our answers. An intellectual inertia encumbers all mortals, professionals and lay people alike. We are slow to question received wisdom. In long-term care, the constant lament about the shortage of certified nursing assistants (CNAs) shows how belief rather than rationality can drive policy. For sure, stability of CNAs lies at the heart of quality. Yet few discussions have been driven by assumptions so thinly justified by findings. ▸ Assumption: The widespread and massive CNA turnover is indicative of the malaise that afflicts long-term care and of the poor quality the profession is noted for. ▸ Research finding: First, although nearly half a million CNAs turn over yearly, turnover in 10 states in the U.S. averages 44% and dips as low as 21% in Hawaii. My InnerView data show a good number of facilities around the nation hold the CNA turnover to below 10%, compared with the fast-food industry, which has employee turnover of more than 300%. Second, some turnover, in fact, is desirable when less-devoted workers leave or are terminated, and fresh, idealistic workers replace them. Third, the turnover rate gets inflated when talented and motivated CNAs move up in the profession and enrich the supervisory and managerial ranks with their bedside experience. Many LTC nurses in top executive and policy positions began their careers as CNAs. ▸ Assumption: CNA turnover nationwide surpasses 70% and the hemorrhage at some nursing homes tops 150%. Such instability means constant change and discontinuity for residents. It erodes staff morale. ▸ Research finding: Much of the turnover among CNAs occurs soon after recruitment and on the fringes of a solid core of stable caregivers who ensure continuity of care and relationships. In a sample of 293 nursing homes in the My InnerView database, 12% of the 4,452 CNAs had quit within 3 months of their start day and nearly 70% had spent less than 5 years at the same nursing home. But a solid 70% did serve in the same facility for more than a year. Furthermore, 15% had been there for 5–10 years. ▸ Assumption: The huge turnover of CNAs combined with nearly 52,000 CNA positions unfilled nationwide (i.e., an average of 8.5% vacancies that climb to 16.5% in some states) shows long-term care holds little appeal and creates a CNA shortage. ▸ Research finding: Consider Florida with its 61% CNA turnover and 2,700, or 8.1%, CNA vacancies in 2002. Training programs in the state prepare CNAs in numbers that exceed the need. It is the oppressive environment in which they work, rather than long-term care's poor public image, that soon disillusions new recruits. ▸ Assumption: Why specifically do so many CNAs turn their back on long-term care? Directors of Nursing (DONs) typically respond: “The job stress is more than CNAs are willing to endure.” Nursing home administrators (NHAs) typically respond: “It's their low wages. Fast- food chains in town pay better.” ▸ Research finding: Job stress and low wages do rank high as causes of CNA dissatisfaction. But they do not bother CNAs as much as does the disrespect and unconcern they experience on the part of the DON and the NHA. My InnerView's analysis of satisfaction survey data leads to a firm conclusion: good managers relate to CNAs as caregivers, not as a human resource. They reach out to the persons behind the CNA role and evoke their loyalty. In practice, the evidence-based approach (EBA) requires that we regularly test our strategy against measurable outcomes. Ideally, it is a mind-set that always searches for the proof, an inquisitive curiosity that seeks answers to questions and even raises questions about the answers. In referring to his achievements, Albert Einstein said, “I have no special talents. I am only passionately curious.”