Nursing Aides Research Articles

Critical nursing and health care aide behaviors in care of the nursing home resident dying with dementia

BackgroundWith the aging of the population, dying with dementia will become one of the most common ways in which older adults will end their final years of life, particularly for those living in a nursing home. Though individuals living with dementia have complex care needs and would benefit from a palliative approach to care, they have traditionally not been recipients of such care. An important aspect of determining quality in end-of-life care is the identification of expert practices, processes or behaviors that may help achieve this care. However, for those living with dementia in nursing homes, we have a limited understanding of how to best support expert end of life care. To redress this gap in knowledge, the purpose of this study was to examine and describe expert care of the individual with dementia approaching death from the perspective of nurses and health care aides (HCAs) identified by their peers as having special expertise in caring for this population.MethodsA qualitative research design known as Interpretative Description was used to conduct the study. Expert nurses and HCAs were identified through a two-phase nomination process. Individual semi-structured interviews were conducted with consenting participants. Data were analyzed using constant comparative analysis to determine the key critical behaviors.ResultsAnalysis of data collected from expert nurses (n = 8) and HCAs (n = 7) revealed six critical behaviors when caring for residents dying with dementia. All nurses and HCAs unanimously endorsed that the overarching goal of care is similar for all residents who are actively dying; to achieve comfort. The six critical behaviors in caring for residents dying with dementia included: 1) recognizing and responding to changes in a resident’s pattern of behavior; 2) attending to the person; 3) working with the family; 4) engaging with others; 5) responding after the death has occurred; and 6) having a positive attitude toward care of the dying.ConclusionsThe critical behaviors described by nurses and HCAs in this study provides emerging evidence of best practices in care of those with dementia and their families, particularly near the end of life within the nursing home setting.

THE INFLUENCE OF STAFF RETENTION ON NURSING HOME QUALITY

The association of retention of Nurse Aides (NAs) with nursing home quality of care is examined. Retention is defined as staff continuously employed in the same facility for a defined period of time. Deficiency citations were used as quality indicators. Data used came from a survey of nursing home administrators, the Certification and Survey Provider Enhanced Reporting (CASPER) data, and the Area Resource File. All of the data was from 2015, and included 3,550 facilities. Analyses included negative binomial regression and multivariate logistic regression models (using GEE). The analytic modeling included staffing variables (turnover, agency use, staffing levels), facility factors (size, ownership, occupancy rate), and market characteristics (competition, Medicaid rates). The average number of deficiency citations was significantly lower (p<.01) in facilities with the higher levels of NAs consistently employed for one year or more. The same was found for facilities with the higher levels of NAs consistently employed for two years or more. While the average number of deficiency citations, the quality of care grouping of deficiency citations, and J, K, L deficiency citations were all significantly lower (p<.01) in facilities with the higher levels of NAs consistently employed for three years or more. Staff retention has been promoted as potentially influential based on little empirical evidence. The findings provide some justification for the importance of NA retention.

CONSISTENT ASSIGNMENT: AN UPDATE ON THE QUALITY IMPACT

The association of consistent assignment of Nurse Aides (NAs) with nursing home quality indicators is examined. Consistent assignment is defined as the same caregivers consistently caring for the same residents almost (80% of their shifts) every time they are on duty. Data used came from a survey of nursing home administrators, Nursing Home Compare, the Certification and Survey Provider Enhanced Reporting (CASPER) data, and the Area Resource File. All of the data was from 2015, and included 3,550 facilities. Several multivariate logistic regression models (using GEE) were used, including staffing variables (turnover, agency use, staffing levels), facility factors (size, ownership, occupancy rate), and market characteristics (competition, Medicaid rates). An average of 77% of nursing homes reported using at least some level of consistent assignment; although some were at low levels. In the multivariate analyses, accepted levels of consistent assignment were used. Turnover and family satisfaction quality were significantly (p<.01) better in facilities with the highest levels of consistent NA assignment. 7 of the 9 Quality Measures and 3 of the 5 Five-Star measures examined were significantly (p<.01) better in facilities with the highest levels of consistent NA assignment. Consistent assignment has developed as a preferred practice in nursing homes based on little empirical evidence. The findings presented here provide substantial justification for the use of this staffing practice for NAs.

ASSOCIATION BETWEEN HOME HEALTH SERVICE USE AND FACILITY ADMISSION IN OLDER ADULTS WITH AND WITHOUT DEMENTIA

This study is a secondary analysis of the Outcome and Assessment Information Set (OASIS) and administrative billing records of 6,153 adults ≥ 65 years old who received home health (HH) from a not-for-profit HH agency in upstate New York in CY 2017. We evaluated the association between the use of home health services (HH) with the hazard of unplanned facility admissions among Medicare patients with and without Alzheimer’s disease and related dementia (ADRD). Outcome was time from HH start of care to an unplanned facility admission of any type, including the hospital, nursing home, or rehabilitation facility. Independent variables included weekly intensity (visits/week, hours/week) of each discipline, including skilled nursing (SN), physical therapy (PT), occupational therapy (OT), social work (SW), and home health aide (HA), separately. ADRD was identified by diagnosis (ICD-10 codes) and cognitive impairment (M1700, M1710, M1740 [OASIS]). In multivariable Cox Proportional hazard models that adjusted for time-varying effects of HH intensity, receiving the highest intensity of SN (3.3 visits of 2.78 hours per week) and PT (2.5 visits of 2 hours per week) was related to up to a 54% and 86% decrease, respectively, in the hazard of unplanned facility admission among patients with ADRD (n=1,525), and decreases of 56% and 90% respectively among patients without ADRD (n=4,628). This is the first study in the United States showing that receiving a sufficient amount and appropriate mix of HH services was associated with substantially reduced risk of unplanned facility admission among patients with ADRD by up to 86%.

Factor Assocoated with Stigma Towards People Living With HIV/AID Among Nursing Students

Background: Stigma towards people living with HIV/AIDS is a problem in control, prevention and treatment of HIV/AIDS. Stigma by health care worker in hospital is one of the main challenges in preventing and manage HIV/AIDS especially in developing country. Methods : this is a cross-sectional study, respondents were bachelor of nursing students program regular, program transfer and recognition of prior learning program. We used KQ-18 questionnaire to assess HIV/AIDS related knowledge, belief and values questionnaire to asses religiosity, modified Nurse AIDS Attitude Scale to assess stigma and stigma perception in workplace. Data were analyzed using SPSS 20. Descriptive statistics were conducted to summarize the sample characteristics. Results: A total 132 nursing students participated, recognition of prior learning nursing students have higher knowledge about HIV/AIDS (mean=13,84), bachelor of nursing students regular program have higher stigma (mean=96,30), person correlation analysis showed that there is a significant correlations between knowledge and stigma towards people living with HIV ( p= 0,001), regression analysis showed that p value = 0,000 which mean that educational background, work experiences and knowledge simultaneously affect stigma towards people living with HIV/AIDS. Conclusions : the finding of this research showed high magnitude of stigma towards people living with HIV/AIDS among nursing students, training and continuing education are needed to improve knowledge and reduce stigma towards people living with HIV/AIDS.

Cancer-oriented comprehensive nursing-caregiving service in Korea: 1 year report

Abstract Background Korean comprehensive nursing-caregiving service, which is covered by national insurance, has been officially initiated in 2016. Following interim analysis presented at JSMO 2018, we report our 1-year experience of cancer-oriented comprehensive nursing-caregiving unit´s outcomes and issues. Methods and Results Our institution is a general hospital (827 beds) with 246 doctors and 703 RNs. We are running cancer-oriented comprehensive nursing-caregiving service (46 beds with 25 RNs and 12 nurses aides) since December 2017. This special ward is caring only medical oncology patients. For 12 months, 11,946 inpatients (average 32.4 patients/day, bed turnover rate 85.7%) and 5,682 patients received chemotherapy in our unit. We evaluated our Results in three categories: structure, process, and outcome. First, structural (environmental) improvements were found in more interval between beds (1.5m), fully automatic beds with fall prevention sensors, comfortable patient lounge. Second, process improvements such as nursing time, quality of oncologic nursing is improved. For example, missed nursing care has been improved (nursing caregiving ward vs. general ward: 0.1 vs. 1.3 events/month). Finally, patient and nurse outcome are much improved when compared with general wards. Patient satisfaction (will to revisit: 91.7% vs. 78.4%, will to recommend to others: 95.0% vs. 76.8%) have been increased. Safety indicators such as pressure ulcer (0.3 vs. 0.8 events/month), falls (1.6 vs. 1.5 events/month) have dropped. Nurse outcomes such as resignation rate have been stabilized (resignation rate: 0 vs. 14.9%). Issues during unit operation were found in still heavy workloads for nursing staff and low compensation by the government compared with other countries. Conclusion Comprehensive nursing-caregiving service for medical oncology patients is a key to success in both improved quality of cancer care and nursing staff´s job satisfaction.

Anthropometric measurements and postural evaluation of Nurse's aide in Selected Hospitals of Shahid Beheshti University of Medical Sciences

Introduction: The lack of anthropometric data in the design of work stations and equipment can lead to injuries associated with work musculoskeletal disorders (WMSDs). Therefore, the aim of this study was to investigate anthropometric and postural evaluation of Nurse's aide in Selected Hospitals of Shahid Beheshti University of Medical Sciences.Materials and Methods: This descriptive-analytic study was performed on the Nurse's aide working in the selected hospitals of Shahid Beheshti University of Medical Sciences. In this study the Body Map questionnaire was used to assess musculoskeletal disorders (MSDs) and discomfort, and QEC (Quick Exposure Check) software was used to evaluate posture. Finally, the data were analyzed using SPSS software version 21 using descriptive statistics, independent T test and Pearson correlation with 95% confidence level.Results: The mean age and work experience of the two groups of men and women were (38.17±9.48 and 37.44±9.51) and (14.27±9.51 and 12.06±8.34) respectively. The QEC score was unacceptable and the results showed that men are more at risk than women, although this was not significant (P = 0.082). In the majority of anthropometric dimensions, there was a significant difference between men and women (p<0.05). Also, the results showed that the highest and lowest incidence of discomfort was in the waist and hips areas respectively.Conclusion: Significant anthropometric differences were observed among men and women. Establishing anthropometric database of Nurse's aide in two groups of women and men and designing a work station suitable for anthropometric dimensions can reduce MSDs.

Increasing colorectal cancer screening orders using unlicensed assistive personnel

BackgroundColorectal cancer (CRC) is among the leading cancer diagnoses affecting both men and women worldwide. Prevention and early detection of CRC is possible by increasing access to and utilisation of...

Intentions of Kentucky School Nurses to Delegate Diabetes-Related Tasks to Unlicensed Assistive Personnel.

Many children have diagnosed diabetes that must be safely managed at school. New laws have created the potential for school systems to rely more heavily on unlicensed assistive personnel (UAP) than on nurses to deliver health services, including administration of insulin injections. Using the theory of planned behavior as a framework, aims were to (1) determine the nature and extent to which health services related to diabetes were being delegated to UAP in Kentucky schools, (2) describe the attitudes of Kentucky school nurses regarding the delegation of diabetes health services to UAP, and (3) examine the relationship of selected variables to school nurses' intentions to delegate diabetes health services. Survey results revealed that school nurses in Kentucky intended to delegate some diabetes-related tasks despite their lack of support for delegation of those tasks.

Implementing quiet hours on a medical telemetry unit

Implementing quiet hours on a medical telemetry unit

The activities/tasks performed by health care aids in hospital settings: a mixed-methods study

The role of Nurses' aides (NAs) in the clinical practice has been widely debated to date. To describe the activities/tasks performed by NAs and the dedicated time; to identify the activities/tasks shifted from nurses to NAs and to investigate the motivations. A multi-center mixed-methods study was conducted. Fifty-six NAs working in 17 hospitals in the North-Italy were observed during daily practice and then interviewed about the motivations associated with task shifting. NAs mainly performed direct care tasks (67.7% of the observed time), such as helping with personal hygiene, feeding and mobilization. Larger hospitals (p = 0.034), surgical units (p = 0.001), a skill mix> 40% (p = 0.044) and a reduced nurse to patient ratio (p = 0.041), were significantly associated with a higher amount of indirect care activities/tasks performed by NAs. The tasks shifted most frequently from nurses to NAs were: mobilization (22; 39.3%) and personal hygiene (21; 37.5%) of unstable patients, feeding patients with dysphagia (19; 34%), intra-venous set replacement (16; 28.6%) and pressure ulcers' dressing (11; 19.6%). NAs reported that they chose to act autonomously because of their experience and the trust-based relationship with nurses, in order to promptly respond to patients needs and to reduce nurse workload. It is necessary to further assess the development of the NAs role in the hospital setting to understand their inclusion in the nursing care.

Community Resources for Forensic Mental Health Aftercare in Zimbabwe

This study sought to identify and describe existing forensic mental health aftercare facilities in Zimbabwe. A descriptive qualitative research design was applied to the study. Twenty-nine participants were purposively sampled. Semi-structured interviews were conducted. Thematic analysis of data was done. Three aftercare centers were identified. The link between special institutions where patients are discharged from and these centers is dependent on the Mental Health Review Tribunal. Models of care in these centers revolve around agro based livelihood activities. Social workers, nurses, nurse aides and volunteers from various medical background constitute care teams in the forensic mental health aftercare facilities. There is however, poor engagement within the identified aftercare facilities and also with mainstream psychiatric services.

Relationships among Training, Mindfulness, and Workplace Injuries among Nurse Aides Working in Long-Term Care Settings

Nursing aides working in long-term care settings experience high rates of injury, musculoskeletal symptoms, and exposure to resident aggression. Some of these injuries and exposure to aggression may be related to trait mindfulness. The aim of this study was to examine the relationships between trait mindfulness, job training, injury, sources of injury, and musculoskeletal symptoms among nursing aides working in long-term care residential settings. Nursing aides working in long-term care settings across Ohio, USA (n = 152) were recruited for the study. Measures of sociodemographic characteristics, job tenure, job training, mindfulness, work injuries, sources of injuries, and musculoskeletal symptoms were obtained. Correlational analyses demonstrated that higher levels of mindfulness and training were associated with lower levels of injury and musculoskeletal symptoms. They were also significantly inversely associated with the following injury sources: lifting/repositioning resident, bumping/hitting equipment, and resident aggression. Results of hierarchical linear regressions indicated that mindfulness was a significant and unique predictor of injuries, exposure to the most common sources of injury, and musculoskeletal symptoms. Specifically, nursing aides with higher levels of mindfulness were less likely to report experiencing injuries, exposure to the most common sources of injury, and musculoskeletal symptoms. Given that mindfulness can be trained and modified, adding mindfulness training to nursing aide educational programs could potentially help reduce risk for injury among this vulnerable population of workers. Further research exploring the potential benefit of mindfulness training could address this possibility.

Cost-effectiveness of professional oral health care in Australian residential aged care facilities.

To conduct a model-based cost-effectiveness analysis, from a health care system perspective, of using oral health professionals to provide oral hygiene services at residential aged care facilities (RACFs) in Victoria, Australia, compared to current practice (CP). Increasingly dentate cohorts of older adults are entering RACFs, making urgent the need of further development and provision of oral health programmes in ageing dentitions. The model was based on 47624 RACFs' places in Victoria over one year. The main outcome measured was "cost per pneumonia case averted." Four different scenarios of oral hygiene provision were compared to CP. Costs included were RACF staff training, professional salaries, programme coordinator office expenses, dental equipment and hospitalisation costs. Effectiveness assumptions for each scenario were based on systematic reviews and randomised control trials. All four scenarios were dominant strategies. The magnitude of negative incremental cost-effectiveness ratio was not informative; therefore, incremental costs and incremental effectiveness were used to present results. "Professional oral health care (POHC) provision once every two weeks and current provision of oral health care the other days" was the most cost-saving alternative (AU $896 per resident saved). The most effective alternative was "POHC provision once a week and non-POHC provision by trained Nurse aids twice per day the other days" (6779 pneumonia cases averted). One-way sensitivity analyses confirmed the robustness of results. The four scenarios were highly cost-effective compared to CP. These results could be a strong basis to implement new oral health programmes in Australian RACFs.

Inverse Dose-Response Relationship Between Home Health Care Services and Rehospitalization in Older Adults

Objectives(1) To examine the impact of specific services [skilled nursing (SN), physical therapy (PT), occupational therapy (OT), and home health aide (HA)] in Medicare-certified home health care (HHC) on subsequent rehospitalization among older patients during a 60-day HHC episode and (2) to test the moderating effect of functional limitation on these services. DesignSecondary analysis of data from the Outcome and Assessment Information Set (OASIS) and HHC administrative records of a statewide not-for-profit HHC agency from January 1, 2016, to December 31, 2016. Setting and ParticipantsParticipants were ≥65 years old and were admitted to HHC within 48 hours of hospital discharge. MeasuresOutcome was time to rehospitalization during the 60-day HHC episode (ie, number of days). Independent variables were visit intensity (number of visits/week) of SN, PT, OT, and HA, respectively. Functional limitation was measured by a composite score generated from 9 OASIS items on physical function. Multivariate Cox Proportional hazard analyses were conducted. Subgroup analysis (high vs low functional limitation) was conducted to examine the moderating effect of functional limitation on specific HHC services. Ad hoc analysis was conducted to examine potential interaction between specific HHC services that were significantly related to rehospitalization. ResultsThe sample included 1377 participants, among whom 11.5% were rehospitalized during the 60-day HHC episode. At the threshold dose of 1 PT or 2 SN visits/week, higher visit intensity significantly reduced the hazard of rehospitalization in these patients by up to 82% for PT (2.30 visits/week; hazard ratio [HR] = 0.18, P value < .001) and 48% for SN visits (2.51 visits/week; HR = 0.52, P value < .05). The effect of PT on reducing the risk of rehospitalization was more pronounced in patients with low versus high functional limitation (2.30 visits/week, HR = 0.08 vs 0.24, both P < .001). SN was only effective in reducing the hazard of rehospitalization in the low functional limitation group (1.70 visits/week, HR = 0.41, P < .05; 2.51 visits/week, HR = 0.29, P < .05), but not in the high functional limitation group (P > .05 at all intensity levels). Visit intensity of HA or OT was not significantly related to rehospitalization. Conclusions/RelevanceAt a threshold of 1 PT visit or 2 SN visits/week, HHC lowered the risk of rehospitalization in older patients by up to 82% and 48%, respectively. Both PT and SN were more effective in avoiding rehospitalization in patients with low functional limitation than in those with high functional limitation. Older patients should receive enough HHC services (especially PT and SN) to avoid rehospitalizations with consideration of their functional limitation.

Delegating as a New Nurse.

This column is designed to help new nurses in their first year at the bedside-a time of insecurity, growth, and constant challenges-and to offer advice as they learn what it means to be a nurse. This article offers strategies new nurses can use and specific steps they can take to help them succeed in delegating tasks to LPNs/LVNs and unlicensed assistive personnel.

243. Prioritization of Antibiotic Administration for STAT Orders in the Septic Patient: A Retrospective Analysis

BackgroundAppropriate antibiotic (AB) therapy is crucial in sepsis and septic shock. Two central factors govern patient survival: adequate empiric coverage and rapid initiation of therapy. The administration of broad-spectrum antibiotics in sepsis and septic shock play an important role diminishing patient morbidity and mortality.1 The sequence of antibiotic administration has been suggested to affect patient outcomes.2MethodsThis is a retrospective study to assess the impact of a pictogram (Figure 1) in the emergency department medication rooms on nurses’ antibiotic administration order in the septic patient. The study population included patients prescribed at least two concomitant AB between January 2017 and January 2018. Each patient’s AB regimen, indication and administration sequence were reviewed using a standardized form. Sequence of administration was deemed appropriate if the sequence followed the pictogram: broad to narrower spectrum AB, and was deemed inappropriate if the sequence differed from the pictogram. Ethics approval was obtained before starting the chart review.ResultsA total of 120 patients were identified pre-/postintervention. 20% (10/51) had received AB in an incorrect sequence prior to the pictogram implementation compared with 11% (8/70) postintervention. AB prescribed were piperacillin/tazobactam (24%), azithromycin (24%) and vancomycin (18%), ceftriaxone (15%) for sepsis arising from pneumonia, urinary tract, and intra-abdominal infections.ConclusionThe availability of a pictogram to guide the sequence of antibiotic administration in the septic patient can assure its correct administration sequence and potentially affect patient outcomes. An improvement (45%,P = 0.2) was seen post implementation suggesting the pictogram to be a helpful visual aid for nurses. Although not statistically significant, the difference implies a tendency that may be explored in a larger sample size to search for a potential effect.

The Birds, Bees, and Special Needs: Making Evidence-Based Sex Education Accessible for Adolescents with Intellectual Disabilities

Adolescents with intellectual disabilities (ID) represent an invisible at-risk population for multiple negative health outcomes. Much like their non-disabled peers, promoting healthy behaviors during adolescence has the potential to improve quality of life later on in life (McPherson et al. in J Appl Res Intellect Disabil 30(2):360, 2017). Many studies have analyzed disparities in obesity (Phillips et al. in Matern Child Health J 18(8):1964, 2014; Stancliffe et al. in Am J Intellect Dev Disabil 116(6):401, 2011), mental health (Charlot and Beasley in J Ment Health Res Intellect Disabil 6(2):74, 2013), and health care access (Baller and Barry in J Disabil Policy Stud 27(3):148, 2016), however sexual health needs further research and translation to practice. Access to sexual health education is limited for many youth with ID (Barnard-Brak et al. in Ment Retard 52(2):85–97, 2014). Studies have shown that students with ID experience higher rates of sexual abuse and assault than their non-disabled peers (Haydon et al. in J Interpers Violence 26(17):3476, 2011; Mahoney and Poling in J Dev Phys Disabil 23(4):369, 2011). Sexually active youth with ID are at a higher risk for contracting sexually transmitted infections compared to their non-disabled peers (Cheng and Udry in J Dev Phys Disabil 17(2):155–172, 2005; Mandell et al. in J School Health 78(7):382–388, 2008). Additional barriers exist including stigma and misperceptions around disability and sexuality and the assumption that the developmental status of the student will prevent sex education comprehension (Sinclair et al. in Educ Train Autism Dev Disabil 50(1):3–16, 2015). Qualitative studies of adult providers (Linton et al. in Sex Disabil 34(2):145–156, 2016; Murphy et al. in J Genet Couns 25(3):552, 2016), parents (Kok and Akyuz in Sex Disabil 33(2):157–174, 2015), and adolescents with ID (Lofgren-Martenson in Sex Disabil 30(2):209–225, 2012) have found overwhelming support for tailored sexual risk reduction interventions (Swango-Wilson in Sex Disabil 27(4):223, 2009). Developing evidence-based, inclusive curricula to prevent sexual coercion as well as promote sexual health self-determination for this vulnerable population is long overdue (McDaniels and Fleming in Sex Disabil 34(2):215, 2016). This study demonstrates the use of Universal Design for Learning (UDL), an educational framework, guidelines, and checklist tools (Eagleton, Universal Design for Learning (UDL), Salem Press, Ipswich, 2015; Center for Applied Special Technology, UDL curriculum self-check 2011 (updated 2011), 2011. http://udlselfcheck.cast.org/resources.php ) to increase accessibility in HIPTeens, an evidence-based sexual risk reduction intervention (Morrison-Beedy et al. in J Assoc Nurses AIDS Care 13(1):21–27, 2002; Res Nurs Health 28(1):3–15, 2005; AIDS Behav 10(5):541, 2006; J Assoc Nurses AIDS Care 21(2):153–161, 2010; West J Nurs Res 33(5):690–711, 2011; J Adolesc Health 52(3):314–321, 2013; J Assoc Nurses AIDS Care 28(6):877–887, 2017). As a result, supplemental curriculum components were developed with UDLguided technology use recommendations. A UDL-integrated evidence-based sexual risk reduction intervention could increase accessibility and, with additional research, could help inform inclusive policy.

JOB SATISFACTION, ORGANIZATIONAL CITIZENSHIP BEHAVIORS AND WORK STRESS: EFFECTS OF NURSING ASSISTANT RESILIENCE

Turnover for nurse aides (NAs) in long-term care (LTC) is estimated to be between 55% and 75% (Wiener, Squillace, Anderson, & Khatusky, 2009) and is related to high levels of employee burnout and low levels of job satisfaction (Rushton, Batcheller, Schroeder, & Donohue, 2015). Employees who are resilient tend to cope positively with work related stressors (Itzhaki et al., 2015); resident aggression is a common workplace stressor experienced by LTC NAs. This study examined whether resilient NAs were more satisfied with their job, experienced less distress from resident aggression, and engaged in more organizational citizenship behaviors (OCBs) as compared to less resilient NAs. In other words, are resilient NAs still engaging in positive work behaviors (OCBs) despite experiencing work-related stress? NAs (N = 110) from six midwestern nursing homes completed a survey that assessed their resilience, job satisfaction, OCBs, and experience of resident aggression. Results indicated that resilience was significantly related to OCBs r(108), p < .001, OCBs were significantly related to job satisfaction r(95), p .002, and resilience was significantly negatively correlated to distress due to resident aggression r(95), p .008. No significant relationships were found between resilience and job satisfaction or OCBs and distress due to resident aggression. Future researchers may consider developing interventions to bolster NA resilience as it is related to OCBs. Subsequently, engaging in OCBs positively relates to job satisfaction which may result in reduced burnout and turnover in NAs. Furthermore, resilience can reduce distress related to a commonly experienced job stress (i.e., resident aggression).

WILL SHE STAY OR WILL SHE GO? FACILITY-LEVEL IMPACTS ON NURSE AIDES’ RETENTION AND TURNOVER RATES IN OHIO NURSING HOMES

Understanding the predictors of direct-care worker turnover rates in nursing homes has received considerable attention. Yet, much less is known about retention rates for direct care workers. Turnover and retention are critical aspects of facilities’ ability to provide cost-effective, high quality, person-centered care. Facilities operate in an environment necessitating constant recruitment, training, and retention efforts to maintain adequate staffing. Our study examines facility-level factors associated with the retention and turnover rates of State-Tested Nurse Aides (STNAs) using data from the 2015 Ohio Biennial Survey of Long-Term Care (response rate = 93.6%; N=898), Medicaid Cost Reports and Nursing Home Compare. We find the mean retention rate for STNAs was 63.9% (s=18.4), the mean turnover rate was 53.9% (s=28.0), and there was a statistically significant negative correlation between STNA retention and turnover (r=-.284). We describe how characteristics, both modifiable and not modifiable at the facility level, affect turnover and retention rates using multiple regression analysis. Facility modifiable characteristics include wage rate, administrator tenure, RN/LPN turnover/retention rates, staffing hours per resident, special unit staffing patterns, culture change, and person-centered care. Non-modifiable characteristics include Medicaid per diem rate, percentage of Medicare residents, facility ownership, facility size, region, occupancy rate, and chain affiliation. Our study compares if the factors that improve turnover also improve retention and provides recommendations about modifiable factors related to direct care worker retention and turnover rates.