Nurse aide turnover linked to scheduling decisions

Long-term care facilities that scheduled part-time Certified Nursing Assistants (CNAs) with more hours and more consistently with the same co-workers had reduced turnover, according to research led by Washington State University. The findings could help address staffing challenges that affect millions of patients at long-term care facilities nationwide.

Using a model based on real scheduling data of thousands of nurse aides, the researchers estimated that a one-hour increase in CNAs' weekly hours worked could reduce turnover by 1.9%. Also, the analysis found that by scheduling CNAs consistently with the same co-workers or team of co-workers, facilities could reduce turnover by around 24% without any added hours or cost—this simple change can reduce annual operating by up to 7%.

"The most impactful factor is whom they work with," said lead author Kevin Mayo, assistant professor of operations management in the WSU Carson College of Business. "By both balancing working hours and maintaining consistent teams, health care facilities can greatly reduce staff turnover."

Mayo, in collaboration with researchers from the University of Cincinnati and Indiana University, analyzed scheduling data of 6,221 part-time CNAs across 157 long-term care facilities in the United States over a 26-month period. They reported their findings in the journal Manufacturing & Services Operations Management.

The researchers uncovered a U-shaped relationship between CNA working hours and turnover rates, meaning both very short and very long working hours can lead to increased staff turnover. Their analysis also revealed the importance of consistent co-worker teams, as frequent changes in team composition are linked to higher turnover rates.

The study has broader implications for health care management, Mayo said, namely, that effective scheduling can lead to better job satisfaction among CNAs, which is directly linked to improved patient care quality.

"The impact of our study goes beyond reducing turnover rates," he said. "It's about scheduling in a mindful way that enhances the work environment for health-care workers, which in turn benefits the patients they care for and improves outcomes."

The study's findings not only apply to the health care sector but also resonate with broader business management practices, the authors said; they underscore the importance of strategic human resource management, especially in industries with high staff turnover and labor-intensive operations.