As nursing homes prepare for the Centers for Medicare & Medicaid Services’ proposed minimum staffing mandate — 0.55 hours per resident day for registered nurses and 2.45 hours per resident day for nurse aides — many are left wondering about the effect on staffing turnover.

Senior care advocates LeadingAge and the American Health Care Association estimate that the proposed mandate could cost up to $7.1 billion in the first year alone. They also argue that high rates of staff turnover would make it difficult for many employers to comply with this proposed requirement. According to a recent study published in the Journal of the American Medical Association, however, “labor unions representing nursing home workers, such as the Service Employees International Union (SEIU), argue that unions can decrease turnover by improving job quality, thus helping to maintain a stable workforce and improving resident care.”

Researchers used cross-sectional regression analysis to estimate the association between the presence of a healthcare workers union and total nursing staff turnover rates in US nursing homes.

According to the data, the presence of a union was associated with a 1.7 percentage point decrease in staff turnover.

“When more than 75% of nursing homes in a county were unionized, the facility-level presence of a union was associated with a 9.0 percentage point decrease in staff turnover,” wrote Adam Dean, PhD; Jamie McCallum, PhD; and Atheendar Venkataramani, MD, PhD; et al. 

Unionization might be one way to reduce staffing turnover, however, Christian Bergman, MD, commented in a separate piece, “in the broader framework of staff retention it may be important to consider a person-centered approach to job satisfaction.”

Bergman suggests that nursing homes find ways to retain staff members by improving employee satisfaction and working conditions.

“Unionized nurses may report better employment rights, improved workplace conditions, and advocacy opportunities but some common drawbacks include union dues, mandatory and unpaid strike policies, lack of performance incentives, and mandatory mediation,” he wrote.

This sentiment echoes findings of a recently published study emphasizing the importance of experienced nurse and administrator retention as perhaps equally important for providing quality care. 

“Given the recently announced federal minimum staffing mandates, there is a lot of policy focus at the moment on boosting the number of staff hours per president day. But our results suggest that we should also be giving similar weight to finding ways to retain staff and reduce turnover in an effort to improve nursing home quality,” said study co-author Brian McGarry, PhD, of the Division of Geriatrics and Aging in the Department of Medicine at the University of Rochester.