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Leadership, Staff Empowerment, and the Retention of Nursing Assistants: Findings From a Survey of U.S. Nursing Homes
Journal of the American Medical Directors Association ( IF 7.6 ) Pub Date : 2020-09-01 , DOI: 10.1016/j.jamda.2020.01.109
Clara Berridge 1 , Julie Lima 2 , Margot Schwartz 2 , Christine Bishop 3 , Susan C Miller 2
Affiliation  

OBJECTIVES We examined the relationship between nursing assistant (NA) retention and a measure capturing nursing home leadership and staff empowerment. DESIGN Cross-sectional study using nationally representative survey data. SETTING AND PARTICIPANTS Data from the Nursing Home Culture Change 2016-2017 Survey with nursing home administrator respondents (N = 1386) were merged with facility-level indicators. METHODS The leadership and staff empowerment practice score is an index derived from responses to 23 survey items and categorized as low, medium, and high. Multinomial logistic regression weighted for sample design and to address culture-change selection bias identified factors associated with 4 categories of 1-year NA retention: 0% to 50%, 51% to 75%, 76% to 90%, and 91% to 100%. RESULTS In an adjusted model, greater leadership and staff empowerment levels were consistently associated with high (76%-90% and 91%-100%) relative to low (0%-50%) NA retention. Occupancy rate, chain status, licensed practical nurse and certified nursing assistant hours per day per resident, nursing home administrator turnover, and the presence of a union were also significantly associated with higher categories of retention (vs low retention). CONCLUSIONS AND IMPLICATIONS Modifiable leadership and staff empowerment practices are associated with NA retention. Associations are most significant when examining the highest practice scores and retention categories. Nursing homes seeking to improve NA retention might look to leadership and staff empowerment practice changes common to culture change.

中文翻译:

领导力、员工赋权和护理助理的保留:美国疗养院调查的结果

目标我们研究了护理助理 (NA) 的留任率与衡量疗养院领导力和员工授权的衡量标准之间的关系。设计 横断面研究使用具有全国代表性的调查数据。设置和参与者 2016-2017 年疗养院文化变化调查的数据与疗养院管理员受访者 (N = 1386) 合并了设施级别的指标。方法 领导力和员工赋权实践得分是从对 23 个调查项目的回答中得出的指标,分为低、中和高。多项逻辑回归加权样本设计和解决文化变化选择偏差确定与 4 类 1 年 NA 保留相关的因素:0% 到 50%、51% 到 75%、76% 到 90% 和 91% 到100%。结果 在调整后的模型中,更高的领导力和员工授权水平始终与高(76%-90% 和 91%-100%)相对于低 (0%-50%) NA 保留率相关。入住率、连锁店状况、每位居民每天的执业护士和经认证的护理助理小时数、疗养院管理员更替以及工会的存在也与较高的保留率类别(与低保留率相比)显着相关。结论和影响 可修改的领导和员工授权实践与 NA 保留相关。在检查最高实践分数和保留类别时,关联最为重要。寻求提高 NA 保留率的疗养院可能会寻求领导力和员工赋权实践与文化变革的共同点。
更新日期:2020-09-01
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