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The Impact of Nurse Turnover on Quality of Care and Mortality in Nursing Homes: Evidence from the Great Recession

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  • Yaa Akosa Antwi

    (Indiana University - Purdue University Indianapolis)

  • John R. Bowblis

    (Miami University)

Abstract

We estimate the causal effect of nurse turnover on mortality and the quality of nursing home care with a fixed effect instrumental variable estimation that uses the unemployment rate as an instrument for nursing turnover. We find that ignoring endogeneity leads to a systematic underestimation of the effect of nursing turnover on mortality and quality of care in a sample of California nursing homes. Specifically, 10 percentage point increase in nurse turnover results in a facility receiving 2.2 additional deficiencies per annual regulatory survey, reflecting a 19.3 percent increase. Not accounting for endogeneity of turnover leads to results that suggest only a 1 percent increase in deficiencies. We also find suggestive evidence that turnover results in lower quality in other dimensions and may increase mortality. An implication of our mortality results is that turnover may be a mechanism for the procyclicality of mortality rates.

Suggested Citation

  • Yaa Akosa Antwi & John R. Bowblis, 2016. "The Impact of Nurse Turnover on Quality of Care and Mortality in Nursing Homes: Evidence from the Great Recession," Upjohn Working Papers 16-249, W.E. Upjohn Institute for Employment Research.
  • Handle: RePEc:upj:weupjo:16-249
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    Cited by:

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    2. Martin Hackmann & Joerg Heining & Roman Klimke & Maria Polyakova & Holger Seibert, 2021. "General Equilibrium Effects of Insurance Expansions: Evidence from Long-Term Care Labor Markets," Upjohn Working Papers 21-357, W.E. Upjohn Institute for Employment Research.
    3. Xavier Flawinne & Mathieu Lefebvre & Sergio Perelman & Pierre Pestieau & Jérôme Schoenmaeckers, 2023. "Nursing homes and mortality in Europe: Uncertain causality," Health Economics, John Wiley & Sons, Ltd., vol. 32(1), pages 134-154, January.
    4. Thomas Rapp & Jonathan Sicsic & Neda Tavassoli & Yves Rolland, 2023. "Do not PIMP my nursing home ride! The impact of Potentially Inappropriate Medications Prescribing on residents’ emergency care use," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(7), pages 1085-1100, September.
    5. Bär, Marlies & Bakx, Pieter & Wouterse, Bram & van Doorslaer, Eddy, 2022. "Estimating the health value added by nursing homes," Journal of Economic Behavior & Organization, Elsevier, vol. 203(C), pages 1-23.
    6. Sean Shenghsiu Huang & John R. Bowblis, 2018. "The principal–agent problem and owner‐managers: An instrumental variables application to nursing home quality," Health Economics, John Wiley & Sons, Ltd., vol. 27(11), pages 1653-1669, November.
    7. R. Tamara Konetzka & Karen B. Lasater & Edward C. Norton & Rachel M. Werner, 2018. "Are Recessions Good for Staffing in Nursing Homes?," American Journal of Health Economics, University of Chicago Press, vol. 4(4), pages 411-432, Fall.
    8. Drost, Alyssa & Alam, M Injamam & Boamah, Sheila & Kralj, Boris & Costa, Andrew & Sweetman, Arthur, 2023. "Multiple jobholding and part-time work among nurses in long-term care homes compared to other healthcare sectors: Evidence from Ontario," Health Policy, Elsevier, vol. 130(C).
    9. Shishir Shakya & Sriparna Ghosh & Conor Norris, 2022. "Nurse Licensure Compact and Mobility," Journal of Labor Research, Springer, vol. 43(2), pages 260-274, June.
    10. Bar, M.; & Bakx, P.; & Wouterse, B.; & van Doorslaer, Eddy.;, 2022. "Estimating the health value added by nursing homes," Health, Econometrics and Data Group (HEDG) Working Papers 22/12, HEDG, c/o Department of Economics, University of York.
    11. Ana Soto-Rubio & María del Carmen Giménez-Espert & Vicente Prado-Gascó, 2020. "Effect of Emotional Intelligence and Psychosocial Risks on Burnout, Job Satisfaction, and Nurses’ Health during the COVID-19 Pandemic," IJERPH, MDPI, vol. 17(21), pages 1-14, October.
    12. Juan Mao & Baolei Qi, 2017. "Determinants and Economic Consequences of Signing Auditor Turnover: A Large-Scale Study from China REPORT," Working Papers 0138acc, College of Business, University of Texas at San Antonio.
    13. Mommaerts, Corina & Truskinovsky, Yulya, 2020. "The cyclicality of informal care," Journal of Health Economics, Elsevier, vol. 71(C).
    14. Vicente Prado-Gascó & María del Carmen Giménez-Espert & Hans De Witte, 2021. "Job Insecurity in Nursing: A Bibliometric Analysis," IJERPH, MDPI, vol. 18(2), pages 1-13, January.
    15. Cécile Martin & Mélina Ramos-Gorand, 2017. "High turnover among nursing staff in private nursing homes for dependent elderly people in France: impact of the local environment and the wage," Economie et Statistique / Economics and Statistics, Institut National de la Statistique et des Etudes Economiques (INSEE), issue 493, pages 49-66.
    16. Castro-Pires, Henrique & Mello, Marco & Moscelli, Giuseppe, 2023. "Foreign Nurses and Hospital Quality: Evidence from Brexit," IZA Discussion Papers 16616, Institute of Labor Economics (IZA).

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    More about this item

    Keywords

    Employee turnover; unemployment rate; quality of care; nursing home;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • J21 - Labor and Demographic Economics - - Demand and Supply of Labor - - - Labor Force and Employment, Size, and Structure
    • E24 - Macroeconomics and Monetary Economics - - Consumption, Saving, Production, Employment, and Investment - - - Employment; Unemployment; Wages; Intergenerational Income Distribution; Aggregate Human Capital; Aggregate Labor Productivity

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