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Association Between Staff Turnover and Nursing Home Quality – Evidence From Payroll-based Journal Data

Qing Zheng, Ph.D., Christianna S. Williams, Ph.D., and Alan J. White, Ph.D., Abt Global; and Evan T. Shulman, MS, Centers for Medicare & Medicaid Services


May 19, 2022

Staff turnover is considered an important indicator of nursing home quality. Abt Global used auditable staffing data from the Centers for Medicare & Medicaid Services (CMS) Payroll-Based Journal (PBJ) system to examine:

  • Turnover among nurse staff and administrators at 13,631 nursing homes.
  • The relationship between turnover and nursing home quality.

We calculated staff turnover measures and linked them to nursing home quality measures and star ratings published on CMS' Nursing Home Care Compare website. Mean annual turnover rates were about 44 percent for registered nurses and 46 percent for total nurse staff. On average, there was one administrator leaving each nursing home during the 12-month period, although about half of nursing homes had no administrator turnover. For-profit and larger nursing homes had higher turnover rates, and higher turnover was consistently associated with lower quality of care.