Background. Registered nurse (RN) shortages, turnover and retention have been concerns of nursing home facilities for decades. Despite increasing attention to nursing home staff turnover, little is known about the association of retention strategies, organizational hygiene features and RN retention in nursing homes.

Methods. Data were obtained from the 2004 National Nursing Home Survey, a nationally representative sample of 1,174 nursing homes in the United States. Our outcome of interest was RN retention of more than one year. The multimodal distribution of RN retention percentages were categorized into grossly equivalent groups of low (0-50%), moderate (51-79%) and high retention (80-100%) facilities. The independent variables consisted of management strategies to retain nurses, features of the work environment, work resources, and organizational attributes. Unweighted and weighted bivariate analyses included Chi Square, t-tests, and ANOVA depending upon the data type. Weighted, multinomial logistic regression analyses were conducted with three, pre-specified models.

Results. Across all groups, the mean retention of RNs was 67.3%. With the exception of career ladders and attendance awards, most retention strategies did not have a significant association with the level of RN retention reported by facilities. Career ladder and attendance award offerings were concentrated in the moderate retention category (51%-79%) versus the high or low retention groups. Nursing homes with chain affiliation, dementia care units, parenteral nutrition services, and those that provided paid sick days for staff had greater odds of being in the moderate RN retention category than the low or high groups. Director of nursing employment tenure had the strongest and most consistent association with RN retention in adjusted analyses with significant variability among low, moderate and high retention categories.

Conclusions. This cross sectional analysis does not provide causal explanations of retention phenomenon in nursing homes, however some relationships were suggested. In order to improve RN retention, nursing home organizations should consider the stability of DON leadership, attend to the clinical practice environment and offer benefit programs that nurses value.