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The impact of nurse turnover on quality of care and mortality in nursing homes: Evidence from the great recession
This paper uses a sample of California nursing homes to causally identify whether higher staff turnover leads to worse quality.
The impact of nurse turnover on quality of care and mortality in nursing homes: Evidence from the great recession
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, a 10 percentage point increase in nurse turnover results in a facility receiving 1.8 additional deficiencies per annual regulatory survey, reflecting a 16.5 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.
American Journal of Health Economics, doi:10.1162/ajhe_a_00096
