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

Yaa Akosa Antwi and John Bowblis
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Yaa Akosa Antwi: Johns Hopkins Carey Business School y.akosa.antwi@jhu.edu Author email: y.akosa.antwi@jhu.edu

American Journal of Health Economics, 2018, vol. 4, issue 2, 131-163

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, 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.

Keywords: employee turnover; unemployment rate; quality of care; nursing home (search for similar items in EconPapers)
JEL-codes: E24 I11 J21 (search for similar items in EconPapers)
Date: 2018
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Related works:
Journal Article: The Impact of Nurse Turnover on Quality of Care and Mortality in Nursing Homes: Evidence from the Great Recession (2018) Downloads
Working Paper: The Impact of Nurse Turnover on Quality of Care and Mortality in Nursing Homes: Evidence from the Great Recession (2016) Downloads
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