How does organization structure affects certified nurse assistant turnover rate?

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Certified nursing assistant (CNA) turnover simply refers to the number of CNAs who are hired by a healthcare organization who end up quitting the job in the long run. A higher turnover rate always affects the staff ratio, patient load and the organization administration negatively which in the long run affects the quality of services and care provided by the hospital. In this research paper I am going to evaluate the various causes of the high rate of CNA turnover within the nursing facility with more emphasis put on the organization structure, job factors, job satisfaction and lastly employees pay and benefits.

Background Information

The organization under review is a nursing facility which provides a 24hour nursing care with services provided divided into three main groups namely; 1) Skilled nursing care- this mainly involves medical care services. 2) Rehabilitative services for the disabled and lastly 3) Long term care services.

However due to the extreme rise in the CNA turnover rate recently within the organization there is a need to carry out research with an aim of identifying some of the common causes of this increase in turnover rate with emphasis put on the job satisfaction, organization structure, job factors and lastly employees pay and benefits. Generally, high CNA turnover rates have also affected other health care organizations in the past and this resulted into poor service delivery by this organizations. Hence, there is a need for the major causes of the high turnover rates to be identified and appropriate action taken which in the long run will ensure that only quality services and care is provided by the organization to its patients.

Statement of the Problem

The high turnover rate of the certified nursing assistants within the nursing facility has greatly affected the quality of services provided by the facility due to the negative impacts it has only the staff ratio, patient load and even the various administrative costs. Hence a research will be carried out to identify the various causes of the high CNA turnover with major emphasis put on organization structure, job factors, job satisfaction, and lastly employees’ benefits and pay.

Research Question

1) How does organization structure affects certified nurse assistant turnover rate?

2) How does job satisfaction affect certified nurse assistant turnover rate?

3) How do different job factors affect certified nurse assistant turnover rate?

4) How do employees payment and benefit affects certified nurse turnover rate?

Purpose of the study

The study will help identify some of the common causes of increase in the rate of turnover of the certified nurse assistants within the nursing facility hence enabling the facility’s administration to come up with and implement various plans to enable them overcome this problem.

Literature review

Organization Structure

According to Mansfield (1997) article on turnover among nursing home staff, organizational factors such as lack of promotional opportunities, long working hours and poor organization communication system contributed greatly to high turnover rates of the nursing staff in an organization. An article by Riggs and Rantz (2001) further emphasizes this. They noted that bureaucratic organizational structures and poor personnel policies with regards to support, communication and supervision were a major cause of increased turnover rate amongst the nursing staff. Those organizations that had maintained the traditional bureaucratic structure which had a standard operating procedure with no room for flexibility had a higher staff turnover rate compared to the more flexible organization with no traditional bureaucratic structure.

Job Factors

According to Cready et al (2008) analysis of 5 nursing homes where CNA empowered work teams had been implemented and 5 other nursing homes where the traditional management methods were still being practiced it was noted that those who practiced traditional management methods had a higher turnover rates than those who had implemented the work empowerment programs. According to Tellis-Nayak, (2010) article it was also noted that some factors such as working under tight regulations, external pressures, court battles and low suits, easy penalizations and lack of motivation were also some of the cause high turnover rates amongst the nursing staff in various organizations.

In addition Hwang, (2009) noted that various financial constraint and low budget allocation to the healthcare sector was also another cause of high turnover rates among nursing staff due to the frustrations that came with inability to offer some necessary services to the needy patients due to lack of resources and various medical equipment.

Also in a bid to reduce the burnout experienced by nurses due to work overload that would in the long run result in a higher turnover rate amongst the overwhelmed work force the Pennsylvania Association of Staff Nurses and Allied Professionals sponsored a bill that would ensure adequate staffing of the California hospitals and also were in support of the prohibition of excessive overtime for the nurses act. This acted as a proof of the fact that work overload and understaffing were some of the common causes of high turnover rates.  Lastly according to Beatty (2006) it was noted that adequate resources allocation and adequate staffing of the healthcare system was a great way of empowering the certified nurse assistant hence ensuring that their turnover rates were greatly reduced.


Job satisfaction

From the various articles reviewed job satisfaction was also seen as a major factor affecting CNA turnover rates. According to Mansfield (1997) those employees who felt that their current job was fully utilizing his/her skills with a good salary in return had a low turnover rate compared to those who felt that they were underplayed and their skills were not being put into full exploitation. This was further emphasized by Snow and White (2007) in their article

Employees Payments and Benefits

According to Mansfield article it was also noted that the pay and availability of general or specialized training to the employees greatly affected their turnover rates. Those who were paid well with various training services provided had a lower turnover rates compared to their counterparts with low pay with no specialized training provided. According to Althoff in one of his articles in oncology nursing forum he stated that provision of specialized training was one of the ways of retaining nursing personel within an organization further emphasizing the idea that provision of training facility greatly affect employee turnover rates. This is further emphasized by Trossman’s article on a bridge between two countries built by nurses.


1) Riggs, C. J., & Rantz, M. J. (2001). A Model of Staff Support to Improve Retention in Long-Term Care. Nursing Administration Quarterly, 25(2), 43-54. doi:10.1097/00006216-200101000-00009

2) Cohen-Mansfield, J. (1997). Turnover Among Nursing Home Staff. Nursing Management (Springhouse), 28(5). doi:10.1097/00006247-199705010-00015

3) Trossman, S. (2018). A bridge between countries built by nurses. Interview by.from

4) Cready, C. M., Yeatts, D. E., Gosdin, M. M., & Potts, H. F. (2008, March). CNA empowerment: Effects on job performance and work attitudes. Retrieved April 12, 2018, from

5) Snow, M., White, L., G. (2007). What do CNAs want? A survey. Retrieved April 12, 2018, from

6) Beatty, L. (2006). Empowering the CNA. Retrieved April 12, 2018, from

7) Tellis-Nayak, V. (2010) Dark clouds over long-term care? Retrieved April 12, 2018, from

8) Pennsylvania Nurses Boost Cna/Nnoc’s Ranks To 80,000. (2008). Journal of Patient Advocacy;Jan2008, Vol. 104 Issue 1, p4

9) Althoff, C. (2006). Treat Me Right; Retention Strategies Give Oncology Staff Commitment to the Unit. Journal on Oncology Nursing Forum, 33(2), 452.

10) Hwang, L. (2009). Getting Results. Retrieved from WWW.CALNURSES.ORG




1) Database used

PubMed. It the most credible and reliable medical website





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