Predictors of job turnover among home health versus hospital nurses: An observational study using the National Sample Survey of Registered Nurses

Authors

Zoe Samson, MaineHealth
Laura M. Wagner, School of Nursing, University of California San Francisco, California, USA; Healthforce Center at University of California San Francisco, USA.
Lauren J. Hunt, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco School of Medicine, California, USA; Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, USA; Global Brain Health Institute, University of California San Francisco, California, USA.
Ulrike Muench, School of Nursing, University of California San Francisco, California, USA; Philip R. Lee Institute for Health Policy Studies, University of California San Francisco School of Medicine, California, USA; Healthforce Center at University of California San Francisco, USA.

Document Type

Article

Publication Date

11-24-2025

Institution/Department

Nursing

Journal Title

International journal of nursing studies

Abstract

BACKGROUND: The need for skilled in-home nursing care is growing, but the home health nursing workforce faces challenges with job turnover, fueling the concern that the supply of these nurses will be inadequate to meet demand. OBJECTIVE: To compare rates and predictors of turnover among registered nurses working in home health compared to hospital settings. STUDY DESIGN: This was a secondary, cross-sectional analysis using data from the National Sample Survey of Registered Nurses (NSSRN) from survey years 2008, 2018, and 2022. POPULATION: Registered nurses in the US labor market (n = 3,381,768 in the 2008/2018 surveys; 1,625,288 from the 2022 survey). METHODS: Data for the 2008 and 2018 surveys were pooled and analyses were conducted separately with the 2022 data due to sample frame changes prohibiting pooled analyses. The primary outcome was job turnover and the independent variable was employment in either a hospital or home health setting. Covariates included sociodemographic, labor and workplace characteristics. We conducted descriptive statistics of sample characteristics and multivariate logistic regression models to estimate marginal effects of predictors on the probability of turnover from the hospital or home health setting. We then assessed interactions between setting and labor/workplace variables to assess predictors of turnover for home health versus hospital registered nurses. RESULTS: Overall, home health registered nurses reported longer career tenures and less advanced educational preparation than hospital nurses. Rates of turnover were comparable between home health and hospital registered nurses. Longer career tenure was generally protective against job turnover, but home health registered nurses were more likely than hospital registered nurses to turnover later in their career. Predicted probability of turnover at 11 to 20 years in nursing was 14.7 % for home health registered nurses (95 % CI 11.2, 18.2) versus 12.1 % for hospital registered nurses (95 % CI 10.9, 13.3). At 21 to 30 years, it was 16.3 % for home health registered nurses (95 % CI 12, 20.5) and 11 % for hospital registered nurses (95 % CI 9.6, 12.4). Interaction terms were also significant for work setting and weekly hours, demonstrating increased likelihood of turnover for home health registered nurses past the 40-h mark. There were no significant interactions identified in the 2022 data. CONCLUSIONS: Our results suggest that attracting nurses earlier in their careers and schedule stabilization may be of particular importance for growth and retention efforts in the home health registered nurse workforce.

First Page

105301

Recommended Citation

Samson, Zoe; Wagner, Laura M.; Hunt, Lauren J.; and Muench, Ulrike, "Predictors of job turnover among home health versus hospital nurses: An observational study using the National Sample Survey of Registered Nurses" (2025). MaineHealth Maine Medical Center. 4227.
https://knowledgeconnection.mainehealth.org/mmc/4227