Please use this identifier to cite or link to this item: https://hdl.handle.net/10419/172211 
Year of Publication: 
2016
Series/Report no.: 
Upjohn Institute Working Paper No. 16-249
Publisher: 
W.E. Upjohn Institute for Employment Research, Kalamazoo, MI
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, 10 percentage point increase in nurse turnover results in a facility receiving 2.2 additional deficiencies per annual regulatory survey, reflecting a 19.3 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. An implication of our mortality results is that turnover may be a mechanism for the procyclicality of mortality rates.
Subjects: 
Employee turnover
unemployment rate
quality of care
nursing home
JEL: 
I11
J21
E24
Persistent Identifier of the first edition: 
Document Type: 
Working Paper

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