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Physical Design, Social Climate, and Staff Turnover in Skilled Nursing Facilities

Originally Published:
Key Point Summary
Key Concepts/Context

High staff turnover in skilled nursing facilities increases workloads, recruitment, hiring, and training as well as negatively impacts morale, social relationships, and quality of care. Examining the overall work context of nursing homes—including their physical design features and social climate—could help to better understand and improve employee retention.


This study evaluates the relationship between staff turnover and staff characteristics, resident resources, physical design, and social climate in community nursing homes and long-term care facilities for veterans. 


Researchers used the Multiphasic Environmental Assessment Procedure (MEAP) to measure physical features, policies and services, resident and staff characteristics, and social climate.

Design Implications
The results suggest that enhancing physical design features such as social-recreational aids and prosthetic aids may support staff’s work efforts and, thereby, reduce turnover. Making facilities more ordered and predictable may reduce conflict and encourage mutual helping among staff and residents, which may lead to improved employee retention. However, to minimize staff turnover, it is important to balance order and predictability with concern for resident input. The findings of this study may be used to generate discussion among administrative and nursing staff about ways to improve the social climate and enhance physical design features that may serve to guide follow-up assessments regarding the effectiveness of physical design features.

The researchers reported that in the Community Facilities Sample, turnover was unrelated to the physical design features, but related to the social climate dimensions (more conflict, less cohesion, less organization, and less resident influence). In the Veterans Facilities Sample, the researchers found that turnover was unrelated to social climate, but greater where there were fewer physical amenities, social-recreational aids, and prosthetic aids and less environmental diversity.


The authors note that one limitation of the study is that it did not address all the areas that can influence staff turnover, such as the labor market conditions, employees’ personal circumstances, or facility benefits. They also note that the case-study design limits the degree of generalizability of the results to other settings.

Design Category
Furniture, Fixtures & Equipment (FF&E)|Interior Material|Room configuration and layout|Unit configuration and layout
Outcome Category
Staff productivity / efficiency
Environmental Condition Category
Attractiveness of physical environment
Primary Author
Brennan, P. L.