Rural-Urban Differences in Addressable Drivers of Staff Turnover in Skilled Nursing Facilities

We conducted a cross-sectional analysis of the Provider Information File from the Centers for Medicare & Medicaid Services using the July 2023 data set. Total nursing staff turnover and, separately, registered nursing staff turnover was obtained from this file. Nursing homes were linked to the county in which they are located based on facility address. Nursing homes were defined as rural or urban based on non-metropolitan/metropolitan status of the county. We compared turnover rates across nursing homes based on rurality, staff workload, ratio across different types of nursing personnel, and quality score. Using descriptive statistics and bivariate analyses, we:

• Examined whether turnover is greater in rural or in urban counties.
• Tested whether nursing homes with the lowest quartiles for nurse to resident hours have higher nursing turnover rates.
• Examined whether that relationship is the same in rural and urban counties.
• Compared the ratio of registered nurse time to other nursing staff time.

Publications

• Rural-Urban Comparisons of Nursing Staff Turnover Among Skilled Nursing Facilities
  Policy Brief
  University of South Carolina Rural Health Research Center
  Date: 09/2025
  This study assessed facility-level turnover rates for nursing and registered nurse personnel across levels of rurality and by region.