Quality of care has been a long-standing issue in US nursing homes. The culture change movement attempts to transition nursing homes from health care institutions to person-centered homes. While the adoption of culture change has been spreading across nursing homes, barriers to adoption persist. Nursing homes that disproportionately serve minority residents may have additional challenges implementing culture change compared with other facilities due to limited financial and staffing resources. The objective of this study was to examine how nursing home characteristics are associated with culture change adoption in Central Florida nursing homes. This cross-sectional study included 81 directors of nursing (DONs) who completed the Artifacts of Culture Change survey. In addition, nursing home organizational data were obtained from the Certification and Survey Provider Enhanced Reports (CASPER). A logistic regression was conducted to examine the relationship between high culture change adoption and nursing home characteristics. The overall adoption of culture change scores in Central Florida nursing homes was low. Nevertheless, there was variability across nursing homes in the adoption of culture change. High culture change adoption was associated with nursing homes having lower proportions of Medicaid residents.

Background/Objectives: Nursing staff turnover can adversely affect nursing home (NH) performance. To address staffing shortages, NHs are increasingly turning to agency nursing staff as a solution. This study examined the relationship between the use of agency nursing staff and turnover rates among NH permanent nursing staff. Methods: This retrospective, observational study used secondary data from several sources, including the Payroll-Based Journal, the Care Compare: Five Star Quality Rating System, and Area Health Resource Files (n: =35,200, years: 2021–2023). The dependent variable was turnover rates among registered nurses (RNs), licensed practical nurses (LPNs), and certified nursing assistants (CNAs). The independent variable was the classification of NHs based on their level of agency nursing staff utilization. Facilities were classified as “high utilizers” (the top 25% in agency nursing staff use) and “low utilizers” (the remaining 75%). This classification was informed by prior research indicating that the impact of agency nursing staff on NH performance is most pronounced at higher levels of utilization. A two-way fixed-effects regression model (facility and year) was used, with appropriate control variables. Results: NHs identified as high utilizers had significantly higher turnover rates among permanent RNs (7%) and CNAs (1.9%) compared to facilities that had low utilization of agency nurses (p < 0.001). No significant association was found between agency LPN utilization and LPN turnover. Conclusions: Greater reliance on agency nursing staff was associated with increased turnover, with the strongest effect observed for RNs. NH administrators should consider strategies to balance agency staff utilization with efforts to retain permanent staff, emphasizing long-term workforce stability.