Date of Conferral

8-20-2026

Date of Award

August 2026

Degree

Ph.D.

School

Management

Advisor

Robert Levasseur

Abstract

Nursing homes frequently experience leadership and structural disruptions that affect facility performance. The purpose of this quantitative correlational study using archival data was to examine the extent to which ownership change, administrator turnover, and registered nurse turnover predict operational outcomes in U.S. nursing homes. Four Centers for Medicare & Medicaid Services (CMS) measures represented indicators of operational outcomes: (a) staffing rating, (b) rating cycle 1 total health deficiencies, (c) number of fines, and (d) total weighted health survey score. Resource dependence theory and transaction cost economics served as the theoretical foundation. Data from July 2025 CMS public files (N = 11,598 to 11,691) were analyzed using four multiple linear regression models. The results indicated that all four multiple regression models were statistically significant (p < .001). Model fit ranged from R² = .033 to R² = .268, with F values ranging from 132.92 to 1415.00. Administrator turnover and registered nurse turnover were statistically significant predictors of poorer outcomes across all four models. Ownership change was a significant predictor of more health deficiencies and higher weighted health survey scores, but not of staffing ratings or fines. Nursing home administrators and policymakers may use the findings to clarify how these disruptions relate to operational performance. Implications for tangible social impact include the potential for nursing home leaders to implement retention strategies that strengthen clinical continuity and workforce stability, support sustainable regulatory compliance, and optimize nursing home residents’ safety, quality of care, and health outcomes.

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