Leavers And Stayers: An Ecological Analysis Of Determinants Of Employee Retention In Long-Term Care

The understanding of issues related to staff retention in long-term care requires a systematic and holistic examination of the care environment. Guided by the joining of two theoretical perspectives, human ecology and community capacity, we compared workers’ responses to a series of questions designed to assess individual, family and community influences on worker retention. Data were gathered from 156 direct care and support services staff members employed at a 120-bed facility. Over an 18-month period, 53% of the employees left the facility. Compared to employees who remained at the facility, those who left were significantly more likely to be younger, have a lower family income, and report feeling less prepared for the responsibilities associated with their job, less of a sense of work community connections, and less collective competence. No significant differences were found in the responses of the leavers by job position. Within positions, nurses who left reported significantly more family worries than those who stayed. CNAs who left were significantly younger than those who stayed. For support staff (i.e., dietary, housekeeping), leavers reported less work community connections, were less prepared for their jobs, and were less commitment to their jobs. Employment intentions for employees who left were explained by job match, job commitment and feeling rewarded. Employment intentions for employees who stayed were explained by family support, community connections, and employment-based outcomes. Findings suggest that multiple contextual and community-oriented factors influence retention of nursing home staff, and ultimately the quality of care of older adults.