A Simultaneous Mixed-Methods Examination of Factors Influencing Intent-to-Leave Among Nursing Home Care Providers in...

We examined nursing home care providers' (NHCPs') self-reported intent-to-leave (ITL) within 1 year and identified associated demographic, well-being, and workplace factors.

We conducted a cross-sectional, mixed-methods study at a single time point via a voluntary, anonymous survey.

A convenience sample of NHCPs from 25 nursing homes associated with 7 academic partners (clusters) in the Centers for Disease Control and Prevention's Nursing Home Public Health Response Network.

The primary outcome was ITL, measured dichotomously. Participants also provided open-ended reasons for their ITL, reported demographics, reported job characteristics, and completed validated measures of burnout, resilience, and workplace incivility. We quantified overall ITL and used multilevel generalized mixed effects regression to identify independent characteristics associated with ITL. Open-ended responses were analyzed using inductive qualitative content analysis.

Overall, 928 NHCPs responded to the survey (49% certified nursing assistants, 29% nurses, 8% therapists, and 13% nonclinical roles). The ITL rate was 36% (cluster average range, 25%-51%), and 35% were classified as burned out (cluster average range, 20%-56%). Most (70%) NHCPs reported experiencing at least 1 type of incivility within the previous 6 months, with 47% reporting high rates. In multivariable models, NHCPs reporting burnout had roughly 4-fold higher likelihood (adjusted odds ratio [aOR], 4.03; 95% CI, 2.79-5.82) of ITL than those without burnout, and NHCPs reporting high rates of incivility were roughly 2-fold more likely (aOR, 2.12; 95% CI, 1.38-3.26) to report ITL. NHCPs most often cited career opportunities (36%), being underpaid (35%), or burnout/exhaustion (20%) as reasons for ITL.

Burnout and incivility in the nursing home workplace were common and increased ITL risk, regardless of job type, duration at facility, or demographics. Interventions to reduce burnout and incivility may promote well-being and reduce NHCP attrition.