Leadership, Resources, and Workforce Stability in Long-Term Care: A Systematic Review

To systematically examine how frontline leadership, including its managerial functions, influences staff turnover and retention in long-term care (LTC) through organizational and psychological processes and to integrate these findings within the frameworks of the Job Demands-Resources model and Conservation of Resources theory.

Systematic review with narrative synthesis.

Studies conducted in LTC settings, including nursing homes, residential care, and aged care facilities.

A systematic search of PubMed and Scopus was conducted for studies published from 2016 to 2026. Studies examining associations between leadership or management factors and turnover or retention outcomes were included. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses-guided screening, 14 studies were selected. A narrative synthesis approach was used to identify common mechanisms.

Across the included studies, more favorable retention-related outcomes were generally observed alongside supportive supervision, higher-quality leader-staff relationships, and leadership commitment, whereas less favorable outcomes were observed with higher job demands, including workload and administrative burden. Most quantitative evidence was cross-sectional, and methodological appraisal indicated variation in measurement approaches and psychometric support, although several studies used established multi-item instruments. Taken together, the findings suggest that leadership-related factors may be linked to turnover and retention through organizational, psychological, and relational pathways. Interpretation within the Job Demands-Resources and Conservation of Resources frameworks further suggests that these patterns may reflect the balance of job demands and resources and employees' experiences of resource gain and loss.

Leadership plays a central role in workforce stability in LTC settings through interconnected structural, relational, and psychological mechanisms. Turnover should be understood as a dynamic process of resource gain and loss. Interventions aimed at improving retention should extend beyond workload management to include strengthening relational environments, fostering psychological safety, and supporting intrinsic motivation. These findings have implications for the implementation of workforce and organizational interventions in LTC settings.