Making tradeoffs between the reasons to leave and reasons to stay employed in long-term care homes: perspectives of licensed nursing staff

Abstract

Background: Turnover of licensed nursing staff in long-term care (LTC) settings (e.g., nursing homes) is a mounting concern and is associated with poor quality of care and low staff morale. Retention and turnover research in LTC have focused primarily on direct care workers (i.e., nurse aides) leaving the issues largely unexplored for licensed nursing staff (i.e., registered nurses and licensed practical nurses).

Objective: The main objective of this study was to understand factors that influence nurses' intentions to remain employed at their current job.

Design: Qualitative descriptive study.

Settings: Seven nursing homes in Ontario, Canada.

Participants: A convenience sample of forty-one licensed LTC nurses.

Methods: Data were collected through focus groups conducted at each of the participating nursing homes. Focus group discussions were transcribed verbatim. Directed content analysis was used to identify and develop themes.

Results: Work conditions were a salient element affecting nurses' intention to stay and included impact of regulations on nurse role flexibility and professional judgment, an underfunded system contributing to insufficient resources and staffing, and a lack of supportive leadership. Factors promoting nurses' willingness to stay included the development of meaningful relationships with residents and staff and opportunities for learning and professional development. Nurses also considered personal and life circumstances (e.g., marital status and seniority) when discussing intention to stay.

Conclusions: Nurses in this study weighed positive and negative work-related factors as well as personal circumstances to determine their intent to stay. Developing a more individualized approach to address attrition of licensed nurses in LTC may be the most successful strategy for improving retention of highly skilled staff in this sector.

Keywords: Intention to stay; Licensed nursing staff; Long-term care work environment; Nursing-staff relationships; Retention; Turnover.