Predictors of nursing staff voluntary termination in long-term care facilities

Background and Objective: Nursing staff turnover is recognized as a large problem in the healthcare sector in many countries. Most attention has been devoted to understanding employee turnover from the facility level, with less attention paid to the work environmental predictors of nursing staff leaving employment at the individual level. Methods: Questionnaire surveys were collected among nursing staff in 18 long-term care facilities on up to five occasions between 2006 and 2012. Voluntary termination data were provided by the company with a complete list of staff terminations in these facilities between May 2006 and March 2012. “Cases” were those who had left employment voluntarily after answering a survey administered by the investigators. “Controls” were survey respondents still employed and matched to cases on age, job category (CNA, LPN, RN), and survey occasion. One control was randomly chosen from the set of possible matches for each case. Results: Conditional regression models suggested that evening shift work was a contributing factor to voluntary termination (HR=1.81, p<0.01), while working other jobs was a protective factor (HR=0.67, p<0.05). Intention to leave predicted later voluntary termination (HR=1.20, p<0.05) and did not mediate the association of the other two factors. Conclusions: This study suggests that voluntary termination from long-term care work is affected by work scheduling issues. Future work might include qualitative studies to elicit nursing staff opinions about reasons for turnover in the long-term healthcare sector.