Turnover & Nursing Assistants: Contingent Factors can Trump Job Satisfaction

Studies on staff turnover in long-term care and assisted living communities have typically focused on the influence of job satisfaction, and have typically used “intent to stay” as a proxy for staff retention. However, other workforce research suggests that job satisfaction and intent to stay may be less influential on staff retention among low-income workers, who are more vulnerable to life contingencies than the higher-resource workers that most theories of staff turnover are based on (and developed by). A forthcoming study in the Gerontologist based on 18 nursing homes in the southern US suggests that job satisfaction and intent to stay may not be as influential on nursing assistant retention as life contingencies and other resource-related factors.

This segment of the workforce is relatively more vulnerable to contingencies such as family crises and economic hardship, and generally required to work irregular hours, late shifts, and weekends. Further, a large proportion of these workers are single mothers or otherwise primary breadwinners, despite receiving hourly wages that are generally only a few dollars above the minimum wage. For these reasons, the authors hypothesized that job satisfaction and intent to stay would be less predictive of retention among these workers, who (for example) may be required to leave a well-liked job due to family crises or to the availability of a higher-paying but less satisfying job, or to stay in a dissatisfying job due to pressing financial need.

The data for the study was based on 315 nursing assistants at the 18 participating nursing homes. Supervisors or administers completed surveys on the organizational structure of each nursing home, while the participating workers completed surveys about job characteristics (such as supervisor support and financial rewards), their perceptions of the quality of care at their place of employment, and relevant “contingency factors,” such as whether or not the worker was the primary breadwinner, a single mother (95% of participants were women), receiving public assistance (used as a proxy for financial need), and having health insurance. Participants also reported their job satisfaction and intent to stay. Finally, the researchers tracked whether the participants were still working for the same employer one year after the survey.

Job satisfaction, perceived job characteristics, and intent to stay were not predictive of actual retention among this sample. Interestingly, primary breadwinners were more likely to report an intent to stay, but were actually less likely to stay at their job. Inversely, workers who had been at their jobs for a longer period of time were more likely to report intending to leave their jobs, but actually more likely to stay.

The fact that contingency factors and individual characteristics were predictive of actual retention, and that job satisfaction and intent to stay were not, has important implications for both research and practice. (This does not suggest that job satisfaction may not be important for quality of life for employees and for quality of care, which were not assessed in the study.) For researchers, it suggests that intent to stay should not be used as a proxy for actual retention among lower-resource workers. For administrators and managers, it suggests that remuneration and practical assistance for life contingencies may be more significant for retention than employee satisfaction.


Dill JS, Morgan JC, and Marshall VW. Contingency, employment intentions, and retention of vulnerable low-wage workers: an examination of nursing assistants in nursing homes. The Gerontologist; (2012). E-pub ahead of print. doi: 10.1093/geront/gns085

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