(P25) Factors Influencing Intent-to-Leave Among Staff in 25 Nursing Homes

Introduction/Objective: High rates of attrition among nursing home care providers (NHCPs) contribute to a shortage of staff vital to caring for an increasingly aging population. We aimed to characterize rates of self-reported intent-to-leave (ITL) their current job among NHCP and to identify demographic, well-being, and workplace factors associated with ITL.

Design/Methodology : A convenience sample of NHCPs (N = 928) from 25 nursing homes (NHs) in the CDC’s NH Public Health Response Network (NHPHRN) reported demographics and job characteristics and completed validated measures of burnout (measured by Mini-Z score ≥3), resilience (Connor-Davidson Resilience Scale: CD-RISC score), and incivility (perception of work-related bullying behaviors) by Short Negative Acts Questionnaire [SNAQ]) to a voluntary anonymous survey during Jan-May 2024. NHCP also answered ITL (“If it were possible, would you leave your current job within the next year?”) Seven academic partners coordinated recruitment of 3-5 NHs each (i.e., clusters). We quantified overall ITL and used multivariable Generalized Mixed Effects regression models to identify characteristics associated with ITL. We used best subset logistic regression to identify the most parsimonious model based on the Akaike Information Criterion.

Results: Of the 928 NHCP who responded to the survey (49% clinical nurse assistants, 29% nurses, 8% therapists, 13% non-clinical roles), the ITL rate was 36%, ranging from 25%-51% between 7 clusters and 35% of NHCP were classified as burned out (range 20% - 56%.). Most NHCP (70%) reported experiencing at least one type of incivility within the previous six months, with 23% reporting some incivility and 47% reporting high incivility rates with variation by cluster. Common types of incivility included having information withheld deliberately which affected the NHCP’s job performance negatively (e.g., best practices, resident preferences) (46%) and being a target of anger or rage (33%, with 9% reporting at least monthly occurrences). In multivariable models, lower rates of ITL were reported by older (age 50-59) NHCPs (adjusted odds ratio = [aOR] 0.43, 95% CI: 0.24, 0.76) compared with NHCP aged 18-29. NHCP reporting burnout had roughly four-fold higher likelihood (aOR 4.22, 95% CI: 2.91, 6.11) of ITL compared to those without burnout, and NHCP reporting high rates of incivility were roughly twofold more likely (aOR 2.17, 95% CI: 1.41, 3.35) to have ITL compared to those without any incivility exposures. Each point increase on the resiliency score was associated with 2% lower likelihood of ITL on univariate but not significant on multivariate analysis (aOR 0.98, 95% CI: 0.94, 1.01).

Conclusion/Discussion : Burnout and experiencing incivility in the NH workplace were common and increased the risk for ITL, regardless of job type, time in facility, family characteristics, or demographics. Developing and implementing interventions to reduce burnout and improve workplace culture may help to promote wellbeing and reduce attrition among NHCPs.