Multilevel Factors Associated with Intent to Leave in U.S. Nursing Home Nurses

Abstract

Background: Intention to leave (ITL) is a prognostic factor of nurse turnover. High nursing turnover is associated with poor patient outcomes. Declining nursing home nurse retention is at a crisis level and requires immediate solutions especially with the predicted increase in nursing home residents. Registered nurses (RNs) working in the hospital setting are most often studied in ITL research; however, nursing home nurses have received little scholarly attention. Nursing homes differ in population served, nursing licensure type and ratio, and chronic disease management. Thus, it is possible that ITL factors may be different in nursing home nurses. Design: A retrospective cross-sectional design utilized the United States 2020 and 2022 National Nursing Workforce Surveys. Purpose: To examine nurse factors associated with intent to leave among a population-based sample of United States nursing home nurses. Method: Nurse respondent inclusion criteria included: (1) currently employed, staff nurse primary nursing practice, and the majority of time providing direct care, (2) age 18-56, and (3) primary setting self-identified as nursing home or extended care. A binary logistic regression model was used to assess the impact of several factors (age, gender, race, ethnicity, highest level of nursing education, tenure, work status (part-time or full- time), opportunity elsewhere, and COVID-19 impact. To examine if nursing home nurse ITL factors are different between licensed practical nurses/licensed vocational nurses (LPN/LVNs) and RNs, the binary logistic regression model was repeated with selected LPN/LVNs and RNs cases. Qualitative content analysis was utilized to examine stress experience in the nursing home workplace during the COVID-19 pandemic. Results: Nurse factors that were statistical significantly associated with increased likelihood of reporting ITL were age, ethnicity, race, tenure, and salary. Factors with statistically significant associations of less likely to report ITL included gender, race, salary, work status, increased workload, and changed work setting. This study found certain nursing home nurse ITL factors are opposite from previously researched hospital nurse ITL factors. These factors included age, ethnicity, race, tenure, workload, and highest nursing education. There were also unique ITL factors depending on nurse license type. Preliminary evaluation of qualitative comments on workplace stress response in nursing homes indicates that further evaluation is needed in both respondent number and longitudinally. Conclusions: Gaining knowledge of ITL factors in U. S. nursing homes informs practice, policy, nursing education, and theory. This study addressed a knowledge gap in nursing home nurse ITL. It is currently the sole study of nursing home nurse ITL utilizing a large nurse population-based sample. Knowledge of factors associated with ITL in nursing home nurses would assist with targeted recruitment and retention strategies.