NIOSHTIC-2 Publications Search

Working conditions, employee mental health, and intention to leave the job.

Zhang Y
CPH News Views 2011 May; (21):1-2
In one survey of 550 nursing home assistants, 30% reported that they planned to quit their job (Parsons, Simmons, Penn, & Furlough, 2003). However, few studies have examined predictors of intention to leave among the caregivers in long-term care centers. Background -- One CPH-NEW study ("ProCare") involves a large chain of nursing homes. The high turnover rate among employees in long-term care is expensive for the employer and disruptive potentially for other employees and the quality of resident care. This report outlines the selected findings from 1589 self-administered questionnaires collected from clinical staff members in 14 skilled nursing care centers and all staff members in 4 other centers. We examined whether intention to leave the job was related to the work environment. We speculated that falling stressed might be one reason for leaving the job, so we also looked at whether the same aspects of the work environment were associated with mental health. Employees' Intention to Leave -- The survey contained the item, "I am likely to leave this job in the next two years." Nearly 38% of the nursing home surveyed employees reported intention to leave the job in the next two years; 12% reported a "strong" intention to leave (SIL). Working Conditions -- The survey also included how well employees get along with and feel supported by supervisors; feeling respected at work; and opportunities for making decisions on the job. Each of these variables (coworker support, supervisor support, receiving respect, and decision authority) was coded as "low" (0) or "high". The ratings of these four working conditions were added to give an index, ranging from 0 to 4, for the number of beneficial job features. A higher number represented better working conditions. Over a third had a '4' on the index, showing that they experienced all four beneficial job conditions. Only 5% of survey participants had a '0' on the working condition index (meaning the poorest working conditions). The Relationship between Working Conditions and Intention to Leave the Job -- "Strong" intention to leave the job in the next two years was dramatically lower in the people with more beneficial job features. In contrast, people with the worst job features were almost 4 times more likely to leave their job in the next two years than people with 3 or 4 good job features. The Relationship between Working Conditions and Employee Mental Health -- Mental health was measured by the SF-12 mental health subscale. Just like the intention to stay on the job, mental health increased significantly with the number of beneficial job features. Employees who felt support from coworkers, support from supervisors, respect received at work, and opportunities for making decisions about how to do their job, had much better mental health. Conclusions and Recommendations -- Better working conditions translate into better mental health and also into a stronger intention to stay on the job. Possible strategies for improving working conditions in the long-term care environment: 1. Establish an employee-recognition program. 2. Genuinely listen to experiences and opinions of aides when difficulties arise with residents. 3. Give more opportunities for frontline care workers to get involved in making decisions about resident care and center changes. 4. Write thank-you notes or give small prizes for working extra time and working on holidays. 5. Recognize personal accomplishments As part of the CPH-NEW study employee-led teams, in some long-term care facilities, have been putting these ideas into practice. For example, clinical staff members in one center are currently working on building a shift report form for nursing assistants to use to complete the loop of communication between shifts and promote continuity of resident care. Employee-led teams promote coworker support and increase ability to become involved in decision-making.
Total-Worker-Health; Medical-care; Medical-facilities; Medical-personnel; Medical-surveys; Men; Women; Humans; Workers; Work-environment; Questionnaires; Stress; Mental-health; Health-care-personnel
Publication Date
Document Type
Funding Type
Cooperative Agreement
Fiscal Year
Identifying No.
Issue of Publication
Priority Area
Healthcare and Social Assistance
Source Name
CPH-News & Views
Performing Organization
University of Massachusetts, Lowell
Page last reviewed: March 25, 2022
Content source: National Institute for Occupational Safety and Health Education and Information Division