title: Stayers, leavers, and switchers among certified nursing assistants in nursing homes: a longitudinal investigation of turnover intent, staff retention, and turnover.
abstract: OBJECTIVE
  Studies of certified nursing assistant (CNA) turnover in nursing homes are typically cross-sectional and include full-time and part-time workers. We conducted a longitudinal study to evaluate the job factors and work attitudes associated with just full-time staying or leaving. For those who did not stay, we assessed reasons for leaving and satisfaction following job transition.
  
  
  METHODS
  A random sample of CNAs identified through the Pennsylvania Department of Health's CNA registry, working ≥ 30 hr weekly in a nursing facility was surveyed by telephone at baseline and 1 year later.
  
  
  RESULTS
  Of the 620 responding to both surveys, 532 (85.8%) remained (stayers), 52 (8.4%) switched to another facility (switchers), and 36 (5.8%) left the industry (leavers). At baseline, switchers reported higher turnover intentions and fewer benefits compared with stayers and left for new opportunities. Leavers had lower job satisfaction and emotional well-being and left for health reasons. Turnover intentions were predicted by low job satisfaction and low emotional well-being. Actual turnover was predicted only by turnover intentions and by the absence of health insurance. Pay was not a predictor of turnover intent or turnover.
  
  
  CONCLUSIONS
  There are two distinct groups of CNAs contributing to turnover. Attitudinal factors, such as job satisfaction and emotional well-being, are mediated via turnover intentions to effect actual turnover. Even accounting for methodological differences, this turnover rate is lower than previous studies, which use alternative methods and include part-time workers. This study should help nursing home administrators better understand the work-related factors associated with staff turnover.
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, WPIC, PA 15213, USA. rosenji@upmc.edu
authors.forename: Jules
authors.initials: J
authors.lastname: Rosen
authors.forename: Emily M
authors.initials: EM
authors.lastname: Stiehl
authors.forename: Vikas
authors.initials: V
authors.lastname: Mittal
authors.forename: Carrie R
authors.initials: CR
authors.lastname: Leana
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D033182:Intention; D007588:Job Satisfaction; D008137:Longitudinal Studies; D008297:Male; D009728:Nursing Assistants / Q000523:psychology / Q000706:statistics & numerical data* / Q000639:trends; D009735:Nursing Homes; D010414:Pennsylvania / Q000453:epidemiology; D010558:Personnel Loyalty; D010563:Personnel Turnover / Q000706:statistics & numerical data* / Q000639:trends; D011795:Surveys and Questionnaires; D000078329:Workforce