Staff Turnover Intention at Long-Term Care Facilities: Implications of Resident Aggression, Burnout, and Fatigue

Elsie Yan*, Debby Wan, Louis To, Haze K.L. Ng, Daniel W.L. Lai, Sheung Tak Cheng, Timothy Kwok, Edward M.F. Leung, Vivian W.Q. Lou, Daniel Fong, Habib Chaudhury, Karl Pillemer, Mark Lachs

*Corresponding author for this work

Research output: Contribution to journalJournal articlepeer-review


Objectives: Staff shortages and the high turnover rate of nursing assistants pose great challenges to long-term care. This study examined the effects of aggression from residents of long-term care facilities, burnout, and fatigue on staff turnover intention. The findings will help managers to devise effective measures to retain their staff.

Design: Cross-sectional descriptive study design.

Setting and Participants: A total of 800 nursing assistants were recruited from 70 long-term care facilities using convenience sampling.

Methods: The participants were individually interviewed and provided information about their turnover intention, resident aggression witnessed and experienced, self-efficacy, neuroticism, burnout, fatigue, and personal and facility characteristics.

Results: Hierarchical multiple regression analysis revealed that the size and organizational practices of long-term care facilities were not associated with staff turnover intention. Staff who spent less time in the industry reported witnessing resident-to-resident aggression, experienced resident-to-staff aggression, reported high levels of burnout, had acute or chronic fatigue, and had low levels of inter-shift recovery were more likely than others to report a high turnover intention.

Conclusions and Implications: Staff turnover poses great challenges to staff, residents, and organizations. This study identified important factors that may help support staff in long-term care facilities. Specific measures, such as person-centered care to diminish resident aggression by addressing residents’ unmet needs, work-directed programs to mitigate burnout and improve staff mental health, and flexible schedules to prevent fatigue should also be advocated to prevent staff turnover.

Original languageEnglish
Number of pages7
JournalJournal of the American Medical Directors Association
Publication statusE-pub ahead of print - 13 Nov 2023

Scopus Subject Areas

  • Nursing(all)
  • Health Policy
  • Geriatrics and Gerontology

User-Defined Keywords

  • long-term care
  • resident aggression
  • Staff turnover


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