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
Pages (from-to)396-402
Number of pages7
JournalJournal of the American Medical Directors Association
Issue number3
Early online date13 Nov 2023
Publication statusPublished - Mar 2024

Scopus Subject Areas

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

User-Defined Keywords

  • long-term care
  • resident aggression
  • Staff turnover


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