Contingency, employment intentions, and retention of vulnerable low-wage workers: an examination of nursing assistants in nursing homes

Abstract

Purpose of the study: While theories of job turnover generally assume a strong correlation between job satisfaction, intention, and retention, such models may be limited in explaining turnover of low-wage health care workers. Low-wage workers likely have a lower ability to act on their employment intentions or plans due to a lack of resources that serve to cushion higher wage workers. In this study, we examine the relationship between job satisfaction, intention, and retention of nursing assistants in nursing homes and the role that "contingency factors" play in employment intentions and retention. We conceptualize "contingency factors" as resource-related constraints (e.g., being a single mother) that likely influence employment trajectories of individuals but can be independent of job satisfaction or intent.

Design and methods: We use survey data from 315 nursing assistants in 18 nursing homes in a U.S. southern state to model employment intentions and retention.

Results: We find that job satisfaction and other perceived job characteristics (e.g., workload and perceived quality of care) are significant predictors of an individual's intent to stay in their job, the occupation of nursing assistant, and the field of long-term care. However, we find that job satisfaction and employment intentions are not significant predictors of retention. Instead, "contingency factors" such as being a primary breadwinner and individual characteristics (e.g., tenure and past health care experience) appear to be stronger factors in the retention of nursing assistants.

Implications: Our findings have implications for understanding turnover among low-wage health care workers and the use of proxies such as employment intentions in measuring turnover.

Figure 1.

A conceptual model of determinants of nursing assistant retention/turnover.