A Life Course Approach to Understanding Job Satisfaction and Turnover Intentions Among Nursing Home Staff: A Mixed Method Study

Nursing homes continue to experience persistent challenges in retaining nursing home (NH) staff. In this dissertation, I argue that understanding the life course context of nursing home staff has the potential to shed needed light on this persistent issue. The life course perspective emphasizes understanding the dynamic interplay of personal, social, organizational, and historical factors and how this dynamism influences lives. I use a mixed method research design allowing me to analyze cross-sectional surveys (n=678, 23 NHs) and interview data (n=25, 2 NHs) complementing each other at various phases of this dissertation. I use multiple linear and ordinal logit regressions to estimate predictive models consisting of demographic, job quality, and life course factors influencing job satisfaction and employment intentions. I use modified grounded theory and constant comparative methods to interpretively identify themes in the interview data, leading to 20 major themes. Life course-relevant findings include intergroup differences in employment intentions by life course markers and identities, e.g., gender, race, marital status, life course stage, and career stage, demonstrating a significant impact on job satisfaction and intent to stay. Life course contingencies such as benefits, and breadwinner status also significantly influence job satisfaction and intent to stay. Further, I find evidence that cumulative disadvantages, job attitude, professional learning, equality and fairness, supportive leadership, emotional burnout and care concerns have additional significant impacts on both job satisfaction and intent to stay. Findings from the analysis of interviews lend support to the quantitative findings. This study has practical implications for nursing home leadership and policy makers. Nursing home leaders must amend their conventional strategies of retaining the LTC workforce by creating tailored support for workers while addressing job quality deficits. Access to mental health services, assessment of turnover risks at various life courses and career stages, professional support, increased leave for caregiving and respite, improved access to high-quality health insurance and benefits that assist this workforce in dealing with contingency factors and career mobility (e.g., small grants, tuition remission) have the potential to alleviate some of the instability in this often-vulnerable workforce.