Understanding factors influencing personal care workers intentions to leave: A systematic integrative review.

Abstract

BACKGROUND AND OBJECTIVES: The global need for older persons' care, driven by demographic shifts such as an aging population and increased life expectancy, is outpacing the available care workforce. Nursing home operators face complex workforce challenges, including high turnover and low retention, particularly among personal care workers (PCW). The objective of this review was to understand the factors influencing PCWs' intention to leave. RESEARCH DESIGN AND METHODS: Following Whittemore and Knafl's methodology and adhering to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, an integrative review of peer-reviewed literature published between 1997 and 2024 was undertaken. A comprehensive search was conducted across several databases, including Business Source Complete, CINAHL Complete, Medline Complete, APA PsycINFO, and EMBASE. All studies underwent independent screening and quality assessment using the Mixed Methods Appraisal Tool. RESULT(S): Included were 21 articles reporting 20 studies using quantitative (n=17), qualitative (n=3), and mixed methods (n=1), which identified various factors influencing PCWs' intention to leave. These factors were categorized as individual, job and organizational, and socio-political-environmental. Demographic characteristics, employee satisfaction, health, career development, workplace conditions, leadership, empowerment, resident connections, and societal perceptions influenced personal care workers' intentions to leave. DISCUSSION AND IMPLICATIONS: The findings of this review reveal opportunities for nursing home operators and policy-makers to implement strategies to mitigate the high rates of turnover through PCW role and organizational reforms. Further, the findings underscore the need for qualitative research exploring the perceptions and experiences shaping the employment intentions of current and former PCWs.Copyright © The Author(s) 2025. Published by Oxford University Press on behalf of the Gerontological Society of America.