Understanding Turnover Among Nurse Aides: The Role of Incontinence Care, Workplace Dynamics, and Job Demands in Long-Term and Acute Care Settings

Abstract Background and Objectives Nurse Aides (NAs) play a critical role in long-term care and acute care settings, yet turnover rates among NAs remain high, particularly in environments requiring intensive incontinence care. This study examines factors contributing to NA turnover, focusing on incontinence care, direct care challenges, interpersonal relationships, and workplace dynamics. Research Design and Methods Drawing from a cross-sectional sample of 307 NAs from nursing homes and acute care settings, the study analyzes the relationship between time spent on incontinence care, perceived workplace challenges, and turnover intentions. Results Results reveal that time spent on incontinence care significantly predicts perceptions of work being challenging but is not directly associated with turnover intentions. Instead, factors such as poor management support, physical demands, and workplace culture were more predictive of turnover. Discussion and Implications The findings underscore the need for multifaceted interventions that address both the specific demands of incontinence care and broader organizational challenges. Integrating the Triple, Quadruple, and Quintuple Aim frameworks and the socioecological model, this study highlights the importance of workforce well-being and health equity in reducing NA turnover. Policy implications include improving staffing ratios, providing better training, enhancing workplace culture, and addressing health disparities in the healthcare workforce. Future research should explore these factors longitudinally and incorporate validated measures of workplace challenges to establish causality and enhance the generalizability of findings.