A dual-driver model of retention and turnover in the direct care workforce.

PURPOSE The purpose of this study was to understand the factors associated with turnover and retention of direct care workers. We hypothesize that a dual-driver model that includes individual factors, on-the-job factors, off-the-job factors, and contextual factors can be used to distinguish between reasons for direct care workforces (DCWs) staying on the job or leaving the job. DESIGN AND METHODS We conducted 7 focus groups with 47 participants. We identified key themes they used to describe their experiences focusing on differences between stayers (had been in the same job for at least 3 years) and leavers (had changed jobs within the past 3 years). RESULTS Five major themes associated with turnover were identified as follows: (a) lack of respect, (b) inadequate management, (c) work or family conflicts, (d) difficulty of the work, and (e) job openings. Themes associated with retention were as follows: (a) being "called" to service, (b) patient advocacy, (c) personal relationships with residents, (d) religion or spirituality, (e) haven from home problems, and (f) flexibility. Themes associated with turnover were different from those associated with retention. IMPLICATIONS DCW turnover and retention are complex, multifactorial issues. Efforts to stabilize the DCW must address the issues associated with retention as well as those associated with turnover. Specifically, factors that promote retention may be qualitatively different than those that prevent turnover. Treating retention and turnover as simply the obverse of each other may be misleading in addressing the underlying problem of job stability among DCWs.