Identifying and reducing stress and job turnover in aged care workers using an innovative virtual-reality approach

A total of 64 employees participated in the initial assessment phase of the project, with 45 employees completing follow-up assessments six months later. Participants completed measures of workplace stress, effort–reward imbalance, overcommitment, workplace hassles, and intention to leave the organisation. Cognitive performance and physiological indicators of autonomic arousal were assessed using the CONVIRT platform. Twelve participants subsequently engaged with the VR relaxation intervention, which involved guided breathing within immersive virtual nature environments. 

Understanding Staff Wellbeing and Retention 

Participants reported levels of workplace stress that exceeded published norms for many occupational groups. Effort–reward imbalance scores were particularly elevated. Effort–reward imbalance occurs when employees feel that the effort they put into their work is not matched by recognition, reward, support, or opportunities for development. Approximately half of participants reported levels associated with increased risk of adverse health outcomes. 

Overcommitment scores were also substantially higher than normative data. This suggests many employees experienced difficulty switching off from work and were prone to think about workplace issues after their shifts had ended. 

Despite elevated stress levels, overall intention to leave the organisation was relatively low compared with published benchmarks. At Time 1, 17% of participants reported levels indicative of a heightened intention to leave, decreasing to 9% at follow-up. 

Analysis of workplace stress factors identified effort–reward imbalance as the strongest predictor of intention to leave. In particular, perceptions of inadequate reward, recognition, status, and career opportunities were more strongly associated with staff intention to leave than workload or effort alone. These findings suggest that employee retention may be improved by addressing how employees perceive the value and recognition they receive from their organisation. 

In addition to examining intention to leave, actual workforce turnover was tracked during the period from November 2025 to March 2026. During this four-month period, turnover among employees who did not participate in the project was 11.3% (81 of 720 employees), compared with 6.3% (4 of 64 employees) among employees who participated in the study. This corresponds to annualised turnover rates of 33.8% and 18.8%, respectively. Although the difference did not reach statistical significance, likely due to the relatively small number of participating employees, the observed pattern suggests that employees who engaged with the project were less likely to leave the organisation during the observation period. While causal conclusions cannot be drawn, the findings provide preliminary evidence that participation in wellbeing-focused initiatives may be associated with improved workforce retention and warrant further investigation in larger studies. 

Physiological Indicators of Workplace Stress 

A unique feature of this project was the use of pupillometry, a technique that measures small changes in pupil size to provide an objective indicator of physiological stress and arousal. Changes in pupil metrics were associated with changes in turnover intention, even after controlling for demographic factors and self-reported workplace stress. The addition of physiological data improved the prediction of employees’ intention to leave the workplace beyond that provided by self-report measures alone. 

These findings suggest that physiological markers of stress may provide valuable supplementary information for understanding employee wellbeing and identifying individuals at risk of disengagement, burnout, or workforce withdrawal. 

Virtual Reality Relaxation Intervention 

Twelve employees participated in the VR relaxation intervention. The intervention consisted of guided breathing exercises undertaken within immersive virtual nature environments, including beach, forest, and river settings.

Although adherence to the six-week intervention was modest, significant immediate benefits were observed following participation. 

The intervention produced substantial reductions in anxiety. Participants demonstrated a 26.9% reduction in anxiety scores following a relaxation session, with over 90% achieving clinically meaningful improvement. Many participants transitioned from high-anxiety classifications to low-anxiety classifications following the intervention. 

Significant reductions in fatigue were also observed. Participants reported lower fatigue scores following the intervention, with many moving from high-fatigue to moderate-fatigue categories. These improvements suggest that brief VR-based relaxation experiences may assist employees in recovering from the physical and psychological demands of work. 

Importantly, objective physiological benefits were also observed. One-third of participants demonstrated reliable reductions in autonomic arousal following participation, indicating clinically meaningful improvements in physiological stress regulation. These findings provide evidence that the intervention influenced not only self-reported wellbeing, but also objective biological markers associated with stress. 

Implementation and Engagement Findings 

One of the most important findings of the project related to employee engagement. Recruitment and participation rates were lower than anticipated despite strong managerial support, paid participation time, and financial reimbursement. 

Feedback suggested that many employees were reluctant to leave their duties to participate because they were concerned about increasing workload for colleagues or reducing support available to residents. This finding highlights the significant commitment employees feel toward both residents and co-workers and suggests that workforce wellbeing initiatives must be carefully integrated into operational workflows. 

The project was developed collaboratively with Sundale management to maximise organisational feasibility and support. However, the engagement challenges suggest that future wellbeing initiatives may benefit from broader co-design processes that include direct care staff alongside managers and organisational leaders. Frontline employees may be uniquely positioned to identify practical barriers, preferred delivery methods, and strategies for integrating wellbeing activities into daily work practices.

The project demonstrates that workplace stress remains a significant issue within the aged care workforce, particularly in relation to effort–reward imbalance and overcommitment. Perceptions of inadequate reward and recognition were identified as key drivers of turnover intention, suggesting that organisational factors play an important role in workforce retention. 

The findings also demonstrate the value of combining subjective and objective measures of employee wellbeing. Physiological indicators of autonomic functioning provided additional insights into employee stress and turnover risk beyond traditional self-report measures. 

The VR relaxation intervention showed promising results, producing reductions in anxiety, fatigue, and physiological arousal. While larger studies are required to determine long-term effects on burnout and staff retention, the intervention demonstrated potential as an accessible and practical workplace wellbeing strategy. 

The project highlighted the importance of implementation processes. While organisational co-design occurred through collaboration with management, future initiatives may benefit from greater involvement of direct care staff in the design and delivery of workplace wellbeing programs to improve participation, ownership, and engagement. 

Based on the project findings, the following recommendations are proposed for industry: 

1. Prioritise reward and recognition initiatives to address effort–reward imbalance and improve workforce retention. 
2. Implement ongoing workforce wellbeing monitoring using both self-report and objective physiological indicators where feasible. 
3. Further evaluate and expand VR-based wellbeing interventions as a practical method of reducing anxiety, fatigue, and physiological stress among aged care employees. 
4. Create organisational conditions that support participation in wellbeing activities, including protected time, visible managerial endorsement, and integration into normal work practices. 
5. Adopt broader co-design approaches that involve direct care staff alongside managers and organisational leaders when developing wellbeing initiatives. Greater frontline involvement may improve relevance, engagement, participation, and sustainability. 
6. Conduct larger-scale longitudinal research to determine whether repeated participation in VR relaxation interventions produces sustained improvements in wellbeing, reduced burnout, lower absenteeism, and enhanced workforce retention. 

7. Recognise workforce wellbeing as a strategic organisational priority, integrating organisational-level improvements with evidence-based individual wellbeing supports to create a healthier, more resilient, and sustainable aged care workforce. 

   Overall, the project provides evidence that innovative technologies such as VR relaxation, combined with objective physiological assessment and employee-centred implementation strategies, have the potential to contribute meaningfully to workforce wellbeing and retention within the aged care sector.

Given the promising findings from the pilot relaxation intervention on autonomic arousal, intention to leave, anxiety and fatigue, we are currently in discussion with Sundale Ltd. about exploring possibilities to use a more explicit method of co-design to better deliver the project at scal