Retention strategies: What helps aged care workers stay in their jobs

Key findings

Organisational  strategies focused on providing training and opportunities, improving leadership and support, addressing job demands and promoting job control and autonomy are more effective in improving retention and a range of retention related outcomes. Individual strategies addressing stress, burnout and workplace culture may contribute to retention but need complementary organisational support to be effective. 

Aged care organisations may choose to apply one or more of the strategies presented below and evaluate the outcomes in their own settings:

1. Capacity building through training

   Organisations may offer structured training sessions to upskill staff in critical areas like long-term care. These trainings can be delivered via workshops, coaching, and reflective learning, often integrated into staff schedules. Leaders and managers can support implementation by participating in training and mentoring, helping staff apply new knowledge directly to their work.

2. Enhancing leadership and team support

   Leadership development programs can be introduced to improve communication and teamwork. Aged care organisations may establish regular, short “huddles” or team meetings led by senior nurses or team leaders to address care challenges collaboratively. 

3. Strengthening workplace culture

   To foster a positive work environment, organisations may implement creative engagement programs such as drama-based activities, that promote connection between staff and residents. Flexibility in work arrangements, such as shift swapping or self-scheduling, can also be adopted to help staff balance personal and work responsibilities. 

4. Integrated organisational and staff wellbeing interventions

   Some providers can take a combined approach by delivering skills training alongside health promotion for staff. These initiatives may include education programs and relaxation sessions. These can assist staff to tailor care to individual resident needs while also being supported to manage their own stress, improving both care quality and staff morale.

5. Supporting individual awareness and wellbeing  

   Organisations can provide programs focused on personal growth and wellbeing. These may include self-compassion and mindfulness training, self-care education and personal growth trainings. Staff can be given tools for guided meditations, relaxation techniques, and wellness kits. Empowerment programs may be helpful to build confidence and support personal growth. 

   Read about implementation approaches, including principles, guides and factors to consider in implementing strategies here.

Presented in this section are the strategies that have been evaluated to help aged care workers feel more supported, satisfied and likely to stay in employment. These are grouped into organisational strategies (focused on workplace systems), individual strategies (focused on personal development and wellbeing) and a combination of both, based on their core or main component. This section also describes the aged care worker roles involved, including the settings where the strategies were used, so readers can make informed decisions related to whether they may work in their own context.

It is important to remember that there is ‘no-one-strategy’ that will work across all types of aged care settings or workforce groups. The aged care context is a complex environment that is characterised by a population from diverse cultural backgrounds (both older people and workforce), organisations that vary in size and location, different staffing levels, resources available and policies in place. Due to this complexity, strategies must be tailored to fit the specific local context and include several components that address the different factors influencing workforce retention. Without a clear understanding of the local context, it will be difficult, if not impossible, to implement strategies that will make aged care workers remain in their jobs. 

The main outcome of interest was retention - how long workers stay in their jobs [1] – but related outcomes such as turnover or turnover rates (degree of movement of individuals out of an organisation) [2], intention to stay or leave (willingness to stay in the original organisation and not looking for other jobs [3]; intention to leave is wanting to leave the organisation and actively seeking other jobs [4] and job satisfaction (worker’s positive feelings and experiences toward their job that makes them fulfilled and satisfied) [5] were also reported in the studies and have been included.

These strategies or programs aim to build staff skills, confidence, and competence (capacity building). These empower staff to adapt, grow, and successfully reach their goals over time.

A coaching training intervention for certified nursing assistants and two education programs for nurses to improve nursing competencies increased retention of nursing assistants and nurses working in residential aged care settings.  [1, 6, 7] The long-term nurse residency education program that addressed additional factors such communication, recognition, job demands, and workplace culture also improved nurses’ intention to stay and job satisfaction. [6] The gerontological nursing competencies program also led to improved job satisfaction among the nurses. [7]  A care education programme addressing need for training in the management of challenging behaviours for older people living with dementia in a specialist unit improved intention to stay and job satisfaction. [8]

• Coaching training intervention for certified nurse practitioners (CNAs)– this program consists of coaching sessions to teach CNAs to assess residents’ needs and adjust the level of assistance they provided. The intervention was provided over a period of three months, with coaching sessions happening weekly for the first 8 weeks, followed by bi-weekly sessions. [1]
• Long-term nurse residency program on geriatric education – this residency program consists of the following modules: leadership and communication, caring for older adults and working in long-term care environment. Resilience training and mentorship are also embedded in the training. The program was provided for a period of nine months and modules were delivered asynchronously via online systems. [6]
• Gerontological nursing competencies (GNC) in long-term aged care – this program consists of 11 gerontological nursing core competencies such as partnering with family and carers, facilitating transitions in care, providing palliative care and dementia care and others. The GNC program was delivered for two days and complemented by a reflective workbook, with support from a facilitator. [7]
• Grip on challenging behaviour care programme (GRIP) - GRIP consists of an education package and of various structured assessment tools that guide professionals in detection, analysis, treatment and evaluation. When a challenging behaviour is observed, a form is completed to document the behaviour, context, and environment. This information is then analysed and discussed in multidisciplinary meetings, leading to the development of a tailored treatment plan. This program was delivered for one year and four months. [8]

Two strategies focused on enhancing capacity of aged care workers, in assessing and managing depressive symptoms, and improving functional activities, for older people in residential aged care settings found no change in job satisfaction. [9, 10] Both strategies aimed to address job control and autonomy. The program on managing depressive symptoms also addressed job demands. [9]

• ‘Act in case of depression' AiD care program – this three-hour workshop program consists of structured assessment, treatment and monitoring treatment results for depressive symptoms observed amongst the residents. [9]
• Korean version of the function-focused care program – this program was based on the original Function Focused Care (FFC) program and with an additional activity, that is eating, specific to the type of food for Koreans. The program was delivered over six weeks, with a two-hour training and additional five hours. [10]

One strategy aimed to address leadership and stress in nursing assistants' residential aged care settings by improving a palliative care approach found lower job satisfaction. 

• Palliative care approach – this intervention focused on relational, emotional, and existential issues, and was delivered in seven, two-hours study circles with workshops in between. [11]

Grey literature findings

Strategies offering quality training opportunities may offer a means of addressing employees’ desire for professional and career development and diverse job roles, ultimately enhancing staff satisfaction and retention. Examples include coaching and mentoring, especially for junior staff. [12] 

Read about factors on workforce retention here.

These strategies or programs aimed to strengthen leadership and create a more supportive environment. Programs focused on improving management practices, developing leadership skills in staff, and fostering team communication. 

A national leadership program for aged care staff in nursing homes led to improved intention to stay. [13] A clinical leadership program for mixed aged care staff working in residential and community settings led to improved job satisfaction but no changes were observed in retention, turnover and intention to stay. [2] Lastly, a structured support intervention using huddles led by nurses in residential aged care settings led to improved job satisfaction. [14]

• ‘Joy-of-Life-Nursing-Homes’ (JoLNH) leadership strategy – this is a Norwegian Government program for municipal health services to improve leadership and care quality nursing homes. It contains tools for care quality and improved leadership. It is a one year certification program with potential for recertification. [13]
• ‘Clinical leadership in aged care (CLiAC)’ program – this program focused on developing leadership and management skills to improve staff support and workplace relationships. It is a one-year program consisting of workshops with individual meetings and/or teleconferences every four to six weeks, mentorship and coaching, and peer support meetings. [2]
• Structured support intervention’ (Nurse Practitioner-led huddles) – this intervention included huddle facilitation training for nurse practitioners (NP) and included toolkits with resources to effectively carry out huddles. These NP-led huddles were conducted for five 5 months of 15mins/huddle; 2x/week (for day and evening shifts). [14]

Grey literature findings

Reports from several organisations highlighted the critical role of positive leadership and management in optimising service coordination, empowering staff, and fostering positive practice environments. [15-17] Monitoring and evaluating leadership initiatives and improving management and leadership capabilities are essential. [18] Good leadership (general management and clinical) impacts the overall performance of staff. Reward and recognition play an important role in attracting and retaining the right individuals for leadership positions. Staff confidence in leaders was a key factor in the care workforce, alongside ongoing training and leadership development programs, for middle managers and nurse leaders. [19] Having authentic leaders who are self-aware, guided by core values, and build trust through consistency, honesty, and respect is closely associated with higher staff job satisfaction. [18] 

Read about factors on workforce retention here.

These programs aimed to create a more positive environment and an engaging workplace by having activities and allowing flexibility in working schedules.  

One creative initiative used theatre activities with care staff and residents to promote fun, and teamwork in the workplace; however, no changes in job satisfaction were noted. [20] Another strategy allowed aged care staff in residential aged care settings, more flexibility in choosing and scheduling their shifts and work patterns, giving them greater control over their time. [5, 21] One of the studies with a mix of aged care staff reported improved retention, intention to stay and job satisfaction [5] whilst the other one found no improvements in nurses’ job satisfaction. [21]

• Ladder to the moon (LttM) culture change studio engagement program (CCSEP) – this theatre program involved a coach and two professional actors who worked with the residents and care staff to adopt main characters of a chosen film and perform. This is a three-day program and on the final meeting, the coach will have discussions with the manager on the culture of care changes. [20]
• Flexible working arrangements – this strategy included choosing, changing or swapping shifts amongst aged care staff. Duration was not mentioned. [5]
• Self-scheduling – this strategy was described as drawing up a work schedule from the employer to the nurses and nursing assistants to give them more control over their hours. This was implemented for one year. [21]

Grey literature findings

Inclusivity and flexibility of the workplace, including a strategy of employers giving staff with children the ability to bring them during school holidays, enable intergenerational engagement and relieve staff stress in arranging childcare. [22] More broadly, strategies that support work-family needs were also considered by workers as helpful in enhancing workplace culture. [18] Developing workplace culture strategies centred on companionate love, feelings of affection for others, compassion, caring and tenderness were related to a sense of teamwork and overall job satisfaction. [18] Fostering and supporting a positive ‘culture of care’ also benefited the wellbeing of consumers and staff. [18] Positive relationships with co-workers and managers also contributed to worker satisfaction. [23] Strategies that provide mutual support, fostering camaraderie and facilitating learning within functional peer networks could be beneficial in supporting the psychological wellbeing of employees engaged in high-stress roles. [24]

Read about factors on workforce retention here.

These strategies or programs focused on both capacity building and personal wellbeing. 

Two training programs for care workers were implemented: one focused on person-centred care (PCC) for residential aged care settings [25], and the other tailored for home care recipients. [26] These were complemented with personal health promotion and management for the care workers. One of the programs used a psychoeducational model to deliver the PCC training. [25] Both programs did not find any improvement in job satisfaction. 

• Psychoeducational intervention for direct care workers caring for people with dementia – this is a PCC psychoeducational (PE) intervention coordinated by a gerontologist and a physiotherapist with previous experience in facilitating PE interventions, with supportive component of relaxation techniques, stretching, and strengthening exercises. The program was implemented for care workers for eight weeks with 90-minute session per week. [25]
• Person-centred and health-promoting intervention – this focused on care tailored to needs and preferences of both the care recipients and staff. An educational program with supervised skills training to deliver PCC to care recipients, accompanied by strategies to reduce stress, increase satisfaction and feel comfortable in their roles were provided for 20 months. [26]

Grey literature findings

It is good to consider having a mix of organisational training opportunities and individual wellbeing strategies to provide a supportive environment and promote work-life balance, resulting in positive workplace outcomes such as retention. Having opportunities to build skills, particularly in interacting and managing people living with dementia, may help staff be more competent, consequently enhancing satisfaction. [27] On an individual level, promoting self-care, providing access to mental health resources can empower staff to manage the emotional demands of their roles. [16, 27] Together, these strategies may create a resilient workforce capable of delivering high-quality care while maintaining their own wellbeing, and hopefully being satisfied in their jobs and staying longer in their organisations. 

Read about factors on workforce retention here.

These focused on helping workers manage emotional stress and use techniques to cope with stress. 

Programs included mindfulness and self-compassion techniques, fatigue awareness and self-care skills education, to prevent burnout and improve wellbeing. [28, 29]  Another strategy included empowerment training to build communication skills, confidence, and understanding of the aged care sector. [30] Retention among certified nurse assistants in long-term care settings improved with fatigue awareness and self-care skills education and empowerment training; empowerment training also improved job satisfaction. No changes were found in turnover, intention to stay and job satisfaction with the other strategies.

• Self-compassion training, mindful self-compassion (MSC) and self-compassion for health care communities (SCHC) – this focused on a mindful self-compassion program for nursing assistants with didactic material and guided meditation. It was delivered for six to eight weeks from 1-2.5 hours per week. [28]
• Compassion fatigue awareness and self-care skills education – this program focused on compassion fatigue awareness and multiple self-care skill strategies for certified nursing assistants. It is a 90-minute program that consisted of presentations, videos and a self-care toolbox. [29]
• Empowerment programme for certified nursing assistants (CNAs) – this program supported CNAs in strengthening their self-awareness, improved communication styles and increased understanding of developments within their own organisations and the overall long term care sector. It was delivered for 10 months with eight hours per week of contact time, every four to five weeks. [30]

Grey literature findings

Strategies focused on helping workers manage stress, burnout and build compassion and personal skills are important to consider. Encouraging staff to maintain a healthy work-life balance and offering support for mental health can further reduce the risk of burnout and improve retention rates. These strategies empower staff to manage the emotional demands of their roles while maintaining their own wellbeing. [27, 31]

Read about factors on workforce retention here.

This summary was informed by a review of the existing literature, where the evidence is still emerging regarding what works best.  An analysis of the quality of each study was not conducted in this review. Whilst the research team carefully compared results across studies to identify consistent patterns and trends, the results of these studies should be interpreted with caution. 

The strategies and findings offer a general overview of potential outcomes when applied, but none of them is strongly recommended. It is crucial to recognise that a one-size-fits-all approach will not suit all organisations or contexts. Therefore, the design and implementation of these strategies should be customised to meet the specific needs and circumstances of each organisation.

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