Unmet expectations: why nursing home staff leave care work.

Background.  The shortages of healthcare professionals have been a common topic in care of older people. Aim and objectives.  The aim of the present study was to illuminate what caused the nursing home caregivers to decide to leave their employment. Design.  A two-year intervention study was performed in three nursing homes in Sweden. Method.  This qualitative interview study was conducted with 18 caregivers who decided to leave their employment during the first year. Content analysis was the method used to analyse the interviews. Result.  The caregivers' decisions to leave their work in care of older people could be encompassed in one main category: 'Unmet Expectations'. Their experiences were lack of encouragement and trust and professional development. Feelings of insecurity, different opinions on the care delivered, being disregarded and betrayed followed as did thoughts of leaving work and pursing other opportunities. Conclusion.  The main findings indicated that organizational work pressure with information about pending financial cutbacks caused the caregivers to leave the nursing homes. Relevance to clinical practice.  The study's results show the value of meeting the needs of caregivers, as caregivers consider that they meet the needs of the older people. Optimal use of caregivers' skills, experiences, competence and respect for their aspirations is also likely to result in cost-efficient care.