Work Environment and Work Context Factors Associated With Homecare Workers' Intention to Leave: An Analysis of a National, Multicenter Cross-Sectional Study.

Given the projected shortage of homecare workers, it is important to examine and optimize working conditions in order to keep them in their field of expertise. However, there is limited knowledge about the prevalence of the intention to leave their job and the modifiable factors that contribute to it. We assessed the prevalence of homecare workers' intention to leave their current job or the homecare sector entirely and the relationship between work environment, i.e., organizational characteristics (e.g., leadership, staffing, teamwork, and predictability) and work context factors, i.e., job characteristics and role definition (e.g., autonomy, overtime, and role clarity) with leaving intentions. This analysis included data from a national, multicenter, cross-sectional study in Switzerland, conducted from January to September 2021. We included 1898 homecare workers of 85 stratified randomly selected homecare agencies, performing descriptive analyses and logistic multilevel regressions to calculate prevalence and examine associations. Overall, 58.5% of respondents reported at least a slight intention to leave the current job, while 12.6% considered leaving the homecare sector. Leadership was significantly negatively associated to respondents' intentions to leave the current job; predictability and job satisfaction were significantly negatively associated with both leaving intentions. Job satisfaction mediated work environment factors such as staffing. Leadership was one of the most important work environment factors related to intention to leave. Therefore, political decision makers and homecare managers need to lay the foundation to foster development, improvement, and empowerment of leadership roles. Homecare agencies should target improvement efforts based on the effect of overtime and the implementation of predictability and social support in their organization in order to reduce intention to leave and improve job satisfaction. Future studies could focus on deepening our understanding by empowering nurse leaders in creating and sustaining a positive work environment.