Dynamics of Occupational Well-Being and Turnover Intention in Long-Term Care: A 12-Month Longitudinal Study of Nursing Assistants

Background/Objectives: High turnover intention represents a critical challenge in the long-term care sector, affecting both workforce stability and quality of care. Identifying the psychosocial factors associated with turnover intention and understanding how they operate over time are essential for developing effective retention strategies. This study examined both between-person and within-person associations between psychosocial variables and turnover intention among nursing assistants, focusing on perceived occupational stress, emotional exhaustion, job satisfaction, and social resources. Methods: Athree-wave longitudinal study was conducted among 52 nursing assistants from a single Italian long-term care facility over a 12-month period. Linear mixed-effects models were used to distinguish within-person (time-varying) and between-person (stable) associations between psychosocial factors and turnover intention. Results: At the within-person level, increases in perceived occupational stress, emotional exhaustion, and job satisfaction were associated with changes in turnover intention across measurement occasions. At the between-person level, higher average emotional exhaustion and lower average job satisfaction were associated with higher turnover intention, while social support showed a smaller negative association. Conclusions: These findings suggest that turnover intention is associated with both stable between-person differences and changes in psychosocial work experiences over time. More broadly, the study highlights the value of adopting a longitudinal multilevel perspective to simultaneously examine strain indicators, job attitudes, and social resources in understanding turnover intention among nursing assistants working in long-term care.