The Knowledge and Implementation Hub (the Hub) team conducted an evidence review of peer reviewed and grey literature to search and synthesise evidence on factors and strategies on aged care workforce retention. ARIIA aims to provide guidance to help the sector address workforce shortages and enhance retention that is crucial in delivering high-quality care for older Australians. This page provides a brief overview of the evidence review process and key findings. The full review will be available soon.
What do the findings mean
Understanding what drives aged care workers to stay or leave and which strategies help them stay, is critical for building a skilled and compassionate workforce. Workforce shortages and high turnover disrupts care, strains resources, and lowers morale. By focusing on the important factors and effective strategies, aged care providers can create safer, more consistent care environments for older adults and reduce the ongoing costs and challenges of replacing staff. However, it is also important to understand local context factors to develop tailored strategies for effective implementation.
What we did
We searched relevant research on aged care workforce retention. Our search focused on peer-reviewed studies from the last ten years and grey literature (like reports or policy documents) from the last five years. We targeted literature that explored both factors on retention and strategies taken to improve it. The review considered any factor or strategy that might affect how long staff stay, such training opportunities, leadership, support, workplace culture, and pay. The aged care workforce includes a wide range of roles – nurses, personal care workers, allied health professionals and admin staff, in any aged care setting. The main outcome of interest was retention – how long workers stay in their jobs – but related outcomes such as turnover (degree of movement of individuals out of an organisation), intention to stay or leave (willingness to stay in the original organisation and not looking for other jobs; intention to leave is wanting to leave the organisation and actively seeking other jobs), and job satisfaction (worker’s positive feelings toward their job that makes them want to stay) were also included.
We worked with the ARIIA Sector Reference Group (SRG) and the Guest Members who are experts in the area of workforce retention. The members provided expert insights in the review process, assisted in prioritising important factors to consider and guided the operationalisation of the evidence to help aged care providers improve staff retention and workforce staff to stay in their jobs.
What we found
Factors
We identified 21 reviews and 46 primary studies (not included in the reviews) that considered factors in relation to retention and retention related outcomes. We grouped all the factors into similar themes, arriving at 32 factor themes. The top 10 priority factor themes identified by the SRG and Guest Members that are included in this report are: job control and autonomy, job satisfaction, leadership, salary, skill mix, staffing, training and opportunities, work and role clarity, workplace culture, and workplace relationships.
The evidence from reviewed literature shows that workforce retention in the aged care sector is shaped by a mix of practical and interpersonal factors. [1] Staff are more likely to remain in their roles where their responsibilities are clear, they are trusted and valued, and they have the resources needed to do their jobs well. [2-4] When workloads are manageable and expectations are well defined, staff can focus on delivering quality care without unnecessary stress or confusion. [5, 6]
In a sector already facing significant workforce challenges, failing to meet these basic staffing and organisational needs risks high turnover. Recent data show that the residential aged care workforce declined by over 45,000 between 2020 and 2023, which highlights the urgency of addressing staff retention to protect care quality for older Australians. [7]
One of the most consistent findings is the impact of leadership on workforce retention. What matters is how well leaders communicate, whether they help create a positive, respectful work environment, and how they engage with staff in their daily work. [8-11] Organisations with supportive style of leadership tend to retain staff for longer. Leadership is also closely connected to how teams are structured. One critical factor is having the right balance of qualified staff - the right skill mix. [12, 13] When care workers are left without sufficient clinical support, the pressure increases, confidence drops, and the likelihood of staff leaving rises. [2, 3] Access to ongoing training and opportunities for professional development also emerged as a key factor in workforce retention, as it helps staff build confidence and see a future in the sector. [14, 15]
Equally important as leadership, staffing, and development opportunities is job autonomy. Staff are more likely to stay when they can contribute to team decisions by offering professional judgement, and when they feel their input is valued. [9, 16] This sense of ownership strengthens their connection and commitment to the role. Importantly, a positive workplace culture supports this further, as a respectful, safe, collaborative, and inclusive environment – where staff experience a sense of belonging – is just as important as fair pay or predictable rosters. [17-19] Salary still matters, however, our findings show that remuneration alone does not determine intention to stay. [4, 20] Participants in the reviewed studies described their work as a meaningful form of service. [21]
In summary, workforce retention improves when leadership, adequate staffing, positive workplace culture, and opportunities for training and development support staff to do their jobs well. The challenge is not identifying what helps retain staff, as this is already clear. The next step is to translate this knowledge into consistent change across the sector.
Strategies
We identified 18 primary studies that assessed the impact of strategies on retention and retention related outcomes. We identified and grouped strategies into organisational strategies (focused on workplace systems), individual strategies (focused on personal development and wellbeing), and a mix of both.
Organisational strategies included those that were about capacity building [22-28], leadership and support [29-31] and workplace culture engagement and enhancement.[32-34] Individual strategies included empowerment training to build communication skills and confidence,[35] and addressing emotional stress and techniques like mindfulness and self-compassion strategies. [36, 37] A combination of organisational and individual strategies included capacity building and health promotion techniques. [38, 39]
Organisational strategies that focus on building the skills and capabilities of nurses and nursing assistants in residential aged care settings have consistently shown positive outcomes for staff retention [26-28] and intention to stay. [25, 27] These capacity-building approaches such as targeted training and professional development, appear to strengthen workforce engagement and stability in a sector where retention is a longstanding challenge.
In contrast, other strategies have produced more variable results across different workforce groups and care settings. This implies that workforce retention strategies need to be tailored to the specific roles—whether nurses, nursing assistants, or care workers—and to the unique organisational structures and challenges present in each aged care environment.
Aged care context
We identified about 65 articles from the grey literature search and 25 of these were Australian context specific. The majority of the grey literature were reports and articles focusing on the issues and challenges to keep workers stay in their jobs, the contextual factors affecting retention and possible strategies to address the ongoing retention challenges, very similar to the focus of the peer-reviewed literature. A broader understanding the Australian aged care context is key in understanding the factors and developing targeted and tailored retention strategies.
The key themes around the aged care context from the grey literature include Australia’s ageing population, workforce demographics, perceptions of the industry, forms of discrimination, sector complexity, ongoing reforms and the use of technology and the need for skills training. [40-44] From these key themes, we present ways stakeholders can address the contextual factors. These include understanding the complex needs of the ageing population, supporting younger and mature workers’ needs, addressing ageism and other forms of discrimination, providing guidance to comply with reforms and using technology to enhance work efficiency.