The gender wage gap among health care workers across educational and occupational groups.

Women perform 77% of health care jobs in the United States, but gender inequity within the health care sector harms women's compensation and advancement in health care jobs. Using data from 2003 to 2021 of the Annual Social and Economic Supplement of the Current Population Survey (CPS), we measured women's representation and the gender wage gap in health care jobs by educational level and occupational category. We found, descriptively, that women's representation in health care occupations has increased over time in occupations that require a master's or doctoral/professional degree (eg, physicians, therapists), while men's representation has increased slightly in nursing occupations (eg, registered nurses, LPNs/LVNs, aides, and assistants). The adjusted wage gap between women and men is the largest among workers in high-education health care (eg, physicians, advanced practitioners) but has decreased substantially over the last 20 years, while, descriptively, the gender wage gap has stagnated or grown larger in some lower education occupations. Our policy recommendations include gender equity reviews within health care organizations, prioritizing women managers, and realigning Medicare and Medicaid reimbursement policies to promote greater gender equity within and across health care occupations.

Retention of Community Health Workers in the Public Health Workforce: Public Health Workforce Interests and Needs Survey, 2017 and 2021.

Objectives. To investigate the organizational factors contributing to the intent of community health workers (CHWs) to quit their jobs in local and state health departments in the United States. Methods. We used the 2017 (n = 844) and 2021 (n = 1014) Public Health Workforce Interests and Needs Survey data sets to predict CHWs' intent to leave with Stata 17 balanced repeated replication survey estimations. Results. CHWs dissatisfied with organizational support, pay, or job security had high probabilities of reporting an intent to leave (50%, P < .01; 39%, P < .01; and 42%, P < .01, respectively) relative to satisfied or neutral workers (24%, P < .01; 21%, P < .01; and 26%, P < .01, respectively). Conclusions. Improving organizational support, pay satisfaction, and job security satisfaction in public health agencies can significantly improve CHW retention, potentially lowering overall organizational costs, enhancing organizational morale, and promoting community health. Public Health Implications. Our findings shed light on actionable ways to improve CHW retention, including assessing training needs; prioritizing diversity, equity, and inclusion; and improving communication between management and workers. (Am J Public Health. 2024;114(1):44-47. https://doi.org/10.2105/AJPH.2023.307462).

Tracking Turnover Among Health Care Workers During the COVID-19 Pandemic: A Cross-sectional Study.

Importance: The health care sector lost millions of workers during the COVID-19 pandemic and job recovery has been slow, particularly in long-term care. Objective: To identify which health care workers were at highest risk of exiting the health care workforce during the COVID-19 pandemic. Design Setting and Participants: This was an observational cross-sectional study conducted among individuals employed full-time in health care jobs from 2019 to 2021 in the US. Using the data from the Current Population Survey (CPS), we compared turnover rates before the pandemic (preperiod, January 2019-March 2020; 71 843 observations from CPS) with the first 9 months (postperiod 1, April 2020-December 2020; 38 556 observations) and latter 8 months of the pandemic (postperiod 2, January 2021-October 2021; 44 389 observations). Main Outcomes and Measures: Health care workforce exits (also referred to as turnover) defined as a health care worker's response to the CPS as being unemployed or out of the labor force in a month subsequent to a month when they reported being actively employed in the health care workforce. The probability of exiting the health care workforce was estimated using a logistic regression model controlling for health care occupation, health care setting, being female, having a child younger than 5 years old in the household, race and ethnicity, age and age squared, citizenship status, being married, having less than a bachelor's degree, living in a metropolitan area, identifier for those reporting employment status at the first peak of COVID-19, and select interaction terms with time periods (postperiods 1 and 2). Data analyses were conducted from March 1, 2021, to January 31, 2022. Results: The study population comprised 125 717 unique health care workers with a mean (SD) age of 42.3 (12.1) years; 96 802 (77.0%) were women; 84 733 (67.4%) were White individuals. Estimated health care turnover rates peaked in postperiod 1, but largely recovered by postperiod 2, except for among long-term care workers and physicians. We found a 4-fold difference in turnover rates between physicians and health aides or assistants. Rates were also higher for health workers with young children (<5 years), for both sexes and highest among women. By race and ethnicity, persistently higher turnover rates were found among American Indian/Alaska Native/Pacific Islander workers; White workers had persistently lower rates; and Black and Latino workers experienced the slowest job recovery rates. Conclusions and Relevance: The findings of this observational cross-sectional study suggest that although much of the health care workforce is on track to recover to prepandemic turnover rates, these rates have been persistently high and slow to recover among long-term care workers, health aides and assistants, workers of minoritized racial and ethnic groups, and women with young children. Given the high demand for long-term care workers, targeted attention is needed to recruit job-seeking health care workers and to retain those currently in these jobs to lessen turnover.

Federal requirements for nursing homes to include certified nursing assistants in resident care planning and interdisciplinary teams: A policy analysis.

Starting in 2016, Centers for Medicare and Medicaid Services implemented the first phase of a 3-year multi-phase plan revising the manner in which nursing homes are regulated. In this revision, attention was placed on the importance of certified nursing assistants (CNAs) to resident care and the need to empower these frontline workers. Phase II mandates that CNAs be included as members of the nursing home interdisciplinary team that develops care plans for the resident that are person-centered and comprehensive and reviews and revises these care plans after each resident assessment. While these efforts are laudable, there are no direct guidelines for how to integrate CNAs in the interdisciplinary team. We recommend the inclusion of direct guidelines, in which this policy revision clarifies the expected contributions from CNAs, their responsibilities, their role as members of the interdisciplinary team, and the expected patterns of communication between CNAs and other members of the interdisciplinary team.

Healthcare organization-education partnerships and career ladder programs for health care workers.

Increasing concerns about quality of care and workforce shortages have motivated health care organizations and educational institutions to partner to create career ladders for frontline health care workers. Career ladders reward workers for gains in skills and knowledge and may reduce the costs associated with turnover, improve patient care, and/or address projected shortages of certain nursing and allied health professions. This study examines partnerships between health care and educational organizations in the United States during the design and implementation of career ladder training programs for low-skill workers in health care settings, referred to as frontline health care workers. Mixed methods data from 291 frontline health care workers and 347 key informants (e.g., administrators, instructors, managers) collected between 2007 and 2010 were analyzed using both regression and fuzzy-set qualitative comparative analysis (QCA). Results suggest that different combinations of partner characteristics, including having an education leader, employer leader, frontline management support, partnership history, community need, and educational policies, were necessary for high worker career self-efficacy and program satisfaction. Whether a worker received a wage increase, however, was primarily dependent on leadership within the health care organization, including having an employer leader and employer implementation policies. Findings suggest that strong partnerships between health care and educational organizations can contribute to the successful implementation of career ladder programs, but workers' ability to earn monetary rewards for program participation depends on the strength of leadership support within the health care organization.

Frontline health care workers and perceived career mobility: do high-performance work practices make a difference?

BACKGROUND: The use of high-performance work practices (HPWPs) related to career development (e.g., tuition remission, career ladders) is becoming more common in health care organizations, where skill shortages and concerns about quality of care have led to increasing investment in the frontline health care workforce. However, few studies have examined the effectiveness of these policies in shaping the career trajectories of health care workers. PURPOSES: The aim of this study is to examine how HPWPs that focus on career development are related to an individuals' perceived mobility with their current employer. We will also examine the relationships between perceived mobility, job satisfaction, and turnover intent. METHODOLOGY/APPROACH: We use confirmatory factor analysis and structural equation modeling to examine the relationships between HPWPs and perceived mobility in a sample of 947 frontline health care workers in 22 health care organizations across the United States. FINDINGS: The findings suggest that tuition remission and educational release time positively predict perceived mobility. Measures of perceived organizational support in one's current position (e.g., financial rewards, workload, and autonomy) and perceived supervisor support for career development are also significant predictors of perceived mobility. Finally, perceived mobility is a significant predictor of job satisfaction and intent to stay with current employer. PRACTICE IMPLICATIONS: Our findings suggest that HPWPs related to career development may be effective tools in improving workers' assessments of their own career potential and improving overall job satisfaction of frontline health care workers. Consequently, HPWPs related to career development may help employers both retain valuable workers and fill worker shortages.

Contingency, employment intentions, and retention of vulnerable low-wage workers: an examination of nursing assistants in nursing homes.

PURPOSE OF THE STUDY: While theories of job turnover generally assume a strong correlation between job satisfaction, intention, and retention, such models may be limited in explaining turnover of low-wage health care workers. Low-wage workers likely have a lower ability to act on their employment intentions or plans due to a lack of resources that serve to cushion higher wage workers. In this study, we examine the relationship between job satisfaction, intention, and retention of nursing assistants in nursing homes and the role that "contingency factors" play in employment intentions and retention. We conceptualize "contingency factors" as resource-related constraints (e.g., being a single mother) that likely influence employment trajectories of individuals but can be independent of job satisfaction or intent. DESIGN AND METHODS: We use survey data from 315 nursing assistants in 18 nursing homes in a U.S. southern state to model employment intentions and retention. RESULTS: We find that job satisfaction and other perceived job characteristics (e.g., workload and perceived quality of care) are significant predictors of an individual's intent to stay in their job, the occupation of nursing assistant, and the field of long-term care. However, we find that job satisfaction and employment intentions are not significant predictors of retention. Instead, "contingency factors" such as being a primary breadwinner and individual characteristics (e.g., tenure and past health care experience) appear to be stronger factors in the retention of nursing assistants. IMPLICATIONS: Our findings have implications for understanding turnover among low-wage health care workers and the use of proxies such as employment intentions in measuring turnover.

Mobility for care workers: job changes and wages for nurse aides.

The long-term care industry in the United States faces serious recruitment and retention problems among nurse aides. At the same time, these low-wage workers may feel trapped in poorly-paid jobs from which they would do well to leave. Despite this tension, not enough is known about how workers fare when they leave (or stay in) such care work. Using longitudinal data from the Survey of Income and Program Participation for the years 1996-2003, we examine the relationship between different job and occupational mobility patterns and wage outcomes for nurse aides, focusing on which job transitions offer better opportunities to earn higher wages and on whether job transition patterns differ by race. Our results confirm high turnover among nurse aides, with 73 percent of the sample working in occupations other than nurse aide at some point during the survey time frame. About half of respondents that transition out of nurse aide work move into higher-paying occupations, although the percentage of transitions to higher paying occupations drops to 35 percent when nurse aides that become RNs are excluded. Among black workers especially, wage penalties for moving into other jobs in the low-wage labor market appear to be rather small, likely a factor in high turnover among nurse aides. The findings illustrate the importance of occupation-specific mobility trajectories and their outcomes for different groups of workers, and for understanding the constrained decisions these workers make.

Caregiving in a patient's place of residence: turnover of direct care workers in home care and hospice agencies.

OBJECTIVE: High turnover and staff shortages among home care and hospice workers may compromise the quality and availability of in-home care. This study explores turnover rates of direct care workers for home care and hospice agencies. METHODS: OLS (ordinary least square) regression models are run using organizational data from 93 home care agencies and 29 hospice agencies in North Carolina. RESULTS: Home care agencies have higher total turnover rates than hospice agencies, but profit status may be an important covariate. Higher unemployment rates are associated with lower voluntary turnover. Agencies that do not offer health benefits experience higher involuntary turnover. CONCLUSION: Differences in turnover between hospice and home health agencies suggest that organizational characteristics of hospice care contribute to lower turnover rates. However, the variation in turnover rates is not fully explained by the proposed multivariate models. Future research should explore individual and structural-level variables that affect voluntary and involuntary turnover in these settings.