Factors Impacting the Turnover Intentions among Public Health Workforce: A Cross-sectional Study before and after the COVID-19 Pandemic

Background: Leaving intentions is the preferred predictor of actual turnover (Yang & Chen., 2020). This is an issue which many healthcare systems view as vital and should be addressed in order for them to maintain a functional sustainable workforce. The use of evidence-based data in the determination of factors which impact the leaving intentions of public health employees, is important for the purpose of putting in the place the key strategies and policies that are required to mitigate possible losses and also to regain and retain the workforce. Through the experiences of going through a global pandemic which exposed weaknesses within health institutions, environments and services, more research is required to gain specific useful data to decrease the loss of this vital workforce.
Objective: This study assessed the trends and important individual, organizational, environmental, along with other important factors, which impacted the turnover intentions of the Public Health Workforce in the United States of America (USA) in both 2021 and 2017.
Methods: A cross-sectional study design was used with quantitative methods, in order to assess the effect of various factors on the leaving intentions of public health employees within the USA, in 2021 and 2017. This was done via a nationally fielded Public Health Workforce Interest and Needs Survey (PHWINS), for the comprehension of the requirements of state and local governmental workforce. Statistical assessments were done via Stata/MP 18.0 to establish the correlation between the variables.
Results: The results determined that the odds of turnover intention were the same in 2021 as in 2017, however this was insignificant (OR=1.00, p=0.429). Gender, age, racial category/ethnicity, education level and tenure were each significantly associated with turnover intention with p-values of <0.001. Of these, being a woman in 2021 and 2017 (OR=0.82, p<0.001; OR=0.87, p<0.001 respectively) had significantly decreased odds of considering to leave, while those who identified as other (OR=1.42, p<0.001; OR=1.55, p=0.001 respectively) had significantly greater odds. Those who were over the age of 30 had significantly decreased odds of turnover intention with p-values of <0.05, except for those over 60 in the year 2017 (OR=1.05, p=0.252). Those who identified as having two or more races when compared to white had significantly increased likelihood of considering to leave in both 2021 and 2017 (OR=1.43, p<0.001; OR=1.28, p<0.001 respectively) and in both bivariate and multivariate analysis. Those respondents with an associate’s degree or above had significantly higher odds of leaving intentions when compared with those without a college degree with p-values of <0.05. The amount of years that a respondent worked had varying significant results between the analyses, in terms of the odds of turnover intention when compared with 0-5 years. Those who were employed full-time had decreased odds of turnover intention when compared with those who worked part-time in 2021 and 2017 (OR=0.94, p=0.138; OR=0.94, p=0.126 respectively), however this was insignificant. Pay (p=0.044), work overload/burnout (p<0.001) and job satisfaction (p<0.001) as the most important reason for turnover intention, were each significantly associated with the period before (2017) and after (2021) the COVID-19 pandemic. Better/other opportunities outside of the agency (p=0.466) as the top reason for turnover intention, was not associated with the period before (2017) and after (2021) the COVID-19 pandemic.
Conclusion: There will always be a necessity to sustain the public health workforce as long as there are possible future pandemics and varying factors that impact the employee’s intention to leave. These being those related to the socio-demographic characteristics of individuals or those viewed as key reasons for leaving intentions. It is therefore vital to seek and investigate evidence-based data in varying environments, to gain the specific knowledge needed to put policies and strategies in place to create a sustainable future workforce. This study adds to that knowledge.
Keywords: Turnover intention, intention to leave, public health workers, healthcare workers, COVID-19 pandemic