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Geriatr Nurs. 2018 Jul - Aug;39(4):407-413. doi: 10.1016/j.gerinurse.2017.12.004. Epub 2018 Feb 27.

Determinants of turnover among low wage earners in long term care: the role of manager-employee relationships.

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Healthcare Management, Department of Management and Marketing, Winthrop University, College of Business Administration, 324 Thurmond Building, Rock Hill, SC 29733. Electronic address:
Winthrop University, College of Business Administration, 113 Thurmond Building, Rock Hill, SC 29733.
Department Marketing, Industrial Distribution and Economics, School of Business, The University of Alabama at Birmingham, BEC204B 1530 3rd Ave S, Birmingham, AL 35294-4460.
Indiana University, Richard M. Fairbanks School of Public Health, Health Policy and Management, Health Sciences Building (RG 5132), 1050 Wishard Blvd. 5132, Indianapolis, IN 46202-2872.


The demand for Long-Term Care (LTC) is steadily increasing as Baby Boomers age and enter retirement. High turnover rates among employees in LTC creates challenges for supervisors and administrators, and can negatively impact quality of care. This study examines manager-subordinate relationship quality using Leader-Member Exchange Theory (LMX) as an antecedent to turnover among low-wage earners in the LTC environment. Survey data measuring LMX, job satisfaction, and demographic information was collected at time 1, and turnover data was collected 18 months later at time 2. The results reveal that all four LMX dimensions were rated significantly different among subordinates who left versus those who stayed, however, only the LMX dimension of supervisor loyalty was a significant predictor of turnover among low wage earners. Our study adds a more nuanced view of the reasons low-wage employees turnover, and presents implications for clinical managers and LTC organizations more broadly.


CNA turnover; Leader-member exchange; Leadership; Long term care; Nurse assistant turnover

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