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REcruiting and RetAining nurses and carers in Care Homes: what works, for which staff, under what circumstances, and at what cost? The REACH Realist Review

2022 Conference Presentation

8 September 2022

REcruiting and RetAining nurses and carers in Care Homes: what works, for which staff, under what circumstances, and at what cost? The REACH Realist Review

Kirsty Haunch , University of Leeds , United Kingdom

Reena Devi, Karen Spilsbury
University of Leeds


The care home sector faces significant challenges with high staff turnover and a lack of new workers entering the sector. High staff turnover and staff shortages impact on quality of care, are costly and increase workload and pressure for remaining staff. The challenges around workforce recruitment and retention are long-standing and has been made worse by the COVID-19 pandemic. In addition, Brexit and changes in immigration policies will challenge the extent to which staff from overseas are recruited to join this workforce.

Salary is undoubtedly important, and evidence suggests additional factors influence staff decisions to join and remain in care home work, such as feeling valued at work, flexible hours, supportive management, good training, and robust team relationships. Different staff groups have different and varied needs, wants and expectations. For example, it is reasonable to expect that young people in their first caring role might have different expectations to staff who are close to retirement. The current evidence does not differentiate between staff groups, organisational characteristics, and the working conditions that influence staff decisions to stay or leave.

At the University of Leeds we are currently undertaking a realist review (funded by the National Institute for Health and Care Research, NIHR131016) focused on understanding what strategies are effective in attracting, recruiting and retaining Registered Nurses and care workers. The value of using this method is that it will allow us to explain how, why, and in what circumstances successful outcomes are generated and the cost implications.

We are developing programme theories that are being shaped iteratively over 4 steps: (1) initial programme theories development; (2) systematic literature searches and screening for credible and relevant evidence; (3) data extraction and analysis using realist logic to develop context-mechanism-outcome configurations; (4) synthesising evidence and drawing conclusions.

Throughout the REACH project we are working closely with care home sector stakeholders. Care workers, Registered Nurses, care home managers, family and friends of people living in care homes, and people working in national social care organisations (e.g. The National Care Forum) are involved in developing, shaping and refining the theories to ensure they are relevant and accurately reflect the everyday working realities of care homes.

In September 2022 at the ILPN2022 conference we will share our initial programme theories which have been developed through expert stakeholder consultations, interviews with care home Registered Nurses and care workers, and scoping literature searches. Given the serious and growing workforce crisis in the social care sector our findings will be critical in informing care homes, policy makers, and social care sector organisations how best to respond to the crisis.