Intentions and actions towards leaving healthcare work since COVID-19: group-based trajectory analyses in the UK-REACH cohort

OBJECTIVES: Retaining healthcare workers is often challenging. We studied predictors and patterns of leaving or wanting to leave healthcare work over time (attrition intentions and/or actions) in a UK cohort. DESIGN: Using five waves of longitudinal data (2020-2024), we performed group-based trajectory analysis to identify subgroups of healthcare workers with similar patterns of attrition intentions and/or actions over time. We described the characteristics of individuals in each trajectory, and used age-, sex- and occupation-adjusted multinomial logistic regression to identify predictors of trajectory membership. SETTINGS: United Kingdom. PARTICIPANTS: = 5499). MAIN OUTCOME MEASURES: 'Attrition intentions and/or actions' was defined as a healthcare worker having intentions (or having taken action) to leave their role (including early retirement). RESULTS: We identified three trajectories of attrition intentions and/or actions: consistently low (47.7%), moderate and increasing (36.8%) and consistently high (15.5%). Attrition intentions were linked to action: the majority of the 'consistently high' group had taken action to leave or change their job. Factors associated with the two latter trajectories included older age, job role (nursing, midwifery and dental), experiencing discrimination and poor mental health. Financial insecurity was strongly associated with attrition intentions and/or actions. CONCLUSIONS: Over half of UK healthcare workers surveyed intended or had taken action to leave or change their role. Interventions to enhance workforce sustainability could be targeted at older workers and those in nursing, midwifery and dental roles and focus on reducing discrimination, improving mental health and protecting the financial security healthcare worker jobs offer.