Factors associated with turnover intention among institutional long-term care workers in China: a multi-center cross-sectional study in China

Introduction: As population aging accelerates, stabilizing the long-term care workforce has become increasingly important. As a key cognitive precursor of actual turnover behavior, turnover intention provides an important indicator of workforce instability among long-term care workers. Objective: The aim of this study was to describe turnover intention and explore its associated factors among institutional long-term care workers. Methods: A cross-sectional self-administered anonymous questionnaire survey was conducted among long-term care workers from 28 older long-term care institutions. Data were collected between November and December 2025 in Zhejiang Province, China. A total of 808 valid samples were included in the study. Hierarchical logistic regression was used to assess the relationship between turnover intention and associated factors. Odds ratios (ORs) and 95% confidence intervals (CIs) for OR were calculated. Results: Approximately 23.0% of the respondents (186/808) were classified as having high turnover intention. The multivariable logistic regression model (Model 4) showed that, compared with age 35 years or younger, being older than 55 years (OR = 0.619; 95% CI: 0.402-0.954) was negatively associated with high turnover intention. Working in public institutions (OR = 0.487; 95%CI = 0.326-0.728) and having a high level of supervisor support (OR = 0.525; 95%CI = 0.331-0.833) were also negatively associated with high turnover intention. Perceived heavy workload (OR = 2.195; 95%CI = 1.315-3.663), perceived difficulty taking leave (OR = 1.882; 95%CI = 1.184-2.991), higher levels of job burnout (OR = 1.046; 95%CI = 1.028-1.064), and poorer sleep quality (OR = 1.079; 95%CI = 1.014-1.149) showed significant positive associations with high turnover intention. Conclusion: The turnover intention of institutional long-term care workers is associated with a range of complex factors. Modifiable factors associated with turnover intention, including supervisor support, heavy workload, difficulty taking leave, job burnout, and poor sleep quality, may provide practical targets for human resource management in long-term care institutions. Therefore, managers should consider organizational-level measures to strengthen support for care workers, improve the work environment, and develop retention strategies that may help reduce turnover intention.