Mental health workers experience high turnover rates of more than 50% (SAMHSA, 2017), a factor that has been linked to inadequate quality of care for patients in community mental health clinics (Bukach, Ejaz, Dawson, & Gitter, 2017). Aside from contributing towards poor quality patient care, high turnover rates among mental health workers impose significant financial burdens on organizations (Cloutier, Felusiak, Hill, & Pemberton-Jones, 2015) and increase worker dissatisfaction (Khamisa, Oldenburg, Peltzer, & Ilic, 2015). Turnover is related to a number of factors such as low salary, poor work-life balance, relationship conflicts, and limited opportunities for career growth (Guha and Chakrabarti, 2016; Willard-Grace et al., 2019). Since high turnover rates among mental health workers can lead to lower quality care, it is essential that health care administrators develop and implement effective retention strategies.
Turnover and Retention in Healthcare
Since mental health workers work closely with patients to develop trust and deliver high-quality care, it is essential that turnover be reduced. A recent report by the Substance Abuse and Mental Health Administration (2017) indicated that factors such as understaffing, increasing workloads, and a lack of training contributed towards turnover among mental health workers. High turnover rates disrupt the workplace cultures of mental health organizations and can have negative consequences at the organizational and individual level. For instance, organizations that experience high turnover might have difficulty with recruiting skilled professionals (Acker, 2018; Kim & Fernandez, 2016), and incur significant costs associated with recruitment and training of new employees (Cameron, Sadlo, Hart, & Walker, 2016). As a result, clinics with high turnover may find it hard to provide high-quality care in the future. Since many workers leave their jobs out of dissatisfaction, effective retention strategies include those that focus on improving employee motivation, workplace satisfaction, and employee engagement (Allen, Peltokorpi, & Rubenstein, 2016).
Employee Job Satisfaction and Dissatisfaction
Employee satisfaction is driven by factors such as workplace culture, available resources, and satisfaction with the work itself (Kok, Herrell, Grossman, West, & Wilk, 2016; Read & Laschinger, 2015). Workplace satisfaction is driven by intrinsic motivation factors such as the opportunity for personal achievement, recognition, and the difficulty of the work (Al-Hamdan, Manojlovich, & Tanima, 2016). Dissatisfaction with work is most often associated with extrinsic motivation factors including workplace relationships, salary, and benefits (Al-Hamdan et al., 2016). Within the mental healthcare industry, workers who have the most direct patient contact, such as nurses, tend to experience the lowest job satisfaction (Grossman-Kahn, Schoen, Mallett, Brentani, Kaselitz, & Heisler, 2017). In organizational settings that are highly dependent on teamwork, such as mental healthcare, high turnover can result in increased workloads on the remaining team members, which can increase job dissatisfaction (Khamisa et al., 2015). Mental health workers also often work in stressful work environments, a factor which can further increase their job dissatisfaction (Richardson, 2017).
Recruitment and Retention
Effective retention strategies capitalize on the factors which motivate workers to join and stay at an organization. Factors that motivate mental health workers to join the field include the desire to care for patients in need (Garcia, McGeary, Finley, Ketchum, McGeary, & Peterson, 2015). Others may seek to reduce the stigma associated with mental illness through education and awareness about possible causes and treatments (Grubbs, Fortney, Dean, Williams, & Godleski, 2015). Workers who believe that they are fulfilling these goals are more likely to stay at their jobs. Workplace retention among mental health workers is also influenced by positive relationships with co-workers; the team delivery of healthcare and a shared understanding of human behavior often serve to form positive connections between mental health workers (Grubbs et al., 2015). On the contrary, factors such as small staff-to-patient ratios may serve to decrease retention among community mental health workers (Liu, Jack, Piette, Mangezi, Machando, & Rwafa, 2016). The high-risk environment in which mental health workers work, coupled with inadequate pay, may also increase employee turnover (Grubbs et al., 2015). A lack of positive feedback or recognition (Holmberg, Sobis, & Carlström, 2015), alongside a perceived lack of opportunity for career advancement (Beidas, Marcus, Wolk, Powell, Aarons, Evans, & Babbar, 2015) also influence turnover rates among mental health workers.
Purpose of the Study
Recognizing that research on possible retention strategies for mental health workers is limited despite the burden high mental health worker turnover imposes on patients, employees, and organizations, the purpose of this study is to explore multiple retention strategies healthcare administrators use to retain their mental health workers with more than two years of experience in Texas community mental health clinics. The research question guiding the study is: What strategies do healthcare administrators use to retain their MHWs with more than 2 years of experience? For the purposes of this study, health care administrators (HCAs) were defined as nonclinical professionals who make decisions related to the day-to-day administrative operations of health care facilities and hospitals and ensure adherence to healthcare laws and regulations (Guo, Berkshire, Fulton, & Hermanson, 2019; Hahn, Steinhäuser, & Goetz, 2020). Mental health workers were those who provide treatment, documents care, and meet the primary health care needs of patients with mental illness or behavioral problems (Herschell, Kolko, Hart, Brabson, & Gavin, 2020).