What is workforce wellbeing?
Workforce wellbeing refers to the physical, social, and psychological health of employees, shaped by their work environment, tasks, and time spent at work. [1] It also includes material wellbeing related to job stability and income. [2]
A positive workplace can foster happiness, a sense of purpose, and job satisfaction, while a stressful environment may contribute to reduced physical and mental health and staff burnout. [3] Since wellbeing directly affects staff retention, productivity, and care quality, employers have a responsibility to provide safe and supportive working conditions and environments. [4-6]
Why workforce wellbeing matters in aged care
Aged care workers navigate unique job stresses and hazards. [7] They provide care for individuals with complex health needs, including multimorbidity, frailty, physical dependency, cognitive impairment, and dementia. [8] Furthermore, many older people in their care will require palliative and end-of-life care. [9] Care in residential settings is particularly intensive, requiring sustained emotional, physical, and social engagement with residents as well as their families and broader social networks. [10] While most Australian aged care workers report finding this work rewarding, [11] these demands—exacerbated by ongoing staff shortages and high workloads—can impact workers’ wellbeing with consequences for care quality and the organisational culture. [12,13]
Burnout, occupational stress, and low job satisfaction are well-documented issues in the aged care sector, affecting nurses, careworkers, managers, and administrative staff alike. [6,14,15] For the sector, the public perception of aged care work is important for attracting and retaining a skilled workforce. This will become increasingly important as the global demand for aged care workers is expected to at least double by 2040 with population ageing. [16]
A complex set of interrelated risk factors contributes to poor workforce wellbeing in aged care. However, services can take meaningful steps to identify, address or mitigate these challenges, even those shaped by sector-wide issues. [7] The Aged Care Quality Standards reinforce this responsibility, particularly within Standard 2, which states: ‘The governing body must lead a culture of quality, safety and inclusion that supports aged care workers to provide quality funded aged care services by … prioritising the safety, health and wellbeing of aged care workers.’ (Outcome 2.2a.) [17]
What the evidence tells us
Aged care research examines a range of wellbeing outcomes for staff in both home and residential aged care. [12] Positive outcomes include job satisfaction, quality of work life, perceived control, and morale. However, most studies to date focus on the negative psychological impacts of this work, such as burnout, anxiety, depressive symptoms, job stress, strain, and intention to leave. [12] Research also explores the physical effects of aged care work, particularly its association with reduced sleep quality [18] and musculoskeletal injuries. [19]
Staff burnout
Workforce wellbeing is often discussed in relation to burnout. [20] Staff burnout is a psychological occupational syndrome that arises when a worker experiences chronic and excessive stress while doing their job. [21] It is characterised by emotional exhaustion, negative feelings of cynicism and detachment towards those in one’s care, and a reduced sense of professional accomplishment. [22]
Burnout is a recognised risk for the aged care workforce. While measured rates vary internationally—undoubtably influenced by differing aged care funding and organisational models—pre-pandemic estimates placed burnout at low to moderate levels. [23] However, evidence suggests that rates have been increasing over time. [8]
Consequences of burnout
Burnout can have serious implications for individuals, those to whom they provide care, and the organisations they work for. For the worker, it is associated with reduced job satisfaction, emotional exhaustion, depression, and anxiety. [24-26] It may also impair decision-making abilities and task performance, potentially leading to errors in care. [27] As it impacts work-life balance, it can come to infuse all aspects of the person’s life. [28,29] In one study, burnout reduced telomere length in aged care workers, increasing their risks of chronic conditions such as heart disease and type 2 diabetes. [30]
Compassion and empathy are central to the role of aged care workers, especially when supporting older people through illness, decline, and death. However, constant emotional engagement and burnout can lead to compassion fatigue, affecting their wellbeing and capacity to sustain quality care. [31]
There is an established link between burnout and less person-centred care approaches by staff, particularly when caring for people with dementia. [32] Care tasks are also more likely to be interrupted, delayed, or missed altogether. [4] Staff report leaving necessary tasks undone, including assisting residents with mobility, eating, or bathing. [33] There is also an association between organisations with high rates of burnout and incidences of hostility, abuse, and neglect of care recipients. [34,35] For aged care services, burnout impacts productivity through increased sick leave [36] and staff intentions to leave the organisation. [24]
Organisational risk factors
A range of interconnected organisational factors contribute to staff burnout in aged care. Among the most significant are staffing and workload pressures. Staff shortages can compromise the quality of care, while excessive workloads, long hours, and time constraints contribute to stress and exhaustion. These pressures also limit opportunities for meaningful interactions with care recipients beyond essential tasks. [37]
Workplace culture and support also play a critical role. Burnout is more likely when staff lack the necessary resources to perform their roles effectively, receive little recognition for their efforts, or feel disempowered or unable to influence their work conditions. Additionally, workplace conflict, exposure to aggression or violence further heighten stress levels. [38]
Moral distress and a ‘troubled conscience’ are also linked to burnout. These experiences arise when staff encounter ethical challenges that conflict with their personal values or professional standards of care. [39] Contributing factors may include organisational policies or resource constraints that prevent staff from providing care that supports an older person’s dignity, comfort, and safety. [40] Additional sources of distress include witnessing disrespect towards residents [41], navigating complex family expectations, or feeling pressured to work beyond their scope of practice due to staffing shortages. [5]
Organisational governance and priorities can exacerbate burnout when productivity, cost containment and regulatory compliance are prioritised over staff wellbeing. In Australia, aged care managers and administrators report high levels of stress when workload expectations related to funding and accreditation standards are not matched by adequate resources. [14]
The cumulative burden of death and dying
Chronic exposure to death and dying is a defining aspect of residential aged care work, leaving staff particularly vulnerable to burnout, most commonly through emotional exhaustion. [42] Distress can arise when time and resource constraints prevent staff from providing the quality, meaningful end-of-life care they believe is necessary. [9,43] Witnessing residents die without privacy, being unable to be present at the time of death and having to quickly remove personal belongings to make way for new residents can heighten feelings of depersonalisation and professional fatigue. [10,42] Staff also report suppressing their grief to maintain a display of professionalism despite the emotional toll of repeated losses. [44] They feel expected to remain emotionally detached, even as they form deep relationships with older people and process the grief when the older person dies. This can create an internal conflict leading to professional fatigue and staff turnover. [44,45]
Experiences of loss may be intensified when there is no structured bereavement support or debriefing following a person’s death, leaving staff to cope with grief in isolation. [46] Organisational cultures that prioritise efficiency over compassionate care can further contribute to burnout, particularly when staff receive limited supervision and inadequate guidance in managing complex end-of-life care issues. [43]
Supporting staff wellbeing
Australian aged care providers, services, and managers have a responsibility to reduce workforce stress, exhaustion, and burnout by assessing working conditions, identifying sources of stress, and addressing them proactively with staff. [22] This includes supporting staff in managing the demands of palliative care and developing skills in self-care. [47]
What can organisations do?
The evidence on specific interventions to reduce workforce stress and burnout is mixed, with no single approach emerging as definitively effective. This may be due to studies being conducted across different countries, care models, participant groups, and timeframes (e.g., pre- versus post-COVID). [48] Many interventions are also small, localised approaches to problems without clear strategies for adapting to different workplace contexts, such as varying facility sizes, resident needs, or workforce diversity. However, this reinforces the importance of tailoring interventions to the unique characteristics of each organisation, considering the needs and preferences of staff, as well as their cultural backgrounds. [48] The following principles appear to cut across the more effective approaches.
Prioritising person-centred care
Education and training in person-centred care have been shown to improve job satisfaction and reduce stress among aged care staff. [49] This is particularly evident in the care of people living with dementia who make up more than half of residents in aged care facilities. [50] Some of the most compelling evidence for preventing burnout comes from interventions that enhance staff communication with people living with dementia and support their quality of life. These include:
- Integrated Snoezelen therapy [51]
- Dementia communication training [52]
- The Validation method for interacting with people with dementia [53]
- Pain management practices tailored to residents living with dementia [52]
- VIPS communication skills training for person-centred dementia care. [54]
These programs may reduce burnout by equipping staff with practical strategies and confidence to manage complex care situations, particularly in responding to distress or responsive behaviours. They may help staff feel more competent, less overwhelmed, and more connected to residents. Just as importantly, participation in these programs can signal that the organisation values compassionate, person-centred care. This organisational commitment can foster a sense of shared purpose and reinforce the emotional rewards of caregiving, buffering staff against burnout. [55]
Building sense of purpose and accomplishment
Research suggests that aged care staff who feel professionally competent, find meaning in their work, and believe they are making a difference report higher job satisfaction. [15,26,56] Organisations that successfully reduce burnout and stress often focus on ways to improve staff sense of professional accomplishment [57,58], especially among personal careworkers who form the backbone of the aged care sector. [59] A consistent finding across studies is that a strong sense of professional accomplishment protects against burnout. Strategies that support this include:
- Public recognition and rewards for staff contributions [60]
- Ensuring access to the material resources needed to perform their roles effectively [61]
- Providing sufficient time to engage meaningfully with residents and clients [62]
- Enhancing nurses’ job control [63] and decision-making autonomy [64]
- Incorporating role complexity for staff to maintain engagement and challenge in their work [22]
- Offering ongoing opportunities for training and professional development. [65]
Creating a supportive work culture
Workplace culture plays a critical role in shaping how staff respond to occupational challenges. Research consistently shows that staff wellbeing and job satisfaction are closely tied to the level and quality of support provided by managers and organisations. [66] When employees perceive strong managerial support, they are more likely to feel that their work is valued and meaningful. [37]
Supportive leadership can take various forms, including regular coaching and feedback, recognition of achievements, role clarity, and investment in staff leadership development. [37] It also includes managers and supervisors who actively listen to staff concerns and genuinely value their input. [67] These behaviours not only support individual wellbeing but also strengthen organisational functioning, with evidence linking supportive leadership to greater nurse engagement in quality improvement initiatives. [37]
In addition to managerial support, co-worker relationships play an essential role in fostering workplace wellbeing. [68] Managers can cultivate strong team dynamics by reserving time for team meetings, promoting open communication, and creating opportunities for shared reflection.
The physical workspace also contributes to a supportive culture. Thoughtfully designed environments—such as shared break rooms, outdoor seating areas, fitness zones, and private spaces for rest—can promote mental and physical wellbeing by offering refuge from stress and opportunities for self-care and peer connection. [13]
Addressing moral distress
Organisations that actively address moral distress among staff are more likely to be effective at reducing stress and burnout. This involves:
- Facilitating open discussions and team-based reflection on ethical challenges in care
- Providing a mechanism for staff to feel safe in expressing concerns about care quality
- Supporting staff in recognising and managing stress related to moral dilemmas. [41,69]
Acknowledging staff grief
Aged care workers frequently experience the deaths of those they care for, yet many feel unprepared or insufficiently trained to navigate this aspect of their role. [43] Without appropriate support, staff are at risk of emotional exhaustion and burnout. [44] Many also report feeling unable to express their grief in the workplace, often suppressing their emotions to maintain a professional demeanour. [45]
Research underscores the importance of managerial support following the death of a resident or a home care client. [9,44] Acknowledging the emotional bonds staff form with older people and their families, and the grief that can result at death, can help reduce feelings of exhaustion and create a deeper sense of professional fulfillment. [70] When organisations implement policies that give staff time to process grief, attend funerals, or formally recognise their role in end-of-life care, it can support emotional recovery and reinforce the value of caregiving work. [10]
Staff may also value additional supports, including:
- Access to and encouragement to engage with Employee Assistance Programs or counselling services
- Opportunities to debrief or share memories with colleagues
- Education and training on death, dying, and grief
- Rituals and memorials to honour those who have died
- Support from an interdisciplinary team, including specialist palliative care nurses. [42,70]
Implementing these strategies can help foster a workplace culture that acknowledges grief as a natural part of caregiving and supports staff in navigating loss.
What can the individual do?
Self-care refers to an individual’s ability to maintain and enhance their wellbeing by remaining self-aware, in control, and self-reliant while regularly monitoring their own needs. [71] It includes taking active responsibility for healthy habits such as adequate sleep, nutrition and physical activity and good mental health. However, people vary in their ability to practise self-care due to personal factors such as low motivation or scepticism about its benefits. [72] Those in caregiving roles may also be inclined to prioritise others’ needs over their own. [73]
Aged care staff report often recognise the value of self-care for sustaining their mental and physical wellbeing. While many view it as a personal responsibility, workplace conditions, including high workloads, long hours, and limited workplace support, can make self-care difficult to prioritise and sustain. [72,74] Staff therefore expect managers and organisations to create a work culture that encourages, normalises, and supports their self-care practices. [73]
The evidence on specific self-care activities such as yoga, breathing techniques, and mindfulness remains mixed, particularly when compared with interventions that build staff capability in areas like dementia care. [48] This variability may reflect the highly individualised nature of self-care and the limitations of a one-size-fits-all approach. [73] However, some studies suggest that training focused on improving self-efficacy, increasing awareness of compassion fatigue, and developing practical self-care strategies may be effective. [75,76]
Page updated 25 March 2025