‘You’re a human being and not a robot that goes out to work’ : A qualitative study exploring factors impacting on wellbeing and intention to leave among lone working healthcare assistants providing palliative and end-of-life care in the community

Background:
Healthcare assistants (paid nursing support workers without professional qualifications) provide care for terminally ill patients but remain understudied in palliative care research. Working alone in patients’ homes presents a distinct set of intersecting challenges: decision-making in distressing situations, professional isolation and limited access to training and support. Despite growing recognition of the importance of staff wellbeing for care quality and workforce retention, little is known about factors affecting wellbeing and intention to leave among this workforce.
Aim:
To explore factors affecting wellbeing and intention to leave among lone working healthcare assistants providing palliative and end-of-life care in the community.
Design:
Qualitative study combining free-text survey responses and semi-structured interviews, analysed using reflexive thematic analysis.
Setting/participants:
Healthcare assistants from a charitable hospice organisation in the United Kingdom.
Results:
One-hundred and eighty-three participants completed free-text survey questions; 14 participated in interviews. A number of societal, organisational and individual factors impacting on wellbeing and intention to leave were generated. Healthcare assistants experience high job satisfaction from meaningful work alongside systematic undervaluation. Many factors that influence wellbeing and intention to leave fall within organisational control, particularly support systems, workplace culture, recognition, and training opportunities.
Conclusions:
Organisations have clear opportunities to improve healthcare assistants’ wellbeing and retention through targeted interventions addressing support, recognition, and professional development needs.