Holding the Line or Heading for the Door: A Phenomenological Exploration of Retention and Turnover Among Direct Care Staff in Inpatient Psychiatry

Abstract

BACKGROUND: Inpatient psychiatry settings rely heavily on non-licensed direct care behavioral health staff to provide continuous patient supervision, therapeutic support, and effective crisis response. Despite their central role, they remain underrepresented in workforce literature, particularly with respect to factors influencing retention and turnover. AIMS: The purpose of the study was to explore the lived experiences of non-licensed direct care behavioral health staff in inpatient psychiatry and identify factors that influence intentions to remain in or leave their roles. METHODS: A qualitative study was conducted using semi-structured virtual interviews with 12 non-licensed direct care behavioral health staff. Participants were employed at six inpatient psychiatric hospitals across the United States and represented multiple job titles and experience. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. RESULTS: Two overarching themes were identified: Barriers to Continuing in the Role and Facilitators of Retention. Barriers included concerns about physical safety, compensation, workload strain, poor leadership communication, and limited career advancement opportunities. Facilitators included positive peer support, meaningful patient connections, supportive workplace culture, and opportunities for supervision and growth. Many participants described peer loyalty as more influential than loyalty to the organization. CONCLUSIONS: Retention among non-licensed direct care behavioral health staff reflects a balance between purpose in the work and sustained occupational risk. Findings suggest that workforce sustainability may be strengthened through intentional peer-support systems, structured post-incident support, leadership visibility, staff safety initiatives, and clear pathways for professional development. Behavioral health workforce planning should more intentionally incorporate the perspectives of non-licensed direct care staff when developing retention initiatives, establishing organizational policies, and implementing workforce strategies.

The authors' abstract, as published at the source. Journal of the American Psychiatric Nurses Association, 2026 · DOI ↗