Why nursing staff turnover is high in incontinence care

Picture this: It's 6:30 AM, and Maria, a certified nursing assistant (CNA) with five years of experience, clockes in for her shift at a long-term care facility. Her first task is to assist Mr. Thompson, an 82-year-old with Parkinson's, who struggled with incontinence through the night. She gently helps him roll onto his side, changes his bedding, cleans him with warm water and wipes, and adjusts his position to prevent bedsores. By 8:00 AM, she's already three more similar routines—each requiring physical strength, patience, and a steady hand. By noon, her back aches from bending, her hands are chapped from constant handwashing, and she's fighting back tears after Mrs. Lopez, a once-vibrant woman with dementia, cried, "I'm so sorry you have to do this." By the end of her 12-hour shift, Maria is emotionally and physically drained. She goes home, collapses on the couch, and wonders if tomorrow will be any easier. Six months later, Maria hands in her resignation. She's not alone—nursing staff turnover in incontinence care is alarmingly high, and the reasons run deeper than just a tough day at work.

The Invisible Weight of Incontinence Care

Incontinence care is often called the "hidden work" of healthcare. Unlike administering medications or monitoring vital signs, it's a task that happens behind closed curtains, away from the spotlight. Yet for nursing staff, it's a daily reality—one that carries physical, emotional, and psychological burdens few outsiders understand. According to the U.S. Bureau of Labor Statistics, the turnover rate for CNAs in long-term care facilities hovers around 55% annually, and experts estimate that incontinence care is a significant driver of this exodus. To understand why, we need to peel back the curtain on the challenges these caregivers face.

Physical Demands: More Than Just "Hard Work"

Let's start with the body. Incontinence care is physically grueling. Imagine lifting a 180-pound patient to change their adult diaper, repeating the motion 10–15 times per shift. Or bending over a bed for hours, adjusting sheets, wiping, and repositioning—all while maintaining proper form to avoid injury. Repetitive strain injuries (RSIs) are common: back pain, carpal tunnel syndrome, and shoulder strain plague nearly 70% of caregivers, according to a 2023 study in the Journal of Nursing Management . For many, these aren't just aches—they're chronic conditions that require physical therapy or even surgery.

"I left because my back couldn't take it anymore," says Jamie, a former CNA who worked in a memory care unit for three years. "I was 28, and I was taking ibuprofen every day just to get through my shift. One day, I lifted a patient wrong and herniated a disc. That was the wake-up call. I couldn't keep sacrificing my body for a job that paid $15 an hour."

But it's not just the lifting. Incontinence care often involves working in tight spaces—squeezing between beds and walls, balancing on unstable surfaces—and exposure to bodily fluids, which increases the risk of slips, falls, or infections. Even with personal protective equipment (PPE), the constant vigilance takes a toll. "You're always on edge," says Lina, a nurse practitioner who oversees a team of CNAs. "One wrong move, and you're dealing with a urine spill, a skin tear, or worse. It's exhausting to be 'on' every second."

The Emotional Toll: Dignity, Guilt, and Compassion Fatigue

While the physical demands are tangible, the emotional weight of incontinence care is often invisible—and even more damaging. For patients, losing control of bladder or bowel function can trigger shame, embarrassment, and loss of self-worth. For caregivers, the responsibility of preserving a patient's dignity while performing intimate tasks creates a unique emotional tightrope.

This emotional labor—empathizing with patients' shame, managing their anger or sadness, and compartmentalizing one's own feelings—leads to what experts call "compassion fatigue." Unlike burnout, which stems from overwork, compassion fatigue is the result of repeatedly absorbing others' pain. Over time, it erodes caregivers' ability to connect, leaving them feeling numb, irritable, or guilty for "not doing enough."

Guilt is a silent killer here. Caregivers often blame themselves if a patient develops a bedsore or feels embarrassed. "I once had a patient who refused to eat because she was ashamed of needing help with incontinence," recalls Raj, a nurse in a skilled nursing facility. "I kept thinking, Did I rush through her care? Did I make her feel like a burden? I lost sleep over it. After a while, you start taking it personally—and that's not sustainable."

Lack of Support: Understaffing and Inadequate Resources

Even the most resilient caregivers can't thrive in a system set up to fail. Understaffing is a crisis in long-term care, with facilities often operating at 80% capacity or less. When a unit is short-staffed, caregivers are forced to rush through incontinence care—sacrificing thoroughness for speed. A 2022 survey by the American Health Care Association found that 78% of CNAs reported skipping "non-essential" steps (like applying lotion to prevent skin breakdown) to keep up with their workload. "You know you should take 15 minutes per patient, but when you have 12 patients and only 4 hours, you cut corners," says Jamie. "Then you feel guilty, and the cycle repeats."

Inadequate resources compound the problem. Many facilities lack basic tools that could ease the burden: waterproof bed pads that stay in place, ergonomic lifting devices, or skin care products that reduce irritation. Without these, caregivers spend extra time troubleshooting—like repositioning a pad that shifts, or soothing a patient's irritated skin after using low-quality wipes. "We begged for better wipes for months," says Lina. "The cheap ones left patients with rashes, which meant more time spent treating the rash—and more stress for everyone."

Training Gaps: When "On-the-Job" Isn't Enough

You wouldn't ask a chef to cook a five-star meal without teaching them to chop vegetables, yet the healthcare industry often expects caregivers to master incontinence care with minimal training. Many CNAs receive just a few hours of instruction on skin care, proper lifting techniques, or managing patient resistance during their initial certification. When they encounter complex cases—like a patient with a colostomy bag or severe skin breakdown—they're left to fumble through, relying on trial and error or the advice of overworked colleagues.

"I had no idea how to handle a patient with a catheter and incontinence until I was thrown into it," admits Sarah, a new CNA. "My trainer said, 'Just wing it—you'll figure it out.' But when the catheter leaked and the patient screamed in pain, I froze. I felt incompetent, and that feeling never really went away. If I'd had proper training, maybe I wouldn't have quit after a year."

Specialized training is rare, too. Incontinence isn't a one-size-fits-all issue: it varies by age, medical condition, and mobility level. A patient with multiple sclerosis may need different care than someone with post-stroke incontinence, but many caregivers never learn these nuances. "We're taught the basics, but not the 'why' behind them," says Raj. "Why does this skin cream work better for diabetics? How do I adjust care for someone with dementia who resists help? Without that knowledge, you're just going through the motions—and that's not fulfilling."

The Cycle of Turnover: When Caregivers Leave, Everyone Suffers

High turnover doesn't just hurt caregivers—it harms patients, too. When a familiar face leaves, patients lose trust and consistency. "Mrs. Gonzalez, my 91-year-old patient, would only let me change her," Maria recalls. "When I left, the new CNA told me she refused care for three days. She said, 'I want Maria.' That broke my heart. Patients bond with their caregivers, and when that bond is broken, their health suffers."

For remaining staff, turnover creates a vicious cycle. As more caregivers quit, the workload increases for those who stay, leading to more burnout and more resignations. A 2024 report by the National Center for Assisted Living found that facilities with high turnover rates had 30% higher rates of patient falls and 25% more cases of hospital-acquired infections—clear signs that rushed, overworked care compromises safety.

A Glimmer of Hope: How We Can Support Caregivers

It's easy to feel hopeless, but there are ways to reduce turnover in incontinence care. The solution starts with recognizing that caregivers aren't just "doing a job"—they're performing a vital, human service that deserves respect, support, and investment.

First, prioritize physical safety. Facilities can invest in lift devices, adjustable beds, and ergonomic tools to reduce strain. Anti-fatigue mats, supportive shoes, and regular stretch breaks can also make a difference. "When our facility got electric bed lifts, my back pain went away almost overnight," Jamie says. "It sounds small, but it made me feel like someone cared about my health."

Second, invest in emotional support. Peer mentorship programs, regular check-ins with supervisors, and access to counseling can help caregivers process their feelings. "At my new job, we have monthly 'debrief' sessions where we talk about tough cases," Sarah shares. "It's not therapy, but it helps to know I'm not alone. My supervisor even said, 'It's okay to cry—this work is hard.' That validation meant everything."

Third, provide specialized training. Workshops on incontinence management, patient communication, and skin care can boost confidence and competence. "I took a course on dementia and incontinence last year," Raj says. "Learning how to redirect a resistant patient with kindness instead of frustration changed everything. I felt like a better caregiver, not just a 'diaper changer.'"

Finally, embrace technology—but don't ｒｅｐｌａｃｅ human connection. In recent years, the rise of care robot has offered a glimmer of hope. These devices can assist with lifting, monitoring skin moisture levels, or even reminding patients to use the bathroom, freeing up caregivers to focus on emotional support. "A care robot can't hold a patient's hand or tell them they're loved," Maria says. "But it can help with the physical tasks, so I have more time to sit and chat with Mrs. Lopez about her grandchildren. That's the part of the job I love—the human part."

Conclusion: It's Time to Value the "Hidden Work"

Nursing staff turnover in incontinence care isn't inevitable—it's a choice. A choice to undervalue the physical and emotional labor of caregivers, to skimp on training and resources, and to ignore the humanity in the "hidden work" of healthcare. But it doesn't have to be this way.

When we support caregivers—with safer tools, emotional validation, and opportunities to grow—we don't just reduce turnover. We create a system where patients receive better care, caregivers find fulfillment, and dignity is preserved for everyone involved. As Maria puts it: "Incontinence care isn't glamorous, but it's sacred. It's about saying, 'You matter, even when your body betrays you.' And the people who do that work? They matter, too."

So the next time you walk past a closed curtain in a hospital or nursing home, pause for a moment. Behind it, a caregiver is likely hard at work—changing bedding, wiping tears, and preserving dignity, one patient at a time. They deserve our respect, our support, and a reason to stay.