Abstract
BACKGROUND: Healthcare assistants play a critical role in providing palliative and end-of-life care in the community across many healthcare systems internationally. Despite working alone in emotionally demanding and unpredictable settings, no research has examined their psychological wellbeing or factors influencing turnover. AIM: To investigate the correlations between mental wellbeing, intention to leave their role and workplace support in lone working healthcare assistants providing palliative and end-of-life care in the community. DESIGN: Explanatory sequential mixed methods study, using cross-sectional survey (Warwick-Edinburgh Mental Well-being Scale and Turnover Intention Scale, project team-developed questions), followed by interviews. Quantitative data analysed using descriptive and inferential statistics, qualitative data analysed using framework approach. SETTING/PARTICIPANTS: Lone working healthcare assistants from a UK non-profit organisation providing palliative and end-of-life care. RESULTS: Among 218 survey respondents (22.5% response rate), 80% (n = 174) reported average to high mental wellbeing (mean = 52.2, SD = 8.6). Intention to leave was low (mean = 14.9, SD = 5.3). Higher wellbeing correlated with lower intention to leave (r(216) = -0.25, p < 0.001). Interviews (n = 14) and survey data revealed support from known individuals, particularly line managers, was most valued and accessed by 87.2% of respondents, significantly associated with higher wellbeing and lower turnover intention. Clinical supervision and peer support were frequently accessed and valued, though impact on wellbeing and retention varied. Anonymous online support services remained largely unused despite high awareness. CONCLUSIONS: The study challenges assumptions about psychological distress experienced by this workforce while showing that targeted, personalised workplace support strategies could be key to retention, offering evidence-based pathways for strengthening workforce sustainability.