# Compensation Stability and Workforce Retention During COVID-19: A Paired Comparative Study of Home Care Nurses

## TL;DR

Home care nurses' compensation satisfaction stayed stable during the pandemic, but retention was influenced more by leadership and professional growth than by pay alone.

## Contribution

The study reveals that workforce retention during crises depends on organizational preparedness and leadership, not just compensation.

## Key findings

- Compensation satisfaction remained stable before and during the pandemic.
- Retention intentions were shaped by financial stability, leadership, and professional growth opportunities.
- Intrinsic job satisfaction improved during the pandemic despite resource-related challenges.

## Abstract

What are the main findings?
Compensation satisfaction among home care nurses remained stable before and during COVID-19.Selected retention-related perceptions, particularly financial stability and feeling well paid, changed significantly and were shaped by organizational and preparedness-related factors, including leadership, communication, and professional growth opportunities.

Compensation satisfaction among home care nurses remained stable before and during COVID-19.

Selected retention-related perceptions, particularly financial stability and feeling well paid, changed significantly and were shaped by organizational and preparedness-related factors, including leadership, communication, and professional growth opportunities.

What are the implications of the main findings?
Compensation stability by itself does not guarantee workforce retention during public health emergencies. While it acts as a hygiene factor, true retention relies on motivators like strong leadership and opportunities for professional growth.Health system preparedness strategies must integrate leadership, professional growth, and workforce resilience planning.

Compensation stability by itself does not guarantee workforce retention during public health emergencies. While it acts as a hygiene factor, true retention relies on motivators like strong leadership and opportunities for professional growth.

Health system preparedness strategies must integrate leadership, professional growth, and workforce resilience planning.

Background/Objectives: Home care nurses play a vital role in maintaining continuity of care for vulnerable populations. However, the COVID-19 pandemic exposed long-standing vulnerabilities in the workforce within home and community-based services. While compensation is often emphasized as a primary driver of workforce retention, less is known about how compensation satisfaction and retention intentions changed over time during a public health emergency. Methods: This study employed a cross-sectional survey with retrospective paired comparisons among home care nurses at five home care agencies in Maryland. To assess temporal changes, respondents retrospectively evaluated compensation satisfaction, job satisfaction, and retention intentions before and during the COVID-19 pandemic. Paired samples t-tests were used to examine within-respondent differences across time periods. Herzberg’s Motivator-Hygiene Theory guided the interpretation of these changes in extrinsic and intrinsic workplace factors. Results: Compensation satisfaction did not differ significantly between the pre-pandemic and pandemic periods. In contrast, selected retention-related perceptions, particularly financial stability and feeling well paid, changed significantly and were associated with organizational and preparedness-related factors such as leadership, communication, and professional growth opportunities. Several intrinsic job satisfaction dimensions improved during the pandemic, while resource-related challenges remained. Conclusions: The findings suggest that compensation stability functioned as a hygiene factor that was insufficient to secure workforce retention during the COVID-19 pandemic. Retention intentions were shaped by the interaction of financial security and organizational preparedness. Workforce policies to strengthen home care systems should combine compensation strategies with leadership development, professional growth opportunities, and emergency preparedness planning to build resilience during future crises.