Exploring the role of psychological need fulfilment on stress, job satisfaction and turnover intention in support staff working in inpatient mental health hospitals in the NHS: a self-determination theory perspective

Abstract

Background

Meeting psychological needs for autonomy, competence and relatedness as described by Self-Determination Theory (SDT) has been associated with increased well-being and job satisfaction in mental health staff and improved care outcomes for patients.

Aims

The study investigated whether psychological need satisfaction predicted stress, turnover intention and job satisfaction in health care assistants (HCA) working in inpatient mental health hospitals in the United Kingdom including full time (FT) and temporary agency worker (TAW) staff.

Methods

A cross-sectional survey explored need satisfaction between FT (n = 63) and TAW (n = 39) staff using the Work-Related Basic Need Satisfaction Scale. Multiple regression was used to explore whether satisfaction of the needs for autonomy, competence and relatedness predicted scores on measures of stress, job satisfaction and turnover intention.

Results

Results were comparable between FT and TAW staff. Autonomy was the need least satisfied, a need which predicted self-reported job satisfaction, stress and turnover intention. Relatedness also predicted job satisfaction and turnover intention.

Conclusions

Recommendations are made to explore experiences of (and barriers to) autonomy and relatedness in inpatient HCA staff to target and improve autonomy and relatedness in this workforce. Implications of doing so are considered at a staffing, organisational and patient level.

Keywords:

• Mental health staff
• inpatient
• health care assistant
• self-determination theory

Introduction

Mental health workers are commonly identified as being at an increased risk of stress, poorer wellbeing and high turnover (Aarons & Sawitzky, 2006; Johnson et al., 2018; Mental Health Network NHS confederation, 2017; Morse et al., 2012). It is necessary to explore the determinants of negative work-related outcomes such as these, as experiences of poor well-being in the mental health workforce have also been associated with reduced patient safety, quality of care and patient satisfaction (Hall et al., 2016; Salyers et al., 2017).

Previous research has used Self-Determination Theory (SDT) to understand worker experiences and outcomes in terms of motivation, performance, psychological adjustment and wellbeing (Gagné & Deci, 2005). Described as a theory of human motivation and personality development, SDT posits that humans have an innate tendency toward growth, development, integrative functioning and wellness dependent on satisfaction of three basic psychological needs “autonomy”, “competence” and “relatedness” (Deci & Ryan, 2000). “Autonomy” refers to an individual’s need to experience ownership of his or her actions and to be self-regulating. In the workplace, this also relates to a subjective sense of “choice and psychological freedom when carrying out an activity” (Deci & Ryan, 2000). “Competence” is described as feeling effective, reflecting a need to experience skill development and mastery and “relatedness” is the desire to experience connectedness and belonging with others including a subjective sense of group membership and supportive collegiate relationships (Van den Broeck et al., 2010).

Since its development, SDT has received empirical validation as a theory for understanding worker motivation, performance and wellbeing (Gagné & Deci, 2005). Autonomy, competence and relatedness have been associated with increased wellbeing and job satisfaction and lower levels of perceived work strain and turnover intentions in a meta-analysis of 99 organisational workforce studies cross-culturally (Van den Broeck et al., 2016). Efforts to target and improve autonomy, competence and relatedness have also been associated with improved work-related outcomes. Increasing perceived autonomy through facilitating participation in organizational decision-making with management for example has been associated with increased job satisfaction, reduced turnover intentions and lower stress in mental healthcare staff working in inpatient psychiatric and residential settings (McDonnell & Wilson-Simpson, 1995; Miller et al., 1990).

Whilst there are comparatively fewer studies exploring the role of psychological need satisfaction in mental health staff, satisfaction of the needs for autonomy, competence and relatedness in this population has similarly been associated with positive work-related outcomes such as reduced stress and increased well-being and job satisfaction (Dreison et al., 2018). Greater need satisfaction in mental health staff has also been shown to improve worker motivation through an internalized adherence to the philosophy of a service and more positive attitudes towards patients (Lynch et al., 2005). Where needs are unmet or thwarted, workers have been found to be at an increased risk of stress, turnover intention and absenteeism (Olafsen et al., 2017).

These results demonstrate potential for the use of SDT’s basic psychological needs (autonomy, competence and relatedness) in understanding mental health worker outcomes as a staff group already at risk of stress, turnover and low job satisfaction (Aarons & Sawitzky, 2006; Mental Health Network NHS confederation, 2017). Research is however limited and has not accounted for differences in working environments and job roles within the mental health workforce. Research concerning need satisfaction in staff working in inpatient mental health settings for example is limited, described as “low quality” and difficult to interpret (Cahill et al., 2004; Richards et al., 2006). Coping with threats of violence, working with patients treated against their will and shift-working patterns may result in this workforce being at greater risk of having their psychological needs unmet or experiencing negative work-related outcomes such as stress, poor job satisfaction and turnover (Cahill et al., 2004; Kelly et al., 2016; Lynch et al., 2005). There has also been a tendency in research to focus on “mental health staff” more generally (Cahill et al., 2004), neglecting to account for the influence of specific job roles on need satisfaction. No study has specifically explored need satisfaction in frontline mental health workers such as healthcare assistants (HCA). HCA staff however represent the largest proportion of the mental health workforce in the United Kingdom who also spend the most time in face-to-face contact with patients (Cavendish, 2013; NHS, 2018).

Across the NHS, staff shortages have resulted in temporary agency workers (TAWs) becoming a widely used resource (Nicholson, 2016). No study has yet investigated experiences of psychological need satisfaction in TAWs working as HCA staff in inpatient mental health settings. Literature referencing this staff group has typically focused on how to limit their use (Nicholson, 2016). In a review of funding and staffing of NHS mental health providers, however, providers were “reliant on TAW staff to meet safe staffing requirements” (Gilburt, 2018). Thus, whilst it may be important to think about reducing spend on TAWs in the long term, in the short term, this staff group represent an important resource for mental health services whose experiences should be accounted for. Research has also identified additional factors which may thwart psychological need satisfaction in temporary workers such as job insecurity (relating to the uncertainty of work availability) and reduced opportunities for social relationships at work due to exclusion by permanent workers (Bosmans et al., 2015; Vander Elst et al., 2012).

Aims

The present study aimed to investigate psychological need satisfaction in TAW and FT-NHS HCA staff in inpatient mental health hospitals as a workforce currently underrepresented in research literature. The study sought to explore degree of satisfaction of autonomy, competence and relatedness in HCA staff and whether need satisfaction predicted work-related outcomes “stress”, “job satisfaction” and “turnover intention” (relating to an intention to quit completely from a place of work). These variables were decided as greater stress, higher turnover intention and lower job satisfaction are common issues in mental health staff (Aarons & Sawitzky, 2006; Mental Health Network NHS confederation, 2017). If a relationship is identified between psychological need satisfaction and self-reported stress, job satisfaction and turnover intention, inferences could be made surrounding the role of autonomy, competence and relatedness in understanding and predicting HCA staff outcomes in inpatient mental health settings. Specifically, findings may give rationale for further research exploring specific factors which facilitate or hinder psychological need satisfaction in this staff group which could allow for targeted measures to be taken to improve need satisfaction in the HCA workforce.

Research questions

1. To what extent do HCA staff (FT-NHS and TAW) working in NHS adult inpatient mental health services experience satisfaction of the needs for autonomy, competence and relatedness?

(2a) Do FT-NHS and TAW staff groups differ in terms of their experiences of satisfaction of the needs for autonomy, competence and relatedness at work.

(2b) Are there differences in scores on measures of job satisfaction, stress and turnover intention between TAW and FT-NHS HCA staff.

(3-5) Are employment type (TAW or FT-NHS) and satisfaction of the needs for autonomy, competence and relatedness significant predictors of job satisfaction (H3), turnover intention (H4) and Stress (H5) in HCA staff working in adult inpatient mental health services?

Materials and methods

Participants

Study participants were 102 HCA staff from 10 wards in three hospitals across two NHS mental health Trusts. Participants were required to be currently working in an HCA role in an adult inpatient mental health setting for a minimum of 30 hours weekly, employed by the hospital (FT-NHS) or through an NHS or non-NHS recruitment agency (TAW). 30 hours was decided to allow comparison between staff groups and that an NHS inpatient mental health setting was likely to be the main source of employment. New staff members (employed <1 month) were excluded. FT-NHS staff made up 63 (62%) of the sample and the remaining 39 (38%) were TAW staff.

Design

Cross-sectional survey methodology was used to collect data from participants at a single time point. Data analysis was completed using IBM SPSS Statistics software (v.26). Scores on standardised measures of psychological need satisfaction, turnover intention, job satisfaction and stress were compared between FT-NHS and TAW HCA staff. Multiple linear regression explored whether satisfaction for the needs for autonomy, competence, relatedness and role type (FT-NHS or TAW) predicted three dependent variables “job satisfaction”, “turnover intention” and “stress”.

Materials

Online and paper surveys captured demographic information including age, gender, education, first language and descriptive information such as role type (FT-NHS or TAW), duration of employment and average weekly hours.

The 18 item Work-Related Basic Need Satisfaction Scale (W-BNS; Van den Broeck et al., 2010) measured psychological need satisfaction. Subscale reliability for autonomy, competence and relatedness scales are (α) 0.79, 0.83 and 0.76 respectively (Van den Broeck et al., 2016). Job-satisfaction was measured using the ten-item Generic Job Satisfaction Scale (JSS), a reliable measure of job satisfaction in multiple occupations (α = 0.77; Macdonald & MacIntyre, 1997). The six-item Turnover Intention Scale (TIS-6) is a reliable measure of turnover intention (α = 0.80) with good predictive validity (Bothma & Roodt, 2013; Roodt, 2004). The 10-item Perceived Stress Scale (PSS; Cohen et al., 1983) measured worker stress. This measure was found to have good internal consistency when used with nurses working in inpatient mental health settings (α = 0.83, Tuvesson et al., 2011).

Procedure

Favourable ethical opinion was given from the University of Surrey (FER-1819-003). Approval was obtained by the Health Research Authority and local NHS Research and Development departments. Ward managers were emailed study information and asked to forward an online survey to HCA employees. Ward managers also facilitated access to seven wards in one NHS Trust. Staff recruited face-to-face were given detailed written and verbal study information and provided written consent to participate. Face-to-face data was collected in 32 hours over 11 days between April and August 2019. To increase access to participants and reflect the 24-hour nature of HCA shifts, recruitment took place during daytime (n = 52) and night (n = 12) shifts.

Results

Descriptive statistics

The online survey was completed by 38 participants (response rate 40.8%), six being TAW staff (16%). The remaining 64 participants comprising of 31 FT-NHS (48%) and 33 TAW (52%) staff members were recruited at their workplace and completed a paper survey (response rate 100%). FT-NHS and TAW staff did not differ significantly in mean number of hours worked per week (p = 0.692) or duration of employment (p = 0.158). Demographic information can be observed in Table 1.

Table 1. Sample descriptive statistics.

	FT NHS	TAW	All
	(n = 63)	(n = 39)	(n = 102)
Age range (years)	22–61	20–64	20–64
(M, SD)	(35.7, 11.44)	(35.9, 12.93)	(35.8, 11.96)
Gender
Male n (%)	25 (39.9%)	19 (48.7%)	44 (43%)
Female n (%)	38 (60.1%)	20 (51.3%)	58 (57%)
Highest Level of Education
High School (e.g. GCSE)	9 (14%)	0 (0%)	9 (8.8%)
College Course	10 (17%)	4 (10%)	14 (13.8%)
A Level	4 (6%)	10 (26%)	14 (13.8%)
University Degree	28 (44%)	14 (36%	42 (41.2%)
Master’s Degree	4 (6%)	6 (15%)	10 (9.8%)
Doctorate level qualification	0 (0%)	2 (5%)	2 (1.7%)
Other (e.g. National Vocational Qualification)	8 (13%)	3 (8%)	11 (10.8%)
Duration of employment (years)
Range	0.08 (1 mth) to 33 years	0.08 to 30 years	0.08 to 33 years
(M, SD)	(5.51, 7.71)	(3.64, 5.52)	(4.79, 6.99)
Hours worked (Weekly)
Range	30–65	30–60	30–65
(M, SD)	(38.5, 4.42)	(39, 7.97)	(38.7, 5.9)

Research question 1 sought to explore the extent that HCA staff working in adult inpatient mental health services experience satisfaction of autonomy, competence and relatedness. Tables 2 and 3 detail total Mean W-BNS scores and dependent variable measures of job satisfaction, turnover intention and stress. Total W-BNS and subscale scores of autonomy, competence and relatedness are described as percentages (of a top possible subscale score of 30) as no cut-scores are provided by the author. A score of 15 out of 30 on the autonomy subscale for example, would indicate 50% satisfaction of the need for autonomy. Satisfaction of the need for “competence” was the highest at 81.1 per cent overall (M = 24.33, SD = 3.56) followed by a 76.83 per cent satisfaction of the need for relatedness (M = 23.05, SD = 3.93). Autonomy was the need least satisfied in both staff groups (64.87%) with a mean score of 19.46 (SD = 4.02) out of 30.

Table 2. Mean scores obtained on W-BNS subscales, overall and between full-time NHS (FT NHS) and Temporary Agency (TAW) Staff.

	FT NHS	TAW	All	Difference between FT NHS and TAW Mean scores (p)
	(n = 63)	(n = 39)	(N = 102)
W-BNS %	73.11%	76.12%	74.27%	2.71 (0.136)
(M, SD)	(65.8, 8.7)	(68.51, 9.06)	(66.84, 8.9)
Autonomy %	64%	66.23%	64.87%	0.67 (0.419)
(M, SD)	(19.2, 4.01)	(19.87, 4.05)	(19.46, 4.02)
Competence %	79.73%	83.33%	81.1%	1.08 (0.176)
(M, SD)	(23.92, 2.96)	(25, 4.34)	(24.33, 3.56)
Relatedness %	75.6%	78.8%	76.83%	0.96 (0.233)
(M, SD)	(22.68, 4.02)	(23.64, 3.75)	(23.05, 3.93)

W-BNS highest possible score of 90; Autonomy, Competence and Relatedness each have a highest possible score of 30. These three subscales make up the total W-BNS score.

Table 3. Mean scores obtained on job satisfaction, turnover intention and stress; overall and between full-time NHS (FT NHS) and Temporary Agency (TAW) Staff.

	FT NHS	TAW staff	All	Difference between FT NHS and TAW Mean scores (p)
	(n = 63)	(n = 39)	(N = 102)
Mean Job Satisfaction (SD)	33.68 (6.23)	36.87 (6.37)	34.9 (6.45)	3.19 (0.014*)
Mean Turnover (SD)	16.38 (6.49)	17.51 (6.29)	16.81 (6.4)	1.13 (0.388)
Mean Stress (SD)	18.14 (7.56)	16.33 (5.82)	17.45 (6.97)	1.81 (0.204)

*p value is significant at the 0.05 level.

Regarding research question 2, The difference in total W-BNS scores between FT-NHS (M = 65.8, SD = 8.7) and TAW (M = 68.51, SD = 9.06) staff was not statistically significant (p=.136). There was no statistically significant difference in FT-NHS and TAW staff scores for “autonomy” (p = 0.419), “competence” (p = 0.176) or “relatedness” (p = 0.233). See Table 2 for group means and respective p values. Mean job satisfaction scores in TAW staff (M = 36.87, SD = 6.37) were statistically significantly higher than in FT-NHS staff (M = 33.68, SD = 6.23, p = 0.014). Yet both staff groups fell in the “high job satisfaction range” on the JSS. There was no statistically significant difference in mean turnover intention scores (p = 0.388) between FT-NHS (M = 16.38, SD = 6.49) and TAW staff (M = 17.51, SD = 6.29). There was no statistically significant difference in mean “stress” scores (p=.204) between FT-NHS (M = 18.14, SD = 7.56) and TAW staff (M = 16.33, SD = 5.82). Both staff groups fell in the “moderately stressed range” overall. See Table 3 for mean scores for each staff group and respective p values.

Preliminary exploration of the data and visual inspection of Q-Q plot and histograms revealed that data met the assumption of normality required to perform linear regression analysis. Data also met the assumptions of homoscedasticity and multicollinearity. Multiple linear regression was used to explore whether satisfaction of the needs “autonomy”, “competence” and “relatedness” and the dichotomous dummy coded variable “role type” (FT-NHS or TAW) predicted the three dependent variables “job satisfaction”, “turnover intention” and “stress” (research questions 3-5). Recruitment strategy was considered as a covariate in regression analyses to control for the possible influence of face-to-face versus online-based recruitment. Recruitment strategy did not contribute significantly to any model.

A linear regression was conducted to see if the predictor variables, autonomy, competence, relatedness and role type predicted job satisfaction. Casewise diagnostics revealed one outlier. The outlier was kept in the model as it was a genuine participant response relating to high job satisfaction and its removal did not significantly influence results. Using the enter method, a significant regression model emerged (F(4, 97) = 23.467, p < 0.001). The model accounted for 49.2% of the variance in job satisfaction scores (R²= 0.492, R²_Adjusted =0.471). Autonomy (β = 0.53, t(97)=6.468, p < 0.001) and relatedness scores (β = 0.194, t(97)= 2.305, p = 0.023) contributed significantly to the model and were significant predictors of job satisfaction. Competence (β = 0.053, t(97)=0.658, p = 0.512) was not a significant predictor of job satisfaction. In this model role type was also a significant predictor of job satisfaction (β= −0.168, t(97)=–2.286, p = 0.024).

To consider “role type” further, Pearson’s correlational statistics were used to explore the relationship between significant predictor variables (autonomy and relatedness) and job satisfaction in FT-NHS and TAW staff respectively. Autonomy was statistically significantly positively correlated with job satisfaction scores in both FT-NHS (r = 0.79, p < 0.001) and TAW (r = 0.42, p = 0.008) staff. Autonomy was significantly more highly correlated with job satisfaction in the FT-NHS staff group (z = 2.959, p = 0.002). Relatedness was statistically significantly positively correlated with job satisfaction in FT-NHS (r = 0.566, p < 0.001) but not TAW (r = 0.263, p = 0.108) staff. Results however indicate a stronger correlation between both autonomy and relatedness and job satisfaction in FT-NHS than TAW staff.

A multiple linear regression was conducted to see if predictor variables autonomy, competence, relatedness and role type predicted turnover intention. A significant regression model emerged (F(4, 97) = 10.608, p < 0.001) accounting for 30.4% of the variance in turnover intention scores (R² = 0.304, R²_Adjusted = 0.276). Autonomy (β = −0.346, t(97) = –3.608, p < 0.001) and relatedness (β = −0.246, t(97) = −2.496, p = 0.014) contributed significantly to the model and were significant predictors of turnover intention. This suggests that higher satisfaction of the needs for autonomy and relatedness predicts a lower turnover intention score. Competence (β= −0.091, t(97)=–0.954, p = 0.342) and role type (β= −0.157, t(97)= −1.829, p = 0.070) were not significant predictors of turnover intention.

A multiple linear regression was conducted to see if the predictor variables autonomy, competence, relatedness and role type predicted stress scores. A significant regression model emerged (F(4,97) = 5.082, p = 0.001), accounting for 17.3% of the variance in stress scores (R² = 0.173, R²_Adjusted =.139). Autonomy was the only variable that contributed significantly to the model (β = −0.312, t(97) = −2984, p = 0.004). Greater satisfaction of the need for autonomy is associated with lower perceived stress.

Discussion

This study sought to explore the role of psychological need satisfaction (as described in SDT) in predicting “stress”, “job satisfaction” and “turnover intention” in NHS inpatient TAW and FT-NHS HCA staff. Satisfaction of the need for competence was highest in both staff groups followed by relatedness. “Autonomy” was satisfied least in both staff groups. This suggests that whilst staff generally felt competent in their roles and experienced relatedness with colleagues, overall they felt less autonomous at work. Results were generally comparable between staff groups challenging previous research suggesting that TAW staff may be at greater risk of their psychological needs being unmet (Bosmans et al., 2015; Vander Elst et al., 2012). One reason for this might be that an increased reliance on use of temporary workers to safely staff services in the NHS (Gilburt, 2018) might have mitigated some of the previously identified threats to psychological need satisfaction in TAW staff such as job insecurity and uncertainty of hours (Vander Elst et al., 2012). It is also possible that the similarity of results between FT-NHS and TAW staff might be due to measures taken to enable comparison between staff groups (e.g. working 30 hours or more per week). Future research could consider TAW staff who work fewer hours or across multiple settings to better reflect the nature of temporary agency work.

In terms of job satisfaction, whilst both groups fell in the “highly satisfied” range overall, TAW staff were significantly more satisfied with their jobs than FT-NHS workers. Future research may benefit from exploration of factors contributing to job satisfaction in this workforce.

Previous research identified significant associations between satisfaction of the need for autonomy, competence and relatedness and increased job satisfaction, reduced stress and lower turnover intention in mental health staff more generally (Dreison et al., 2018; Olafsen et al., 2017). In the present study however, autonomy was the only significant predictor of job satisfaction, stress and turnover intention in both staff groups. The nature of agency work is such that shifts are optional which may explain why TAW staff experienced slightly higher scores than their FT-NHS colleagues on the W-BNS autonomy subscale. Greater perceived autonomy predicted higher job satisfaction and lower turnover intention and stress. The significance being such that autonomy was also the need which was satisfied least overall compared to “competence” and “relatedness” scores. This finding supports previous research identifying HCA staff as experiencing lower levels of perceived autonomy compared to other mental health professionals (Johnson et al., 2012). Our results also add weight to existing arguments which have long highlighted an association between lower perceived autonomy and poorer wellbeing and increased stress in mental health staff (Browner, 1987; Donat et al., 1991).

Relatedness was also a significant predictor of job satisfaction and turnover intention in the overall sample. Relatedness was more strongly correlated with job satisfaction in FT-NHS staff than their TAW colleagues. This may reflect TAW experiences of working across different wards within the inpatient mental health hospital setting (rather than being part of a core ward team). This may have resulted in them experiencing relationships with many more colleagues but with differing expectations as to the quality and potential for closeness. “Competence” did not predict stress, job satisfaction or turnover intention in either staff group. The reasons for these findings are unknown. The identified high perceived competence in this worker population in the context of also experiencing comparatively lower autonomy is however worth consideration. Specifically, the predictive value of autonomy on job satisfaction, stress and turnover intention may be understandable in the context of workers feeling competent but not able to use perceived competence in an autonomous way at work.

Recommendations and implications for practice

The present study explored experiences of psychological need fulfilment on work-related outcomes in NHS inpatient mental health HCA staff, a workforce (and workplace) previously underrepresented in research literature. Results suggest that “autonomy” and “relatedness” could be useful for predicting inpatient mental health HCA staff outcomes. “Autonomy” was the most consistent and influential predictor of turnover intention, job satisfaction and stress but also the need least met. Interventions to understand, target and increase perceived autonomy in HCA staff may be beneficial for worker outcomes.

A consideration of “autonomy support” in the context of inpatient mental health staff must however account for characteristics of working in a ward environment which may thwart worker autonomy. This includes tasks to manage patient safety such as prescriptive timetables of daily duties, patient observation, allocation of set break-times and decisions around care generally being made by staff in higher grade roles. We suggest further exploration of experiences of, and barriers to, perceived autonomy in this workforce. Qualitative interviews could help consider factors which support and thwart autonomy on a ward-by-ward basis, ensuring that autonomy supportive interventions are generated in and “done with” rather than imposed on teams. Totman et al. (2011) also discussed the importance of improving staff perceptions of autonomy through participation in team meetings and asking for opinions and suggestions as to ward policies, day to day ward activity and patient care. Facilitating worker involvement in this way may also improve relatedness, a need which predicted higher job satisfaction and lower turnover intention. This is particularly relevant in inpatient mental health wards where recruitment and retention are described as “problematic and costly” (Johnson et al., 2010).

At a patient level, HCA staff spend the most time with patients (Cavendish, 2013). Research has previously identified that staff who experience more autonomy at work have also been shown to be more “autonomy supportive” of patients, who in-turn experience more warmth (relatedness) in the patient-staff relationship (Lynch et al., 2005). The significance of this is such that patient-level psychological need satisfaction is associated with engagement in positive health behaviours and treatment motivation even in inpatient settings where treatment may be mandated and engagement autonomy can be low (Chang, 2012; Wild et al., 2016). Future research could consider need satisfaction in HCA staff and whether this has implications for patient level engagement and treatment outcomes.

Limitations

Face-to-face recruitment was necessary to protect participation time in a busy workforce. It is possible that results were subject to social desirability biases owing to the potentially sensitive nature of discussing experiences of work whilst in the workplace. Participants were aware that individual responses would not be available to their employer. In contrast, some participants reported finding the questionnaire methodology limiting. Future research could consider qualitative methodologies allowing for more exploration of factors influencing need satisfaction. An extended recruitment period could also increase numbers of TAW participants to improve generalisability of findings allowing for fairer comparison of staff groups.

Conclusions

The present study explored the role of psychological need satisfaction on worker outcomes in HCA staff working in NHS inpatient mental health settings. Scores on measures of autonomy, competence and relatedness (basic psychological needs defined by SDT), stress and turnover intention did not differ significantly between FT-NHS and TAW staff groups. Autonomy was the need least satisfied overall and predicted job satisfaction, stress and turnover intention. Relatedness also predicted job satisfaction and turnover intention. We recommend further research to explore factors which support or thwart experiences of autonomy and relatedness in this workforce. This may allow for targeted action to increase perceived autonomy and relatedness. The potential clinical implications of doing so, are considered in terms of staff and patient-level engagement and outcomes.

Disclosure statement

No potential conflict of interest is declared by the author(s).