1 Introduction

Caregivers are an indispensable and important component of elderly care services, playing a key role in the elderly care service system. At present, researches on nursing staff in elderly care institutions in China mainly focus on job satisfaction, vocational training and labor compensation. Exploration has been conducted on the role that nursing staff play in enhancing the quality of elderly care services, strengthening nursing service capabilities, and constructing evaluation systems, with corresponding suggestions and strategies having been put forward. The research conducted by Xue Ping et al. showed that Shanxi Province had effectively improved the professional level of nursing staff and patient safety by constructing a standardized training system for medical nursing staff [1]. The investigation carried out by Zhou Wenjuan and others disclosed that deficiencies existed in the training of caregivers in medical and elderly care institutions, and attention should have been paid to the comprehensiveness and pertinence of the training content [2]. Dong Feng's research, through a questionnaire survey, pointed out that nursing training should have focused on basic theories and operational skills to improve the satisfaction of hospitalized patients [3]. Lu Wei's research explored the current situation of nursing workers in terms of cognition, emotion, and behavior from the perspective of professional attitude, and proposed corresponding educational strategies [4]. The study by Wu Min et al. pointed out that elderly nursing staff in Jinan's elderly care institutions generally lacked professional education background, and there were problems with personnel management [5]. Wang Hongli and others revealed the dynamic evolution process of nursing workers' professional identity through grounded theory analysis, providing practical inspiration for improving the management of grassroots work groups [6]. Dong Weiwei and Tan Lei's research focused on the labor management and difficulties faced by caregivers in private elderly care institutions, emphasizing the role of public policies in improving the working conditions of caregivers [7]. Xue Xiaojing and Yang Xiaolin discussed the issue of the shift-based service model for nursing staff in tertiary hospitals, and suggested strengthening the vocational training of nursing staff and improving the hospital management system [8]. However, existing research had paid little attention to using push-pull theory to analyze the mobility issues of caregivers. The reasonable mobility of caregivers was of great significance for optimizing the allocation of elderly care resources. This article used the push-pull theory to conduct research on caregiver mobility through interviews, which had certain value in improving the professionalism and stability of nursing services in elderly care institutions, and promoting the high-quality development of elderly care services.

2 Understanding and Suitability Analysis of Push-Pull Theory on Occupational Mobility of Nursing Home Caregivers

2.1 The Connotation and Development Process of Push-Pull Theory

The origin of push-pull theory can be traced back to the 1880s. The earliest scholar to study population migration was British scholar Livingstone, who proposed seven migration rules to explain the reasons for population migration. In the 1960s, American scholar Everett Lee further revised the theory, dividing the factors that affect migration into two categories: "push" and "pull". Among them, "thrust" is regarded as a negative factor affecting population migration, which prompts people to leave their original place; The 'pulling force' is seen as a positive factor affecting population migration, which drives people to move to their destination. In addition, Lee also introduced a third factor called “intermediary barriers”, which hinder migration due to factors such as personal beliefs, cultural differences, or local protection policies. According to push-pull theory, actual population migration occurs when intermediate barriers are eliminated and the "pushing" and "pulling" forces are in an unbalanced state; When the intermediate obstacles are not eliminated or when the "push" and "pull" are in equilibrium, and other conditions remain unchanged, actual population migration does not occur [9].

2.2 The Appropriateness of Push-Pull Theory and Occupational Mobility for Elderly Care Workers

2.2.1 Integrated Analysis of Multidimensional Factors

Push-pull theory provides a multidimensional analytical framework by distinguishing between "pushing" and "pulling" factors. This can comprehensively encompass various factors that affect the mobility of elderly care workers, including pulling factors such as working conditions, salary and benefits, career development opportunities, as well as pushing factors such as work intensity, social status, and professional identity. This multidimensional analysis facilitates a deeper understanding of the occupational mobility behavior of elderly care workers.

2.2.2 Reflection of Dynamic Changes

Push-pull theory can dynamically reflect changes in the elderly care worker market. With an aging population and the increasing demand (pulling force) for elderly care, the supply side (pushing force) may weaken due to issues such as high work intensity and low social identity. Push-pull theory can capture this dynamic change and provide timely feedback to policy makers and elderly care institution managers, enabling them adjust recruitment, training, and retention strategies.

2.2.3 Consideration of Intermediate Obstacles

Intermediary barriers, such as biases against external caregivers or family obligations, may hinder or promote the mobility of elderly care workers. For example, some regions may have biases against foreign caregivers, or caregivers themselves may be unwilling to relocate due to family responsibilities. The existence of these intermediate barriers requires push-pull theory to analyze and predict the flow patterns of elderly care workers in more detail.

By harnessing the principles of push-pull theory, nursing homes can effectively forge stronger bonds with potential employees, alleviate migration anxieties, and generate compelling pull factors to entice talent. Moreover, the government should tackle intermediary barriers through methodical planning, rigorous policy execution, and stringent process oversight to coordinate and surmount these intermediate challenges, thereby facilitating a rational and orderly circulation of skilled individuals.

3 Object and Method

3.1 Survey Subjects

10 nursing staff are employed in the nursing home, including 3 males and 7 females, aged between 43 and 60 years old, with an average age of 52.3 years old. There is 1 person with a university education, 4 people in high school, and 5 people in junior high school.

3.2 Survey Method

The interview survey method is adopted, and the interview outline is designed by the author. The purpose and answer method of each question were explained to the interviewees, using anonymous methods to ensure the privacy and honesty of the interviewee. The interview outline is designed from the following four aspects: first ,Career cognition: including understanding and recognition of the nursing profession, as well as the reasons and motivations behind their choice of this job. Second, Professional emotional experience: including job satisfaction, perceived work pressure, relationships with colleagues and seniors, and how these factors affect their emotional state. Third, Occupational behavioral tendencies: including caregivers' enthusiasm for work, willingness to serve the elderly, behavioral responses to challenges, and their planning and expectations for career development. Fourth, Work environment and conditions: including work intensity, working hours, work safety, resource availability, and how these conditions shape their work experience and career satisfaction.

The interview outline had guided interviewees to delve into the various dimensions mentioned above through open-ended questions, in order to collect qualitative data and gain a more comprehensive understanding of the professional attitudes and work environment of caregivers. This in-depth interview had provided richer and more specific information as well as targeted recommendations.

4 Results and Analysis

4.1 Occupational Cognition

While 80% of caregivers found their work is meaningful and can meet the needs of society and the elderly, 20% of caregivers viewed it a merely a means of livelihood, reflecting differences in the perception of the meaning of their work among the caregiver group.

4.2 Professional Emotional Experience

While 90% of caregivers reported 10% of caregivers believed that their career choice to limited education, resulting in low self-esteem and lack of confidence. Notably, all the caregivers were looked down upon by their family and friends when they first entered the caregiver industry, reflecting a certain bias towards the caregiver profession in society. 90% of caregivers relieve negative emotions on their own when an elderly person passes away, and 10% of caregivers talk to colleagues to relieve emotions. This indicates that the emotions of caregivers in their work have not been given attention, and the hospital should provide guidance.

4.3 Occupational Behavioral Tendency

All respondents expressed enthusiasm for elderly services, willingness to do what the elderly need without violating professional ethics, and subjectively willing to work hard, demonstrating strong service awareness and a positive work attitude.

4.4 Working Environment and Conditions

There are 9 regular nurses, working 24 hours a day and 24 hours a day off. There is 1 trainee nurse, working from 8 am to 5:30 pm, and the workload is quite intense. This work mode poses a significant challenge to both the physical and mental health of caregivers. The job mainly includes taking care of the elderly's eating, drinking, defecating, handling emergencies, providing rehabilitation care, psychological care, as well as cleaning, delivering meals, chatting with the elderly, and other various tasks. The work is complex and tedious, requiring caregivers to have high patience and comprehensive skills.

Most caregivers believe that there is a shortage of caregivers in nursing homes, especially experienced caregivers, indicating that there is a shortage of personnel in the nursing home and also reflecting the current situation of talent shortage in the nursing industry.

Involvements of the Nurses' union in the learning of rehabilitation, psychological care and other skills can motivate the caregivers. For example, some nurses have the idea of being promoted to supervisors, and intern nurses have the idea of becoming regular. However, the training and promotion system of the overall nursing industry still needs to be further improved to enhance the career development space of nursing workers, improve the working environment and conditions, and enhance the attractiveness of the industry.

5 Analysis of the Problem of Caregiver Turnover in Nursing Homes from the Perspective of Push-Pull Theory

5.1 Push Factor

5.1.1 Employment Threshold and Training Pressure

While the educational requirements for nursing home caregivers are not at the top level, they necessitate systematic nursing knowledge and practical skills. Most regions require certification for employment, which involves multiple courses and long-term training, posing great challenges to potential practitioners with weak cultural foundations. Heavy training "pushes" some potential practitioners away.

5.1.2 Work Intensity and Physical and Mental Burden

The nature of the work of caregivers requires them to work long hours, often "two shifts", with responsibilitie for taking care of the elderly's diet, daily life, caring for disabled people's turning over and scrubbing, etc. Long term high-intensity work and frequent result in unexpected situations among the elderly have led to physical and mental exhaustion among caregivers, and many people are unable to bear the burden and resign.

5.1.3 Social Prejudice and Status Cognition

Traditional beliefs often associate caregiving with servitude, leading to a low societal status for caregivers. Disrespectful treatment from families undermines their self-esteem and reduces their sense of professional identity, resulting in high turnover rates.

5.2 Pull Factors

5.2.1 Market Demand and Employment Security

With the intensification of social aging, the expansion of nursing homes and the increasing demand for caregivers have led to abundant employment opportunities and strong job stability for caregivers in a market demand that exceeds supply. This high demand ensures job stability, making caregiving an appealing option for middle-aged individuals with limited education or employment opportunities. Skill growth and career advancement

The knowledge and skills in the nursing field are continuously updated, and nursing workers can master new skills such as rehabilitation nursing and psychological counseling through continuous training and learning, thereby being capable to manage superior positions such as nursing supervisors, expanding their career paths, and increasing the attractiveness of their profession.

Emotional Rewards and humanistic value: The humanistic care and emotional investment of caregivers in their daily work, the establishment of deep friendships with the elderly, the gratitude of the elderly, and the recognition of family members during end-of-life care, endow caregivers with special humanistic value and emotional satisfaction, and constitute the driving force to stick to their posts.

6 Recommendations for the Mobility of Nursing Home Workers from the Perspective of Push Pull Theory

6.1 Optimize the Training System and Reduce Barriers to Entry

Collaborate with communities and vocational schools to carry out targeted training, streamline theory, strengthen practical operations, combine online and offline, learn and obtain qualifications while working, and reduce the initial pressure on practitioners. Increase policy and financial support, improve training quality, and ensure that caregivers can quickly adapt to job requirements.

6.2 Improving the Working Environment and Transforming the Intensity of "Thrust"

Reasonable scheduling, sufficient manpower, ensuring that workers have sufficient rest time, and reducing work intensity. Introduce intelligent nursing equipment to assist and improve work efficiency. Set up a psychological counseling room for employees, pay attention to the physical and mental health of caregivers, conduct regular physical examinations, and team building can improve work comfort, reducing physical and mental burden.

6.3 Enhance Social Image and Strengthen Professional 'Attraction'

Enhance the social image of caregivers through positive media promotion, select and commend outstanding individuals, and strengthen their sense of professional honor. The nursing home organizes a family caregiver exchange meeting to enhance understanding and respect, and to improve the social respect and professional identity of caregivers. Provide clear career development paths and promotion opportunities to attract and retain talent. Improve salary and benefits, enhance job satisfaction and career attractiveness of caregivers.

7 Conclusion

The nursing profession in nursing homes is struggling to move forward under the push and pull force. Addressing these challenges requires concerted efforts from policymakers, society, and the eldercare industry. Enhancing the professional ecosystem is essential to attract and retain caregivers, ensuring a robust human resource foundation for eldercare services. While this study focuses on the Yongai Elderly Care Apartment in Tianjin, broader research across multiple regions would provide a more comprehensive understanding of caregiver dynamics.