Antecedents and outcomes of work engagement among nursing staff in long-term care facilities-A systematic review

Changing Trends in Job Satisfaction and Burnout for Care Aides in Long-Term Care Homes: The Role of Work Environment

OBJECTIVES

This study examined the association between care unit work environments in long-term care (LTC) homes and trends in care aides' job satisfaction and burnout (exhaustion, cynicism, reduced professional efficacy) from 2014 to early 2020.

DESIGN

This was a retrospective longitudinal study using data from care aide surveys collected by the Translating Research in Elder Care research program over 3 periods: September 2014-May 2015 (T1), May 2017-December 2017 (T2), and September 2019-March 2020 (T3).

SETTINGS AND PARTICIPANTS

The study included 631 care aides from a stratified random sample of 84 LTC homes in 3 Canadian provinces, who participated in data collection at all 3 time points.

METHODS

We used mixed-effects linear regression with a "time by work environment" interaction to assess whether work environment is associated with trends in job satisfaction (Michigan Organizational Assessment Questionnaire Job Satisfaction Subscale) and burnout (Maslach Burnout Inventory-General Survey). We standardized the outcomes using z-scores.

RESULTS

Between T1 and T2, care aides in care units with less favorable work environments-characterized by less supportive leadership, weaker work culture, less effective team communication and feedback mechanisms, and insufficient structural resources and staffing-experienced a statistically significant decline in job satisfaction (B = -0.17, P < .01) and professional efficacy (B = -0.20, P < .01), along with an increase in exhaustion (B = 0.15, P < .05) and in cynicism (B = 0.27, P < .001). Those in more favorable work environments exhibited no statistically significant changes in these variables during the same period. Moreover, care aides in less favorable work environments continued to experience an increase in exhaustion from T2 to T3 (B = 0.16, P < .05).

CONCLUSIONS AND IMPLICATIONS

A positive work environment at the care unit level mitigated the deterioration in care aides' job satisfaction and burnout over the period studied. Targeted interventions to improve work environments show promise in sustaining the resilience of the care aide workforce.

Job characteristics, personal characteristics and well-being of nursing assistants in long-term care facilities: A mixed methods systematic review and narrative synthesis

BACKGROUND

Within long-term care facilities, paraprofessional nursing assistants account for the largest proportion of the health care workforce and provide essential direct care to older people with complex care needs. There is a gap in developing a theory-driven, systematic synthesis of the job characteristics and well-being outcomes specific to this occupational group, as most existing studies evaluate either professional health care workers or both professional and nursing assistants.

AIM

Develop an occupation-specific conceptual model on the job characteristics and well-being of nursing assistants in long-term care facilities drawing upon the job demands-resources model.

DESIGN

Mixed methods systematic review following the Joanna Briggs Institute approach. The review protocol was registered on PROSPERO (2023 CRD42023403654).

METHODS

The review included qualitative, quantitative, and mixed-method studies meeting these inclusion criteria: (1) peer-reviewed empirical research; (2) involved paraprofessional nursing assistants in long-term care facilities; (3) addressed well-being outcomes; (4) addressed occupation-specific job characteristics. Studies that are (1) not written in English, or (2) published before 1 January 2000 were excluded. A convergent synthesis approach was conducted using the content analysis method.

DATA SOURCES

Database searches (i.e., MEDLINE, PsycINFO, Embase, CINAHL, Web of Science, Scopus, and Google Scholar) and manual searches were conducted. The last search was conducted on July 31st, 2024.

RESULTS

A Nursing Assistants Job Demands-Resources Model was developed based on 21 studies included. Nursing assistants are particularly vulnerable to burnout and mental health conditions, as well as occupational hazards, because of their job characteristics. Working time demands, physical care task stressors, and emotional demands are occupation-relevant job demands, while financial rewards, professional development resources, work environment, and emotional resources are motivational job resources. Strain-related personal characteristics are also relevant to nursing assistants. Findings indicated a spiral of vulnerabilities characterized by the vicious cycle of individual vulnerabilities, poor quality job, and health inequalities among nursing assistants in long-term care facilities.

CONCLUSION

This study finds that empirical evidence on nursing assistants' job characteristics and well-being is underdeveloped compared to research focusing on professional and all health care workers. We adapt a conceptual model and identify job and personal characteristics specific to the occupation group. Occupational-specific macro, meso, and micro-level strategies that mitigate job demands and nurture job resources should be developed to tackle the occupational health disparities that nursing assistants face in long-term care facilities.

REGISTRATION

The protocol of this study was registered on PROSPERO (2023 CRD42023403654).

Updating Factors Influencing Nurse Work Engagement in the Hospital Settings: A Systematic Review

Background

Understanding the factors influencing work engagement among nurses is crucial for ensuring high-quality care and positive patient outcomes. Despite numerous factors associated with nurse work engagement, many were explored before the pandemic, potentially overlooking aspects relevant to the current context.

Aim

To explore and update factors related to nurse work engagement in the new normal era.

Design

Systematic review.

Data Sources

The search was restricted to articles published from 2019 to 2024 in CINAHL, PubMed, Scopus, ScienceDirect, Web of Science, and ProQuest, with full English text. The search was conducted from September 13th to 15th, 2023. Quantitative research articles that examined factors related to work engagement were included.

Review Methods

Data extraction, quality appraisal, and data analysis were performed in all included studies. Manual content analysis method was used to classify and group the factors.

Results

Sixty-one research articles were included in the final review. Five key groups of factors were generated from content analysis, including 1) individual-related factors, 2) organizational-related factors, 3) job and role-related factors, 4) work-life balance, and 5) work environment.

Conclusion

Understanding and addressing these multifaceted factors holistically is essential to develop strategies to sustain optimal engagement levels among nursing staff and improve overall patient care outcomes. Further studies are needed to confirm the findings.