Institutional loyalty and job satisfaction among nurse aides in nursing homes

The Relationship Between Nurses' Quality of Work-Life on Organizational Loyalty and Job Performance in Saudi Arabian Hospitals: A Cross-Sectional Study

Purpose

The purpose of this study is to analyze the relationship between quality of work-life on the organizational loyalty and job performance in Saudi Arabia.

Methods

This study used a cross-sectional design for collecting the data related to the nurses' quality of work-life, organizational loyalty, and job performance from nursing staff in Saudi Arabian hospitals. Three questionnaires were used in this study, which includes Quality of Work Life Scale (QWLS), Organizational Commitment Questionnaire (OCQ), and Individual Work Performance Questionnaire (IWPQ). An online version of the survey questionnaire was generated using the Google survey, to which a link is generated for collecting data. At the end of the survey, 243 responses were received. After removing the incomplete responses, 209 responses were considered for the data analysis. The statistical techniques including t-tests and Pearson's correlation were used in the data analysis.

Results

Nurse managers reflected good quality of life, and high loyalty toward their employers, and also reflected good job performance levels. However, staff nurses reflected poor quality of work-life, organizational loyalty, and job performance. Training and development had strong positive correlation with continuance commitment (r = 0.628, p < 0.01). Job satisfaction and job security held strong positive correlation with task performance (r = 0.601, p < 0.01) and contextual performance (r = 0.601, p < 0.01).

Conclusion

Quality of work-life, organization loyalty, and job performance are positively correlated, and poor quality of work-life can negatively impact job performance and organizational loyalty of nurses.

Job Satisfaction of Nursing Home Administrators and Turnover

We know little about factors associated with job satisfaction and dissatisfaction for nursing home workers. In this investigation, the authors use data from a large sample of nursing home administrators (NHAs) to examine: (1) their levels of job satisfaction, (2) whether job satisfaction is associated with intent to leave, (3) whether job satisfaction is associated with turnover after 1 year, and (4) whether job satisfaction after 1 year varies for NHAs who left based on where they subsequently worked. Overall, NHAs were more satisfied with the job satisfaction subscales of: rewards, work skills, and workload but were less satisfied with work demands and coworkers. NHAs appeared particularly sensitive to work skills, with this area of job satisfaction being associated with intent to turnover and actual turnover. In general, the authors found a stronger association with job satisfaction and actual turnover than with intent to turnover.

Voluntary and Involuntary Nursing Home Staff Turnover

The goal of this study was to identify nursing home characteristics that have differential associations to voluntary and involuntary turnover among formal caregivers (i.e., registered nurses, licensed practical nurses, and nurse aides). Primary data from 354 facilities from four states were merged with data from the 2004 Online Survey, Certification and Recording system. Multinomial logistic regression analyses were conducted to determine whether organizational characteristics were related to a greater probability of high or low levels of voluntary and involuntary turnover among formal caregivers. The analysis revealed that a higher ratio of nurses to beds, a smaller number of quality-of-care deficiencies, and a smaller proportion of residents using Medicaid were all associated with lower voluntary turnover but higher involuntary turnover. The findings indicate that controlling turnover is a complex process that may involve monitoring the organizational levels not only of voluntary separations but also of involuntary terminations.

The Influence of Organizational Context on Quitting Intention

This study uses multilevel methods to investigate the effects of organizational context on job satisfaction and quitting intention among staff working in long-term mental health care settings. Two types of organizational features are examined: group job satisfaction and structural features of the work unit (unit size, workload, and level of client functioning on the unit). A review of the organizational literature reveals that most empirical research has investigated job satisfaction at the individual level of analysis rather than the group level. The authors argue that the affective context of a group has real and measurable consequences for individual attitudes and behavior, independent of individual attitudes toward the job. Using multilevel modeling, study findings support the premise that group job satisfaction exercises effects on intention to quit independent of individuals’ dispositions toward their jobs. These effects are both direct and interactive. The findings underscore the importance of affective context in shaping individual attitudes and behavioral intentions.

Moral Imagination in Long-Term Care Workers

Our study focused on the cultural construction of dying and death in long-term care facilities. This article centers on direct care workers' perspective of residents' deaths. The data on which this article is based were gathered in a multi-year, multi-site study through formal ethnographic interviews, informal conversations, and on-site observations of residents and staff members. During fieldwork, we noticed an aptitude of direct care workers to deal with residents' deaths, which we named “moral imagination.” The term is borrowed from other disciplines to describe a “way of seeing” residents. The case studies presented—that of three direct care workers: a dietary aide, a nurse aide, and an assistant activities director—are suggestive of workers in each category. Our study offers implications for future research concerning direct care workers' value to residents' quality of life. We also propose questions for long-term care facilities about standards of formal caregiving at the end of life.

Job Satisfaction and Intention to Quit Among Nursing Home Nursing Staff: Do Special Care Units Make a Difference?

Special care units (SCUs) for nursing home residents with dementia continue to proliferate rapidly. However, the research findings on the benefits of these units for residents and staff vary. Using a large sample from 38 randomly selected facilities in two states, this study examines job satisfaction and intention to quit for SCU and traditional-unit nursing staff. SCU staff report significantly higher job satisfaction and less likelihood of quitting than those on traditional units. Multivariate analyses examining demographic, environmental, and personal relationship variables indicate that the benefits to staff of working on an SCU depend significantly on the positive relationships that staff have with supervisors, coworkers, and families. Nursing home units of all types should strive to improve and support such relationships for their staff to improve morale and staff retention.

Determinants of Longer Job Tenure Among Home Care Aides

An inadequate supply of direct care workers and a high turnover rate in the workforce has resulted in a “care gap” in our long-term care system. As people are increasingly choosing community-based care, retention of home care workers is particularly important. The mixed-method study described herein explored determinants of longer job tenure for home care aides ( n = 261). Study participants were followed for 18 months, completing two mail surveys and one telephone interview each. Predictors of longer job tenure included older age, living rurally, lower physical function, higher wages, a greater sense of autonomy on the job, and less frequent feelings of personal accomplishment. Thematic analysis of telephone interviews revealed long-term stayers to be less concerned about low wages and inconsistent hours than those who left their jobs within a year; both groups of workers reported high levels of job satisfaction. Policy implications of study findings are discussed.

Working Conditions in Home Care: Comparing Three Groups of Workers

Cette étude porte sur les similitudes et les différences entre les méthodes de soins utilisées par trois groupes de prestateurs de soins, soit les proches parents, les femmes au foyer et les bénévoles. Dans le contexte des conditions de travail, des questions ayant trait au milieu de travail, à l'isolement, à la communication, aux réactions, à l'autonomie, à la motivation et au choix font l'objet d'une comparaison au sein de ces trois groupes. Même si les capacités fonctionnelles des personnes âgées bénéficiant des soins étaient semblables, les circonstances touchant la prestation de soins variaient beaucoup. L'étude démontre que le contexte au sein duquel les soins sont prodigués représente un élément clé dans le cadre de discussions futures en matière d'établissement de politiques. Elle suggère que les tâches particulières relatives à la prestation de soins ne sont qu'un élément secondaire servant à comprendre le contexte dans lequel chaque prestateur de soins accomplit son travail.

Why do they leave? Factors associated with job termination among personal assistant workers in home care

Recruiting and retaining an adequate number of personal support workers in home care is both challenging and essential to allowing elders to age in place. A mixed-method, longitudinal study examined turnover in a sample of 261 personal support workers in Maine; 70 workers (26.8%) left their employment in the first year of the study. Logistic regression analysis indicated that younger age and lack of health insurance were significant predictors of turnover. Analysis of telephone interviews revealed three overarching themes related to termination: job not worthwhile, personal reasons, and burnout. Implications of study findings for gerontological social workers are outlined.

Expanding the scope of practice for enrolled nurses working in an Australian rural health service - implications for job satisfaction

Career opportunities have been limited for enrolled nurses (ENs) working in small, rural health services. Medication endorsement offers ENs expanded scope of practice which may lead to improved job satisfaction. This small study compared job satisfaction between a group of ENs with recent medication endorsement and a group who elected not to undertake the course in a small, isolated health service. A questionnaire was designed to measure job satisfaction containing the measure of job satisfaction (MJS) scale and other information regarding the course in medication administration. Interviews were also conducted with medication endorsed nurses to gain a greater understanding about the course and their expanded scope of practice. Medication endorsed nurses were newer to nursing and their current job, and reported higher job satisfaction on all five factors. Non-medication endorsed nurses cited lack of confidence and ability as key reasons for not undertaking the course while medication endorsed nurses reported professional and personal reasons for expanding their scope of practice. Most enjoyed the responsibility and reported satisfaction from distributing medications and responding to pain while one viewed it as added work. The findings from this small study suggest that providing local education will improve job satisfaction of ENs.

Leadership styles of nursing home administrators and their association with staff turnover

PURPOSE

The purpose of this study was to examine the associations between nursing home administrator (NHA) leadership style and staff turnover.

DESIGN AND METHODS

We analyzed primary data from a survey of 2,900 NHAs conducted in 2005. The Online Survey Certification and Reporting database and the Area Resource File were utilized to extract organizational and local economic characteristics of the facilities. A general linear model (GLM) was used to estimate the effects of NHA leadership style, organizational characteristics, and local economic characteristics on nursing home staff turnover for registered nurses (RNs), licensed practical nurses (LPNs), and nurse's aides (NAs).

RESULTS

The complete model estimates indicate that NHAs who are consensus managers (leaders who solicit, and act upon, the most input from their staff) are associated with the lowest turnover levels, 7% for RNs, 3% for LPNs, and 44% for NAs. Shareholder managers (leaders who neither solicit input when making a decision nor provide their staffs with relevant information for making decisions on their own) are associated with the highest turnover levels, 32% for RNs, 56% for LPNs, and 168% for NAs.

IMPLICATIONS

The findings indicate that NHA leadership style is associated with staff turnover, even when the effects of organizational and local economic conditions are held constant. Because leadership strategies are amenable to change, the findings of this study may be used to develop policies for lowering staff turnover.

An instrument to measure job satisfaction of nursing home administrators

Background

The psychometric properties of the nursing home administrator job satisfaction questionnaire (NHA-JSQ) are presented, and the steps used to develop this instrument.

Methods

The NHA-JSQ subscales were developed from pilot survey activities with 93 administrators, content analysis, and a research panel. The resulting survey was sent to 1,000 nursing home administrators. Factor analyses were used to determine the psychometric properties of the instrument.

Results

Of the 1,000 surveys mailed, 721 usable surveys were returned (72 percent response rate). The factor analyses show that the items were representative of six underlying factors (i.e., coworkers, work demands, work content, work load, work skills, and rewards).

Conclusion

The NHA-JSQ represents a short, psychometrically sound job satisfaction instrument for use in nursing homes.

Determinants of staff job satisfaction of caregivers in two nursing homes in Pennsylvania

BACKGROUND

Job satisfaction is important for nursing home staff and nursing home management, as it is associated with absenteeism, turnover, and quality of care. However, we know little about factors associated with job satisfaction and dissatisfaction for nursing home workers.

METHODS

In this investigation, we use data from 251 caregivers (i.e., Registered Nurses, Licensed Practical Nurses, and Nurse Aides) to examine: job satisfaction scores of these caregivers and what characteristics of these caregivers are associated with job satisfaction. The data were collected from two nursing homes over a two and a half year period with five waves of data collection at six-month intervals. The Job Description Index was used to collect job satisfaction data.

RESULTS

We find that, overall nursing home caregivers are satisfied with the work and coworkers, but are less satisfied with promotional opportunities, superiors, and compensation. From exploratory factor analysis three domains represented the data, pay, management, and work. Nurse aides appear particularly sensitive to the work domain. Of significance, we also find that caregivers who perceived the quality of care to be high have higher job satisfaction on all three domains than those who do not.

CONCLUSION

These results may be important in guiding caregiver retention initiatives in nursing homes. The finding for quality may be especially important, and indicates that nursing homes that improve their quality may have a positive impact on job satisfaction of staff, and thereby reduce their turnover rates.

Organizational Commitment and Turnover of Nursing Home Administrators

In this investigation, the associations between organizational commitment (OC), intent-to-turnover, and actual turnover of a large sample of nursing home administrators (NHAs) are examined. Data used come from a mail survey, from which 632 responses were received from the NHAs (response rate = 63%). The one-year turnover rate of NHAs was 39 percent, and in almost all cases (87%) these NHAs had also exhibited low OC scores. The intent-to-turnover results show thinking about quitting comes before searching for a new position, which in turn both comes before the intention to quit. Multivariate analyses show work overload has a strong and robust association with both intent-to-turnover and turnover of NHAs, and may indicate that NHAs are leaving their positions because they are understaffed.

Organizational Culture and Work-Related Attitudes Among Staff in Assisted Living

In this study, the author examines the relationship between staff perceptions of organizational culture and their work-related attitudes in assisted living. Data were collected from 317 staff in 61 facilities using self-administered questionnaires. Staff who had more favorable perceptions of organizational culture reported greater job satisfaction, coworker satisfaction, and organizational commitment. Among the dimensions of organizational culture, perceptions of teamwork had the strongest influence on satisfaction with coworkers, and perceptions of organizational morale had the strongest influence on job satisfaction and organizational commitment. Those who want to improve staff attitudes should focus on creating organizational cultures that promote teamwork and high organizational morale.

Organizational Characteristics Associated With Staff Turnover in Nursing Homes

PURPOSE

The association between certified nurse aide, licensed practical nurse, and registered nurse turnover and the organizational characteristics of nursing homes are examined.

DESIGN AND METHODS

Hypotheses for eight organizational characteristics are examined (staffing levels, top management turnover, resident case mix, facility quality, ownership, chain membership, size, and Medicaid census), using Online Survey, Certification, and Reporting (known as OSCAR) data. Turnover information came from primary data collected from 854 facilities in six states (Missouri, Texas, Connecticut, New York, Pennsylvania, and New Jersey).

RESULTS

The 1-year turnover rates were 56.4%, 39.7%, and 35.8% for certified nurse aides, licensed practical nurses, and registered nurses, respectively. The results consistently show that, for all caregivers, lower staffing levels, lower quality, for-profit ownership, and higher bed size are associated with higher turnover. Some differences also are found for different levels of turnover, but there are few differences among types of nursing staff.

IMPLICATIONS

Given that turnover rates are problematic, this study gives us a better understanding of the phenomenon and at the same time helps us further understand the wide variation that is known to exist between nursing homes, based on their organizational characteristics.

Job and organizational determinants of nursing home employee commitment, job satisfaction and intent to turnover

The purpose of this study was to examine whether job characteristics, the work environment, participation in quality improvement activities and facility quality improvement environment predicted employee commitment and job satisfaction in nursing homes, and whether those same predictors and commitment and satisfaction predicted turnover intention. A total of 6,584 nursing home employees from 76 nursing homes in a midwestern state participated. A self-administered questionnaire was used to collect the data. The results supported the hypotheses that job and organizational factors predicted commitment and satisfaction while commitment and satisfaction predicted turnover intentions. The implications for retaining nursing home employees are discussed.

Predictors of organizational commitment among staff in assisted living

PURPOSE

This study examines the role of organizational culture, job satisfaction, and sociodemographic characteristics as predictors of organizational commitment among staff in assisted living. It is particularly important to examine organizational commitment, because of its close links to staff turnover.

DESIGN AND METHODS

Data were collected from 317 staff members in 61 facilities, using self-administered questionnaires. The facilities were selected from licensed assisted living programs and were stratified into small, traditional, and new-model homes. Staff questionnaires were distributed by a researcher during 1-day visits to each facility. Organizational commitment was measured by the extent of staff identification, involvement, and loyalty to the organization.

RESULTS

Organizational culture, job satisfaction, and education were strong predictors of commitment, together explaining 58% of the total variance in the dependent variable. Higher levels of organizational commitment were associated with more favorable staff perceptions of organizational culture and greater job satisfaction. In addition, more educated staff members tended to report higher levels of organizational commitment. Other than education, sociodemographic characteristics failed to account for a significant amount of variance in organizational commitment.

IMPLICATIONS

Because job satisfaction and organizational culture were strong predictors of commitment, interventions aimed at increasing job satisfaction and creating an organizational culture that values and respects staff members could be most effective in producing higher levels of organizational commitment.

Turnover Begets Turnover

Purpose: This study examined the association between turnover of caregivers and turnover of nursing home top management. The top managers examined were administrators and directors of nursing, and the caregivers examined were registered nurses, licensed practical nurses, and nurse aides. Design and Methods: The data came from a survey of 419 nursing facilities and the Online Survey, Certification, and Reporting system. Multinomial logistic regression analyses were used to examine the association between turnover of nursing home top management and turnover of caregivers. Results: A 10% increase in top management turnover is associated (p &lt;.05) with a 21% increase in the odds that a facility will have a high turnover rate of nurse aides and is associated (p &lt;.05) with an 8% decrease in the odds that a facility will have a low turnover rate of nurse aides. A 10% increase in top management turnover is associated (p &lt;.1) with a 30% increase in the odds that a facility will have a high turnover rate for registered and licensed practical nurses. Implications: This study provides preliminary evidence that the turnover of top managers may have an important influence on caregiver turnover in nursing homes.

Direct care workers' response to dying and death in the nursing home: a case study

OBJECTIVES

This paper is based on research that explored the cultural construction of dying and death in nursing homes and assisted living facilities in a large Northeastern city. It focuses on direct care workers' responses to elders' dying and death within the facility.

METHODS

Data were gathered in a multiyear, multisite study through formal ethnographic interviews, informal conversations, and on-site observations of staff members.

RESULTS

We introduce the case of Jayson, an activities director in a for-profit nursing home. We show how his belief system and experiences outside the facility, especially those concerning dying and death, shape his view of the nature and content of his work and his reaction to residents' deaths.

DISCUSSION

We suggest caretaking at the intersection of gender, race, socioeconomic status, and the inside and outside life of direct care workers as topics for future research.

A conceptual framework for achieving high-quality care in nursing homes

Nursing home care accounts for 12% of healthcare expenditures in the United States, yet serious concerns remain about the quality of care provided in these settings. This article describes a comprehensive systems model that views organizational environments as consisting of four interacting dimensions: organizing arrangements, social factors, technology, and physical setting. This model is then used as a conceptual framework (vis-à-vis an extensive literature review) to identify factors that contribute to poor-quality care in nursing homes and to highlight previous research efforts. The literature review also provides a useful framework to guide nursing home administrators and healthcare quality professionals in their implementation of quality improvement processes and serves to help direct future research in this very important arena.

The psychosocial quality of nursing home work

Trained observers used components of the functional job analysis technique to categorize 3,371 tasks performed by 214 nursing assistants in four nursing homes on five occasions over 12 months. The extent to which each task was oriented toward residents versus data or things was coded along with the "level of complexity" of each of these orientations. A psychosocial index was created by multiplying orientation by complexity. Three questions structured the analyses: (a) To what extent do nursing assistants' tasks involve interacting with residents, as opposed to focusing on data or manipulating things? (b) How complex are these tasks? (c) What are the implications of the task analysis data for assessing the quality of psychosocial care? Findings reveal that even among the direct care tasks (69% of total), the orientation was not predominantly toward the resident. Functional complexity of the tasks observed was consistently low. Those task types with the greatest psychosocial quality were those performed least frequently and vice versa. Implications of these results for restructuring nursing assistants' work are discussed.