Purpose | Location, Sample & Measurements | Findings | Authors |
Identify areas of satisfaction for NAs with high versus low job satisfaction |
- Utah
- 6 rural and urban nursing homes
- 1138 NAs,
- 33RNs,
- 41 LPNs
- In-house surveys, 21 items with Likert response set
|
Top areas of satisfaction of NAs (range of 1 to 5, mean scores reported
Satisfaction Areas | High Sat. NAs |
Low Sat. NAs |
enjoy helping people | 4.72 | 4.42 |
job fits w/future plans | 4.57 | 3.12 |
supervisor helps out sat. | 4.35 | 3.38 |
plan to be in LTC years | 4.17 | 2.92 |
good job for education | 4.14 | 3.23 |
pleasant co-workers | 4.00 | 3.67 |
job viewed as short-term | 3.94 | 2.96 |
affirmed by co-workers | 3.86 | 3.14 |
pay is satisfactory | 2.52 | 2.04 |
| Anderson, Aird, & Haslem, 1991 |
Determine factors important to NA job satisfaction |
- Midwestern states
- 24 nursing homes
- 283 nursing assistants
- Survey: Hackman and Oldham's Job Diagnostic Survey
|
- Factors important to job satisfaction
- (significant correlations at p ≤ .05)
- Personal growth & development
- Job security
- Job challenge
- Fair treatment & respect (p ≤ 0.1)
|
Atchison, 1998 |
Determine why NA turnover rate is so high and what can be done to make work more appealing.
Determine relationships among attitudes. |
- Madison, Wisconsin
- 1 home care agency
- 30 working NAs and 26 former NAs
- Mail or in person survey
- -Attitude To Disabled Persons(ATDP)
- -Gordon Personality Profile
- -Gordon Personality Inventory
- -Likes, dislikes & reasons for leaving
|
- Like best=able help others 38%
- Like least=low salary 27%
- lack benefits 18%
- Reasons for quitting:
- Change in school schedule 23%
- Client died/need more hours 20%
- Ways Job could be improved:
- Fringe benefits, days off, paid vacation, paid sick days
- Recommendations:
- Support Groups, 86%
- Training, 65%
- Train disabled, 70%
|
Atkins, Meyer, & Smith, 1982 |
Identify NA attitudes compared to nurses regarding elderly & care |
- Cleveland, Ohio
- 7 nursing homes
- 239 NAs,
- 62 LPNs
- & 62 RNs
- In-house survey:
- -Attitudes toward seniors
- -Preference for custodial vs. therapeutic treatment
- -Empathy Ability
|
- Compared to nurses,
- NAs had lowest empathy levels,
- highest custodial orientation
- and most negative attitude toward old people.
- Relationships of attitudes:
- - more negative attitude=lower empathy
- - higher custodial orientation=greater negativism & lower empathy
|
Bagshaw & Adams, 1986 |
Examine aspects of work stress, signs of burnout & job satisfaction among home care hospice staff |
- Sweden
- One hospice home care agency
- 21 NAs,
- 9 RNs
- & 5 MDs
- Self-administered questionnaire, 219 closed-ended questions with 4 & 5 point response sets
|
- Daily stress often to very often:
- Demands from relatives 17%
- Confusing orders 15%
- Lack info for job 15%
- Job satisfaction often to very often
| Current | Desired |
Is meaningful | 89% | 97%* |
Works without supervision | 86% | 60%* |
Opportunity for social contact | 77% | 43%* |
- (*significant difference, < 0.01)
- RNs and MDs, as compared to NAs, more often felt their work gave them new skills
and was varied and stimulating
|
Beck-Friis, et al., 1991 |
Explore views of staffing and quality |
- USA
- 4 nursing homes
- 38 NAs
- In-depth interviews and participant observations over 2 years
|
- NAs defined quality as a good relationships that leads to trust, respect and affections
- Records did not reflect reality of tasks
- Staffing impacted greatly ability to provide quality care
|
Bowers, Esmond, & Jacobson, 2000 |
Top of Page |
Analyze NAs' job perceptions compared to other LTC nursing staff |
- Pennsylvania
- 21 nursing homes
- 388 nurse's aides
- 101 LPNs
- In-house surveys, using Hackman & Oldham's Job Diagnostic Survey (JDS)
|
Mean Scores (1-5 range)
Job Characteristics |
| All Jobs | Aides | LPNs |
Skill variety | 4.5 | 4.3 | 5.2 |
Task identity | 4.6 | 5.1 | 4.8 |
Task sign. | 5.5 | 6.2 | 6.6 |
Autonomy | 4.8 | 4.8 | 5.4 |
Job Feedback | 4.8 | 4.9 | 5.1 |
Feedback Others | 4.1 | 4.1 | 4.4 |
MPS | 122 | 157 | 128 |
MPS = is motivational potential score |
Job Satisfaction Areas |
Pay | 4.2 | 3.8 | 4.2 |
Security | 4.8 | 4.6 | 4.8 |
Co-workers | 5.3 | 6.0 | 5.9 |
Supervisory | 4.8 | 5.0 | 5.0 |
|
Brannon, et al., 1988 |
Identify how specific managerial practices support NA job satisfaction |
- Cincinnati metropolitan area
- 3 home care agencies
- 42 home care attendants
- In-house surveys
- Michigan Organizational Assessment Questionnaire (MOAQ) revised components,
- Leadership support,
- Mission implementation,
- In-service Style
- Job satisfaction - intrinsic factors from Feldman's study
|
- 52% of intrinsic job satisfaction variance explained by supportive
leadership practices, client-centered in-service training style, and mission implementation.
Hierarchical
Regression Results |
(R2 = 0.52) |
Personal Characteristics | |
Education, age, job tenure | .063 |
Managerial Practices | |
Client centered in-services | .223** |
Supportive leadership | .392*** |
Mission implementation | .515*** |
|
Buelow, Winburn, & Hutcherson 1999 |
Gain insight into the experience of quality care for seniors |
- Central Texas
- 4 nursing homes
- 30 NAs in 4 focus groups
- Focus groups with structured questions
- -NAs definition of quality
- -management's facilitation
- -visitors' considered quality care
|
Most were highly committed to quality care for their residents.
Gave managers suggestions
to show their commitment to quality |
Burke, Summers, & Thompson 2001 |
- Identify job satisfiers for excellent NAs
- Determine whether reasons for beginning NA work are same as reasons for remaining in jobs
|
- North Carolina
-
- 3 nursing homes
- 30 excellent NAs selected by DON
- In-person interviews, open-ended questions
|
- Most Satisfying Aspect of Work
- 98% feel needed and useful
- 53% some aspect of job environment (e.g., co- workers, shift working)
- Initial attraction to job
- 40% pleasure helping older people
- 40% always wanted to be a nurse
- 23% needed a job
- 23% positive role models in family
- People who started working because of love of older people, nursing ambition or who had
positive role models had same reasons for staying in job.
|
Bye and Iannone, 1987 |
To identify the values of NAs. |
- Southeastern Florida,
- 12 nursing homes
- 120 NAs
- In-house surveys using modified Rokeach Value Survey (ranked 9 values by their importance)
|
Values ranked in order of most to least important.
Median Values of NAs |
Ambitious | 2.5 |
Helpful | 3.4 |
Cheerful | 3.9 |
Capable | 4.2 |
Independent | 4.7 |
Self-controlled | 5.3 |
Broad minded | 6.1 |
Logical | 6.8 |
Imaginative | 7.6 |
|
Carter, Kooper- man & Clare, 1988 |
Top of Page |
Determine relationship between turnover of NAs and Maslow's basic human needs |
- Washington
- 74 nursing homes (both rural & urban, profit & nonprofit)
- 996 NAs
- Mail survey
- Variables:
- Job tenure (LOS) in one state
- - 56 items with rankings according to Maslow's needs
|
- Maslow's levels related to job tenure
- First: Physiological
- Salary, % salary spent on food and shelter, ratio of staff-patient assignment
- Second: Safety & Security
- Assignments changed less often, health insurance, retirement plan, received CPR in orientation
- Third: Love & Belonging
- Felt needed by patient, felt part of "group," charge nurse who listened
- Fourth: Self esteem
- Allowed to criticize, free to make decisions, self rank skills high
- NAs stayed twice as long when felt working in a quality facility versus in poor quality facility
|
Caudill & Patrick, 1989 |
Identify factors which may influence plans to leave nursing home employment |
- Washington
- 74 nursing homes (both rural & urban, profit & nonprofit)
- 996 NAs
- Mail survey
- - 56 item questionnaire
|
Plan to... | Stay | Leave |
n = | 817 | 179 |
Mean age | 35 | 28 |
Mean stay, months | 37 | 20 |
Hourly rate of pay | $4.97 | 4.63 |
Plan stay in nursing | 89% | 11% |
First job in nursing | 81% | 9% |
Skill level (10=perfect) | 8 | 7 |
# of in-services/year | 7 | 6 |
Attend care conf. | 81% | 19% |
Free to criticize | 81% | 19% |
Did criticize | 81% | 19% |
Attend in-services | 82% | 18% |
Responds to suggestions | 83% | 16% |
|
Caudill & Patrick, 1991-1992 |
Assess the attitudes of nursing staff toward the elderly |
- Mississippi
- 2 nursing homes
- 70 NAs, 10 RNs, 21 LPNs
- In-house survey
- Palmore's FAQ #2
- Kogan's Attitudes toward Old People Scale, 17 questions using Likert response scale
|
- Neutral = 3-4
- Palmore's FAQ #2 average = -13, which is more significantly more positive than
national average of -19
- Kogan's OP Scale average= 3.45, which falls within the range for neutral
attitude toward old people (3-4)
- Of the 3 groups, the NAs were the least positive, but within the neutral range.
|
Chandler, Rachal, & Kazelskis, 1986 |
Examine nursing assistants in the home care industry |
- New York City
- 9 home care agencies
- 306 home attendants
- 181 home health aides
- 2 hour interviews in assistants' homes in English, Spanish or Creole
- Follow-up group interviews
|
- Negative behaviors experienced:
- 40% expected to do things not part of the job - many to several times
- 20% difficulty with clients & drug or alcohol abuse
- Family Relations
- 14% families ask them to do things not part of job
- Worker-Client Relationships
- 88% clients accept and trust them
- 85% can frequently do a favor for their clients that makes them happy
- 77% frequently able to spot problems beforehand
|
Chichin, 1991a |
Determine if home assistants who live with their clients around the clock are any different
from home care assistants who do not live with their clients |
- New York City
- 7 home care agencies
- 306 home attendants, 44 live-in and 262 daily attendants
- random sample from home care agencies
|
Many similarities between two groups of workers, few differences
- Similarities
- - very low-income, immigrant women
- - low measures of job related strain and high measures of job satisfaction
- Differences with Live-ins
- - more likely to be widowed, older
- - more likely to develop close relationships
- - most important tasks were emotional support versus household tasks
|
Chichin, 1991 |
Identify interactions between home care assistants and clients. |
- New York City
- 9 home care agencies
- 306 home attendants
- 181 home health aides
- 2 hour interviews in assistants' homes in English, Spanish or Creole
- follow-up group interviews
- 124 questions, single items and standardized scales.
|
- Worker-Client Interactions
- Occur Frequently
- Clients accept & trust me 88%
- Clients make me feel needed 86%
- Spot problems before serious 77%
- Family-worker relationships
- Good quality of relationship 73%
- Very often knows families 51%
- Often cares re: workers' feelings 43%
- Neg. family behaviors
- Not available when needed 17%
- Ask to do things not part of job 14%
- Don't seem to care for elder 9%
- Worked extra hours without pay 33%
- Get sense of accomplishment from work 95%
|
Chichin, E. 1992 |
Top of Page |
Evaluate recruitment, job satisfaction & retention factors |
- Midwestern state
- Home care agency from national corporation
- 57 NAs
- Focus groups and survey closed and open ended questions regarding sociodemographic
characteristics, job satisfaction and recruitment methods
|
- Common Recruitment Methods
- Word of mouth 53%
- Newspaper ads 40%
- Primary reasons for choosing home care:
- one-on-one patient care & flexibility
- Mod -Very Imp. Retention Factors
- Job satisfaction, flexible hours, working conditions,
type of nursing and availability of job
- Slightly Mod - Imp. Retention Factors
- Salary, job location, job status, company policies, recognition, educational
opportunity orientation program, weekend hours, career growth, bonus
- Lowest dimensions of job satisfaction:
- - nurse interaction, autonomy & professional status
|
de- Savorgnani Haring & Davis, 1992 |
Examine home care NA attitudes and character- istics which influence job satisfaction |
- Missouri
- 15 home care agencies
- 345 home care aides
- mail survey
- Variables:
- - Oberleder attitude scale re: age stereotyping;
- - Rosenberg self esteem scale;
- - Housekeeping knowledge;
- - Job satisfaction;
- - Quality of training
|
| Mean | Range |
Job satisfaction | 4.78 | 1-6 |
Housework | 9 | 2-12 |
Quality of training | 3 | 1-4 |
Self-esteem | 7 | 1-8 |
Age Stereotyping | 10 | 4-16 |
- Regression model revealed self esteem and marital status accounted for
6.2% of explained variance in job satisfaction, no attitude variables
- Younger NAs and those with longer work weeks had more stereotypes
|
Dillard & Feather, 1991 |
To develop a descriptive profile of homemakers and understand work stress of homemakers |
- New York City
- 75 home care agencies
- 404 workers (70% black, 26% Latino, 45% foreign born)
- In-person 2 hour interviews
- Variables:
- - Overall Work Stress Scale
- - Job vs. home Conflict
- - Role Conflict
- - Responsibility
- - Quality concerns
- - Psychological distress (Langer)
- - Job sat. - 1 scale question
|
- Job Satisfaction Levels:
- 33% very satisfied
- 52% somewhat satisfied
- 13% not satisfied at all
- Worker Autonomy
- 81% report setting own pace
- 76% free to decide how to do work
- Negative working conditions
- low pay 96%
- poor fringe benefits 88%
- no chance for promotion 82%
- no influence re policies 79%
- Positive job characteristics
- Jobs are important to health care 96%
- see results of their work 95%
- skill & experience needed 94%
- value their work 87%
- Stress Factors rated Sometimes- Often
- Workload
- Require work very fast 62%
- Require work very hard 66%
- Supervisory Support
- rely on when things tough 84%
- will listen to job problems 76%
- helpful in getting job done 72%
- Correlation of work stress & job satis = -.21***
- Using Langer's psychological distress scale, 53% of NAs had significant
symptoms compared with 32% of general population
|
Donovan, 1989 |
Examine nursing home staff stress, psychological well-being, relaxation behavior and coping skills. |
- Manchester and Redditch, England
- 11 nursing homes
- 112 nursing staff, 67% were NAs; mail survey
- 7 measures in questionnaire:
- demographics, stressor check-list type A / B behavior, job satisfaction,
psychological well-being, relaxation behavior, coping check-list
|
- Greatest Causes of Staff Stress:
- - Unsatisfactory wages
- - Shortage of essential resources
- - Staff shortage per shift
- - Feeling undervalued by management
- - Lifting heavy patients
- - Working with colleagues who are happy to let others do the work
- Significant multi-item factors contributed to stress variance:
- - Differing expectations about resident care 29%
- - Management Factors 7%
- - Lack support of other staff 5%
- - Feel inadequately trained 4%
- - Home-work conflicts 4%
- Moderately satisfied with jobs, found management factors, lack of support from
co-workers and inadequate training significantly correlated
- Most frequent method of relaxing was drinking coffee, cola or eating. 91% smokers, number drinking
daily twice rate of general population
|
Dunn et al., 1994 |
Identify qualities needed in outstanding home care assistants. |
- New York City
- 1 home care agency
- 6 homecare assistants with outstanding job performance
- open ended questions
|
- 3 qualities key to working successfully:
- - patience, compassion and respect
- Greatest satisfaction from seeing clients improve and their close relationships
- Difficult situations viewed as challenges & took pride in overcoming
|
Ebenstein, 1998 |
Top of Page |
Identify levels and components of job satisfaction among NAs in PACE and Nursing homes |
- US, nationally dispersed
- 5 PACE agencies
- (136 NAs)
- 5 traditional nursing homes
- (213 NAs)
- 1 hour survey w/Job description questions
- Reality Check indicators
- Job satisfaction
- - Minnesota Satisfaction Questionnaire
- - Myers Briggs Personality type Indicators
|
Job satisfaction was significantly higher among PACE NAs
| PACE | Nursing Home |
Mean sat. score | 4.12 | 3.83 |
Turnover rate | 30% | 58% |
- Regression model (R2=.21)
- Positive variables, order of significance:
- Frequency respect for suggestions
- Importance of ongoing in-services
- Frequency of chance to organize work
- Age
- Work in PACE program
- Negative influences=
- Frequency to discuss patients w/team
- Regular experience w/elderly as child
- Note: higher job satisfaction related to work environment, not NA characteristics
|
Friedman, et al., 1999 |
Analyze NA turnover with exit interviews |
- Southern region of U.S.A.
- 1 nursing home
- 35 resigned NAs
- Exit interviews; 22 closed and open ended questions
|
Majority of NAs terminated during first 45 days of employment
Reasons for termination |
Another position | 24% |
Personal/staff conflict | 24% |
Wages | 13% |
Other | 38% |
Satisfaction | Poor- Good | Fair- Avg. | Excel |
Supervisor concerned | 34% | 17% | 50% |
Good work recognized | 47% | 31% | 22% |
Communication | 36% | 21% | 42% |
|
Gaddy & Bechtel, 1995 |
Examine reasons NAs left jobs |
- Massachusetts
- 15 home care agencies
- 66 resigned NAs
- Mail survey
- Closed & open-ended questions
|
Reasons for Resignations |
Working conditions | 45% |
Poor Salary | 39% |
Lack of Benefits | 30% |
Lack of Recognition | 35% |
Burnout | 21% |
|
Specific Working Conditions |
Instability of work hours | 39% |
Emotional strain of job | 31% |
Lack input in care plans | 25% |
No time to complete tasks | 23% |
Lack of professional advancement | 21% |
|
Gilbert, 1991 |
Determine NA attitudes towards a variety of work aspects
Determine the extent to which attitudes
are related to institutional loyalty |
- New York City
- 2 nursing homes (unionized staff with turnover
rates < 20% & competitive benefits)
- 219 NAs
- In-house survey:
- Institutional Loyalty (Porter, commitment scale)
- Job Satisfaction,
- Organizational Attitude Scales
|
Hierarchical Regression Analysis: | R2 |
Sociodemographics | 0.16 |
Morale & social support | 0.17 |
Job satisfaction var.: | 0.38 |
- Social atmosphere *
- Job tasks
- Job benefits *
- Job process
- Administration *
- The largest proportion of loyalty accounted for by these 3 variables
|
Grau, et al., 1991 |
Evaluate the level of satisfaction among NAs in a depressed urban area and affluent suburb
Evaluate satisfaction levels with prior study of nursing home aides |
- St. Louis
- 2 nursing homes,
one in affluent area & one in depressed area
- Survey with Minnesota satisfaction Questionnaire (MSQ),
- 20 items with Likert response set
|
- No difference between intrinsic or total satisfaction scores.
- Extrinsic satisfaction:
- less dissatisfaction with urban home vs. suburb
- Lowest satisfaction areas -
- pay & amount of work, chances for advancement, praise for good job,
way policies put into effect, working conditions, way employer handles people
- Highest satisfaction areas -
- to do things for other people, to do things that use my abilities, to do things that
agree with conscience, able to keep busy, feeling of accomplishment
|
Grieshaber Parker, & Deering, 1995 |
Top of Page |
Identify burnout attitudes of nursing assistants
Identify differences in NA working
in nursing homes versus hospitals |
- Pacific Northwest
- 3 hospitals, 10 NAs
- 7 nursing homes, 96 NAs
- Mail survey
- Maslach Burnout Inventory includes scales of emotional exhaustion,
depersonalization & personal accomplishment.
|
CNAs experienced moderate levels of burnout
in emotional exhaustion & depersonalization, not in personal accomplishments
No significant differences were found between NAs working in
nursing homes versus hospitals |
Hare & Pratt, 1988 |
Identify NA descriptions of their care |
- Urban Southern area
- 3 nursing homes
- 8 NAs identified by charge nurses as experts
- 2 question interviews:
- How do you contribute to resident care?
- Describe the different types of care you give
|
- Three themes emerged:
- Functional care activities -
- "major contribution" to overall health. ADLs and IADLS
- Psychosocial care -
- to maintain or promote resident emotional and mental health
- Delegated care -
- by the licensed nurse to assess resident status and changes in physical state.
|
Hartig, 1998 |
Identify home care assistants' character- istics and conditions |
- Washington state
- 16 home care agencies
providing publicly funded social services
- 1900 NAs
- Mail survey
|
- Home Care Worker Characteristics
- 92% paid minimum amount stipulated for state vendors
- 29% worked 31-40 hours/ week;
- 89% worked more than 41 hours/week, didn't get overtime
- 43% had no insurance, pension, sick leave, holiday or vacation
- 73% not paid for travel time to client homes
- Training topics desired:
- Personal care skills,
- Infection control
- Communication skills,
- Nutrition info.
- Lifting & transfer skills,
- Cleaning,
- CPR & first aid
- 26% reported harassment or abuse (primarily verbal)
|
Hayashi, Gibson, & Weather- ley 1994 |
Examine respect and attachment of NA & residents |
- Cleveland
- one nursing home
- 40 NAs & 37 residents
- In-person interviews, closed ended questions & open ended questions
regarding personal experiences
|
- NA views
- 87% said they are sensitive and responsive to residents' feelings
- NA experiences re: respect
- 45% faced accusations from residents & families about inadequate
care & theft
- 30% reported verbal abuse & insults from residents.
- Perspectives re: attachment
- 95% NAs expect to be like family
|
Heiselman & Noelker, 1991 |
Identify areas of satisfaction and dissatisfaction of NAs to improve nursing home environment |
- National
- 36 nursing homes
- 245 NAs
- Job attitude scales, 17 questions with 5 point Likert response set
|
Areas of Satisfaction |
Job is important | 91% |
Proud to tell about job | 66% |
Time for residents | 53% |
Job activities | 53% |
Have input on care plans | 52% |
|
Areas Not Satisfied |
Admin/Super respect NAs | 71% |
Pay | 71% |
Co-workers with pay | 60% |
Benefits/working conditions | 38% |
|
Helmer, Olson, Heim, 1993 |
Investigate how important motivation- hygiene factors are to NAs employed 12 months or
more in nursing homes |
- Massachusetts
- 3 nursing homes
- 31 NAs
- In-person interviews, 20 closed ended questions with Likert response set
|
Rated as extremely important or very
important to job satisfaction: |
Interpersonal relationships | 100% |
Supervision | 90% |
Achievement | 90% |
Responsibility | 90% |
Work itself | 84% |
Salary | 77% |
Recognition | 77% |
Adm. Policies | 77% |
Work Condition | 88% |
|
Holtz, 1982 |
Top of Page |
Investigate nursing assistants' training needs |
- Wisconsin
- 18 nursing homes & 21 home care agencies
- 97 NAs
- 20 questions re: training needs
|
67% facilities lack training programs
| No | Some | Great |
Psychosocial | 55% | 50% |
5% |
Physical | 80% | 18% | 2% |
Legal | 68% | 35% | 7% |
|
Janz, 1992 |
- Determine the relationship between staff burnout and resident-staff
interactions.
- Determine the relationship between decision making and resident-staff interactions.
|
- United Kingdom
- 2 residential care homes
- 24 residential workers
- Survey included:
- - Maslach Burnout Inventory (MBI)
- - Perceived
- Involvement in decision making
- Observations re:
- Quality of Interactions
|
- Lower overall
burnout scores significantly correlated to more staff resident interactions (r=0.52)
- Higher decision making involvement correlated with
fewer negative staff resident interactions (r=0.58)
- Staff distress, emotional exhaustion & depersonalization not
significantly correlated to quality or quantity of staff-resident interactions
|
Jenkins & Allen, 1998 |
Determine NA preferences for outcomes as quality indicators of home care |
- Minneapolis area
- 6 home care agencies
- 6 NAs in focus group discussions
|
- Top outcomes expected for . . .
- Seniors with minimal needs:
- Abuse free,
- Prevent nursing home admission
- Satisfaction with care
- Seniors with heavy needs:
- Abuse free
- Safety
- Satisfaction with care
- Seniors with cognitive impairments:
- Abuse free
- Safety
- Prevent morbidity
- NAs emphasized importance of human element of care, especially the
compatibility between NA and client
|
Kane, et al., 1994 |
Determine preferred educational styles & needs: home care NAs / homemakers |
- New York City
- 3 home care agencies
- 67 NAs / homemakers
- In-person interviews, rated various educational styles & open ended questions
|
- Top preferred ed. styles (0-4 scale)
- On job experience 1.8
- Personal experiences 1.4
- Classes at school 1.2
- Relative Importance of education v experience:
- Experience took precedence over education,
although both strategies believed necessary.
- Situations didn't feel prepared for
- - emotionally needy clients
- - client dissatisfied with service
- - medical or other emergencies
- - client dissatisfied w service plan
- - physically disabled client
|
Kaye, 1985 |
Understand relationships between home care workers and their clients |
- New York City
- 3 home care agencies
- 67 NAs/ home makers
- In-person interviews
- Variables:
- Client & Staff affectivity used 7 questions with Likert responses
& open-ended questions
|
Clients were perceived to have higher levels of
affection for workers than workers for client
| Perceived Client Affectivity |
Self Affectivity |
Mean | 17.82 | 19.97 |
Std. Dev. | 3.86 | 3.93 |
- (Possible score range = 7-35, with higher
scores for lower affectivity)
- Positive correlations found between worker and client
affectivity and length of employment
|
Kaye, 1986 |
Explore factors related to job satisfaction & intent to leave. |
- North Carolina
- 7 branches of one home health agency
- 309 home care assistants
- In-house interviews.
- 8 open-ended questions and 91 items on 3 part scale re:
- affinity for the clients;
- working relationship with the supervisor;
- relationship with older people;
- personnel benefits and specific reasons
for considering leaving the job
|
- Top factors related to job satisfaction
- -Affinity for clients:
- - 96-98% like their clients & believe making a difference
- Relationship with supervisor:
- -95-97% know job responsibilities & hear positive reports
about their jobs
- Relationship with older people:
- -92-97% feel sense of accomplishment, needed and wanted by
older person
- Personnel benefits:
- -83-95% want pay increases, health insurance
& safe neighborhood
- Reasons for possible resignation:
- 49% no pay increase,
- 43% not feeling appreciated,
- 39% no health insurance
|
Kennedy- Malone, 1996 |
Determine significant contributors to job turnover |
- Detroit & Seattle
- 6 nursing homes
- -308 staff (75% NAs)
- & 12 community service agencies
- -50 staff (75% NAs)
- In-house survey:
- Personal data,
- Attitudes:
- Affect toward aged
- Affect toward clients
- Job characteristics:
- Work type, hours, job status, etc.
- Job Satisfaction
Intent to leave
- 1 year later check actual turnover
|
Regression Outcomes: |
Job Satisfaction R2 =.24**(p≤.01) |
Age | .19 * |
Client oriented work | -.14 * |
Job tenure | .16 * |
Professional job status | .20 ** |
Community agency | -.13 * |
Affect toward aged | .17 * |
|
Intent to leave: R2 = .28**(p≤.01) |
Age | .36 ** |
Job tenure | .15 * |
Agency type | .13 * |
Job satisfaction | .14 * |
|
Actual Turnover R2 = .26**(p≤.01) |
Intent to leave | .35 ** |
Job tenure | .18 ** |
|
Kiyak, Namazi, & Kahana, 1997 |
- Describe experiences of empathy and burnout among staff caring
for demented seniors
- Compare experiences, burnout and empathy between staff in a collective living
unit (CLU) & nursing home
|
- Small town in Sweden
- 10 nursing assistants in collective living
unit & 10 from nursing home
- Interviews in 1988 and 1989
- 3 instruments:
- semi-structured interview, empathy rating scale and burnout measure 21 items
on 7 point scale
|
- Similarities more than differences
- Both felt valuable & useful
- Both sometimes felt exhausted
- Both had deep care & concern for patients, confident
in caring abilities
- CLU staff described seniors with only positive descriptions,
nursing home both negative and positive.
- No significant differences in empathy scores
- Significantly lower burnout scores in the CLU in 1988 & 1989
|
Kuremyr et al., 1994 |
Top of Page
|
Develop an overall picture of assistants' work experiences related to
violence from residents |
- Ann Arbor, Michigan
- 7 nursing homes
- Focus group meeting and approximately 8 hours observation of nursing
assistants in each home
|
- All 7 nursing home groups reported
physical abuse
- Assistants reported they "get hurt everyday"
- patients hit, scratch, pull hair, kick, bite, pinch.
- Specific injuries reported:
- Black eye, swollen arm, torn rotator cuff & knee injury
(requiring surgeries), injured jaw, dislocation of thumb.
- Difficult to protect themselves because of necessary proximity
to residents and violence is often unpredictable.
|
Lusk, 1992 |
Understand perceptions of compensation training and abuse in nursing homes |
- Arkansas, urban areas
- 3 nursing homes
- 27 NAs
- 2 hour interviews with open-ended questions
|
- Compensation Perceptions
- experience not reflected in wages
- 50% or more worked extra shifts or second
job "to cover basics"
- Training and In-services
- 60% said training boring & repetitious, most very critical
- NAs with in- house training much less cynical
- 75% wanted in-service on how to communicate with residents
with dementia and depression
- Training areas desired: dealing with aggressive
behaviors, CPR and vital signs
- Racial Discrimination within home
- 78% reported much discriminatory language &
behaviors primarily from residents & families
- Abuse to Residents
- 92 % witnessed residents being abused;
most episodes were verbal
- Abuse from Residents
- 92% reported verbal or physical abuse,
mostly from demented residents
|
Mercer, Heacock & Beck, 1993 |
Explore attitudes toward employment in nursing homes |
- Oregon rural areas
- 7 nursing homes
- 76 NAs
- In-person interviews, open ended questions
|
- Themes,
in order of frequency
- Attachment to others
- - like helping and working with people;
do not like working short of staff / seeing residents given
less than optimum care
- Gratification
- - work is rewarding, enjoy being needed &
appreciated
- Demands
- - physically & emotionally demanding;
sources of stress include lack of staff & supplies &
becoming emotionally attached
- Monetary Needs
- - pay is pitiful and benefits are insufficient.
- Suggestions:
- pot-luck dinners, aide of the week recognition,
respect and caring from administration, smiles and 'thank yous'
|
Monahan & McCarthy, 1992 |
Evaluate the quality of NA education and training |
- Baltimore, Maryland
- 6 nursing homes & 5
home care agencies
- 48 NAs
- In-person interviews, open-ended questions
|
- Comprehensiveness of courses -many thought most
of what was learned was needed;
- criticisms include:
- -Courses present unrealistic view of the workload,
lead to early burnout
- -Courses didn't identify nature of most impairments,
dementia, and incontinence
- -Courses didn't present proper balance
of activities; do much more personal care work
- Training needs identified:
- interpersonal skills with patients & coworkers;
understanding/managing cognitive impairments
|
Morgan, 1996 |
Examine the effects of caring for cognitively impaired residents
on nursing assistant burnout. |
- Winnipeg, Manitoba
- 25 nursing homes
- 225 nursing assistants
- In-person interviews
- Variables
- Proportion of cognitively impaired in caseload
- Minutes/day NA spends on care
- Disturbing behaviors (Memory and Behavior Problems
Checklist, 35 items on 5 point scale)
- Appraisal significance
- Maslach's Burnout Components
- Personal characteristics of NAs
|
- NAs showed mild burnout on emotional exhaustion &
depersonalization & moderate burnout on personal accomplishment
- Regression Results - R2 &
beta values
Emotional Exhaustion
R2M= .23** |
Proportion of cog. impaired | .098 |
Reaction to specific behaviors | .426** |
Pleasantness of tasks | .080 |
Personal Accomplishment R2= .09** |
Freq. disturbing behaviors | -.25 |
Reaction to specific behaviors | .215** |
Task pleasantness | .076 |
Depersonalization R2= .21** |
Age | -.147* |
Proportion of cog. impaired | .086 |
Minutes in physical care | -.187* |
Reaction to specific behaviors | .272** |
Pleasantness of tasks | .220** |
|
Novack & Chappell, 1994 |
Determine how much and what type of abuse occurs from staff to residents |
- New Hampshire
- 31 nursing homes
- 352 NAs,
- 225 LPNs & RNs
- Telephone survey
- First asked to report on abuse observed from other staff
- Second actions they took
- - Conflict Tactics Scale
- - Frequency response scale
- - Burnout scale
|
Physical Abuse: 2-10 times |
| Never | Year |
Pushed, grabbed . . . | 83% | 9% |
Slapped or hit | 88% | 6% |
|
Psychological Abuse: 2-10 times |
Yelled w anger | 30% | 44% |
Insulted or swore | 50% | 30% |
Isolated | 77% | 12% |
Threatened to hit | 85% | 9% |
Denied food, etc. | 87% | 8% |
- Persons /w high burnout more likely to abuse
- Persons /w stressful personal lives more likely to abuse psychologically
|
Pillemer & Moore, 1989 |
Top of Page |
Identify the knowledge and perceived imple- mentation of resident
rights by nursing home staff. |
- Colorado
- 5 nursing homes,
- 83 NAs, 62 nurses
- Survey during in-service. 11 case scenarios
re: specific resident rights issue.
- For each scenario, staff answered:
- How should the situation be handled?
- How is the situation being handled at your facility?
|
NA responses: |
Resident Right | Should Be | Is |
*significant difference between what knew should be &
is in their facility |
Voice concerns | 99% | 79 * |
Choice- bathing | 97 | 84 * |
Privacy | 96 | 72 * |
Respect | 93 | 57 * |
Activities | 92 | 75 * |
Roommate selection | 73 | 56 |
Physical restraints | 68 | 52 |
Chemical restraints | 66 | 57 |
|
Roberto et. al., 1997 |
- Describe and compare attitudes toward elderly held by nursing assistants
of African American, Haitian, and English-
speaking Caribbean cultural backgrounds
- Identify NA personal beliefs & feelings of appreciation.
|
- New York City
- 5 nursing homes
- (3 religious & 2 proprietary)
- 246 NAs; 77 African Americans, 79 Haitian
and 90 English-
speaking Caribbean.
- Instrument
= PES - Perceptions of the Elderly Scale,
29 questions with Likert response format.
- 11 Belief & Appreciation questions with Likert response
|
- All three of the cultural groups held favorable
attitudes toward older persons with few differences noted
- Regard sons or daughters placing their parent in
a nursing home negatively
- Majority would not place own parent in a nursing home
- Majority feels appreciated by residents
- Majority feels opinion is not asked or only occasionally asked by doctors and nurses.
|
Robinson, 1993 & 1994 |
Determine job satisfaction factors of home care NAs & homemakers. |
- Ohio
- 1 home care agency
- 132 NAs/ homemakers
- In-house survey
- Locke's Action Tendency Interview Schedule for Job Satisfaction (ATIS),
11 items with 5 point Likert scale
|
Job Satisfaction Items |
| Often Very Often |
Look forward to going to work | 54% |
Suggest this job to a friend | 52% |
|
Support & Appreciation |
When have concerns turn to Agency personnel | 79% |
|
How know clients appreciate their work |
Tell me | 50% |
Trust & depend on me | 32% |
|
How do you know when you are doing a good job? |
Feedback from supervisor | 55% |
Heard from clients | 32% |
|
Royse, Dhooper, & Howard, 1988 |
Investigate NA perspectives of job commitment, organizational commitment and
other work areas |
- Cleveland metropolitan area,
- 5 nursing homes
- 114 NAs
- In person interviews
- Variables:
- Job commitment -
- rate how strongly would like to still be working as a NA in 3 years
- Organizational commitment -
- rate how strongly want to be working in a nursing home
three years from now
- Open-ended questions
|
- Job commitment:
- - Over ½ did not want to be in job in 3 yrs.;
many wanted to be nurses
- Organizational commitment:
- - Over 1/3 did not want to work in nursing home;
most wanted to be in hospitals or other health organizations.
- Impact of staffing problems:
- - Over 3/4th had been asked to change their scheduled shift time,
to stay late or come in early in past 2 months
- Involved in decisions:
- - 75% never or only minimally involved in residents' pre admission conference
- - More than 50% are never or only minimally involved in
attending resident care planning conference
- Supervision:
- - More than ½ dissatisfied with amount of feedback received,
lack of attention to suggestions & lack of recognition
- Career opportunities:
- - More than ½ dissatisfied with opportunities for promotion
|
Schur, et al., 1998 |
Top of Page |
Determine the impact of NA attitudes, supervisors' leadership and management
practices to quality ratings |
- Florida & Texas
- 25 nursing homes
- (for profit and nonprofit)
- (2 failed state inspections for quality care, 23 passed)
- 530 NAs
- In-house surveys
- - Organizational commitment,
- - job tension,
- - co-worker cohesion
- - Attitude toward residents
- - Leadership behaviors
- - Organization climate
|
- Organization commitment much higher in nonprofit homes than in
for-profit homes (no difference for failed homes)
- Leadership behaviors varied by for profit versus nonprofit
(no difference for failed homes)
- Maintenance attitudes much higher in failed homes than successful homes
- Failed homes had lower human relations climate dimensions and higher
laissez faire and status orientation climates
|
Sheridan, White, & Fairchild, 1992 |
- Identify homemakers perceptions of supervisor support
- Identify linkages between supervisor support and staff satisfaction and desire
to remain on the job
|
- Southwest state
- 1 large home care agency
- 94 homemakers
- In-office survey
- Job sat - 4 items & 7 point scale (Happock's)
- Propensity to remain - 3 items & 5 interval scale
- Personal concern - 10 items, 7 point scale
|
Personal Concern by supervisor |
Mean scores, scale 1-7, 7 highest |
Input is listened to & valued | 4.7 |
Trust & confidence in staff | 4.7 |
Feel free to talk to supervisor | 4.8 |
|
Work Group Climate |
group is friendly | 5.8 |
group is helpful | 5.8 |
take personal interest in others | 5.1 |
trust in group | 5.4 |
look forward to group | 5.0 |
|
Recognition |
annual picnic is beneficial | 5.5 |
recognition banquet is beneficial | 5.6 |
Correlations to job satisfaction & Intent to Stay
(all statistically significant at p≤.05) |
| SATISFIED | STAY |
Trust staff | . 25 | .26 |
Can talk to supervisor | .31 | .27 |
|
Work Group Climate |
group is friendly | .23 | .26 |
group is helpful | /// | .31 |
interest in individuals | .28 | .39 |
Trust in group | .31 | .33 |
Look forward to group | .51 | .51 |
|
Recognition |
Annual picnic is beneficial | /// | .35 |
Recog. Banquet is valued | .32 | .34 |
|
Smith, Hood, and Piland, 1994 |
Understand contributing factors to NA turnover and NAs' opinions regarding
facility management |
- Central Texas
- 11 nursing homes
- 119 Nursing Assistants
- 30-40 minute interviews, closed and open questions
- Variables:
- NA turnover
- Individual characteristics
- Opinions about management
|
In Homes with NA turnover > 50% |
|
Characteristics of NAs |
Only on-the-job training | 80% |
No experience with elderly | 68% |
Correct on aging quiz | 56% |
No nursing home experience | 47% |
|
Management Areas |
No opportunity for advancement | 73% |
Nothing done about problems | 44% |
|
Wagnild, 1988 |
- Determine if job turnover could be related to:
- 1) wages and benefits
- 2) job satisfaction
- 3) perceptions of ward atmosphere and/or
- 4) quality of care
|
- Philadelphia
- 7 nursing homes (proprietary)
- 234 NAs
- Orally administered questionnaire,
- 115 items Minnesota Satisfaction Scale,
- Moos Atmosphere Scale,
- Self report employment,
- Employment records
- HR turnover rates
- Nurse quality ranking
- Annual state inspection & citations records
|
- No correspondence appeared between the
severity of turnover problems and homes' quality or compensation offered.
- Homes with higher turnover had
- - better compensation
- - higher order, organization & program clarity
- - greater job satisfaction for aides
- - higher quality by state records and nurse rankings
|
Waxman, Carner, & Berken- stock 1984 |
Top of Page |