Voices of Frontline Staff

Table 5. Voices of Frontline Staff

Printer Friendly...Table 5

PurposeLocation,
Sample &
Measurements
FindingsAuthors
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 AreasHigh Sat. NAs Low Sat. NAs
enjoy helping people4.724.42
job fits w/future plans4.573.12
supervisor helps out sat.4.353.38
plan to be in LTC years4.172.92
good job for education4.143.23
pleasant co-workers4.003.67
job viewed as short-term3.942.96
affirmed by co-workers3.863.14
pay is satisfactory2.522.04
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
 CurrentDesired
Is meaningful89%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

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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
AidesLPNs
Skill variety4.54.35.2
Task identity4.65.14.8
Task sign.5.56.26.6
Autonomy4.84.85.4
Job Feedback4.84.95.1
Feedback Others4.14.14.4
MPS122157128
MPS = is motivational
potential score
Job Satisfaction Areas
Pay4.23.84.2
Security4.84.64.8
Co-workers5.36.05.9
Supervisory4.85.05.0
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
Ambitious2.5
Helpful3.4
Cheerful3.9
Capable4.2
Independent4.7
Self-controlled5.3
Broad minded6.1
Logical6.8
Imaginative7.6
Carter, Kooper-
man & Clare, 1988

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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...StayLeave
n =817179
Mean age3528
Mean stay, months3720
Hourly rate of pay$4.974.63
Plan stay in nursing89%11%
First job in nursing81%9%
Skill level (10=perfect)87
# of in-services/year76
Attend care conf.81%19%
Free to criticize81%19%
Did criticize81%19%
Attend in-services82%18%
Responds to suggestions83%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

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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
 MeanRange
Job satisfaction4.781-6
Housework92-12
Quality of training31-4
Self-esteem71-8
Age Stereotyping104-16
  • 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

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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
 PACENursing Home
Mean sat. score4.123.83
Turnover rate30%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 position24%
Personal/staff conflict24%
Wages13%
Other38%
SatisfactionPoor-
Good
Fair-
Avg.
Excel
Supervisor concerned34%17%50%
Good work recognized47%31%22%
Communication36%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 conditions45%
Poor Salary39%
Lack of Benefits30%
Lack of Recognition35%
Burnout21%
 
Specific Working Conditions
Instability of work hours39%
Emotional strain of job31%
Lack input in care plans25%
No time to complete tasks23%
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
Sociodemographics0.16
Morale & social support0.17
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

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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 important91%
Proud to tell about job66%
Time for residents53%
Job activities53%
Have input on care plans52%
 
Areas Not Satisfied
Admin/Super respect NAs71%
Pay71%
Co-workers with pay60%
Benefits/working conditions38%
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 relationships100%
Supervision90%
Achievement90%
Responsibility90%
Work itself84%
Salary77%
Recognition77%
Adm. Policies77%
Work Condition88%
Holtz, 1982

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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
 NoSomeGreat
Psychosocial55%50% 5%
Physical80%18%2%
Legal68%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
Mean17.8219.97
Std. Dev.3.863.93
  • (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

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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
 NeverYear
Pushed, grabbed . . .83%9%
Slapped or hit88%6%
 
Psychological Abuse: 2-10 times
Yelled w anger30%44%
Insulted or swore50%30%
Isolated77%12%
Threatened to hit85%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

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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 RightShould BeIs
*significant difference between what knew should be & is in their facility
Voice concerns99%79 *
Choice- bathing9784 *
Privacy9672 *
Respect9357 *
Activities9275 *
Roommate selection7356
Physical restraints6852
Chemical restraints6657
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 work54%
Suggest this job to a friend52%
Support & Appreciation
When have concerns turn to Agency personnel79%
 
How know clients appreciate their work
Tell me50%
Trust & depend on me32%
 
How do you know when you are doing a good job?
Feedback from supervisor55%
Heard from clients32%
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 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 dissatisfied with amount of feedback received, lack of attention to suggestions & lack of recognition
  • Career opportunities:
  • - More than dissatisfied with opportunities for promotion
Schur, et al., 1998

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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 & valued4.7
Trust & confidence in staff4.7
Feel free to talk to supervisor4.8
 
Work Group Climate
group is friendly5.8
group is helpful5.8
take personal interest in others5.1
trust in group5.4
look forward to group5.0
 
Recognition
annual picnic is beneficial5.5
recognition banquet is beneficial5.6
Correlations to job satisfaction & Intent to Stay
(all statistically significant at p≤.05)
 SATISFIEDSTAY
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 training80%
No experience with elderly68%
Correct on aging quiz56%
No nursing home experience47%
 
Management Areas
No opportunity for advancement73%
Nothing done about problems44%
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

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Table 6. Observations of Frontline Staff

Printer Friendly...Table 6

PurposeLocation,
Sample &
Measurements
FindingsAuthors
Understand how NAs organize their work

Distinguish differences between short term and long-term NAs
  • Urban, Midwest City
  • 3 nursing homes
  • 30 NAs (15 worked 3 months or less and 15 worked 1 year or more)
  • 5 months of participant observation and in-depth interviews (worked 40 shifts)
  • Orientation taught tasks, but NOT how to organize & integrate tasks & develop an organizational style
  • One major difference was experienced NA's ability to integrate multiple and simultaneous demands
  • Experienced NAs often increased efficiency by sequencing residents that did not take account of residents' preferences
  • New NAs appeared to be more responsive by answering residents' requests. However, their residents were often found half bathed, half fed or sitting on a toilet.
  • All NAs cut corners. Experienced NAs cut corners that could not be traced to them.
  • NAs that left were:
  • 1) those who couldn't distinguish between visible and invisible infractions and
  • 2) those for whom cutting corners violated their perception of acceptable care.
Bowers & Becker, 1992
Identify how much NA work involves interacting with residents versus other work
  • Pennsylvania
  • 4 nursing homes
  • 214 NA
  • 480 observer hours -
  • > 3,371 recorded tasks over 12 months
  • 6 tasks = over 70% of the work
    (mobility assistance, stocking chores, bathing & hygiene, cleaning chores, socializing, independent of other tasks, & feeding assistance)
  • 69% = direct resident care work
  • 31% = chore work
  • Direct care work = 45% people, 9% data and 46% thing.
  • Least frequently observed tasks = reality orientation, ambulating, meal training and range of motion
Brannon, Streit, & Smyer, 1992
Analyze care from a nursing assistant perspective
  • Illinois
  • Participated as NA in three nursing homes for almost 2 years
  • Analyzed work and comments from nursing assistants
  • Themes drawn from work:
  •   - Minimum wages caused NAs to work 2 jobs.
  •   - Invisibility of caring work; if it isn't charted in accountable terms it didn't happen
  •   - Need ability to framing every day tasks into business, cost accounting terms
Diamond, 1986 & 1992
Identify NA behaviors and perspectives
  • New York City
  • 1 nursing home
  • Followed & interviewed 35 NAs for 8 months
  • From 35 observed assistants:
  •   4 frequently abusive and mean
  •   4 often indifferent, sullen and unresponsive
  •   4 never unkind
  •   23 - occasionally psychologically abusive or unkind (generally very sensitive)
Foner, 1994
Identify unofficial NA work that is hidden from supervisors
  • Florida
  • Worked as a NA in nursing home for 13 months
  • Ethnographic methods
  • Themes:
  • Adaptive behaviors needed to be efficient
  •   - during meals 1 assistant pours all beverages
  •   - memorize personal habits of each resident (e.g., preferred # sugar packets, removing napkins if eat paper)
  • Folk Therapist Actions used, such as:; identifying subtle changes and acting on them (e.g., take vital signs, clear bowel impactions). If actions don't work, then alert nurse for further care
Henderson, 1994
Describe how different interactions between staff and residents affect autonomy in long-term care settings.
  • Pennsylvania
  • 2 nursing homes & 1 independent-living facility
  • 50 observation hours, survey & interviews with staff
Found the spoken value of autonomy was not supported in direct actions or conversations. Passive behaviors were much more favored.

This was not found with independent-living staff. The staff behaviors and conversations here favored autonomous seniors.
Lidz, Fischer, & Arnold, 1992
Describe the verbal and nonverbal behaviors of NAs while assisting residents with meals.
  • California
  • Urban proprietary nursing homes
  • 6 months of observing 60 meals
  • Observed both ineffective and effective interactions.
  • Ineffective Behaviors:
  •   - failure to address the resident (37%)
  •   - don't tell residents about meal or foods (71%)
  •   - NA assumed total control of meal (95%)
  • Effective Behaviors (occurred occasionally):
  •   - address the resident by name
  •   - sensitive to resident subtle cues to enhance eating
  •   - shares a meal or coffee with resident
  •   - provides socialization during mealtime
Schell & Kayser-Jones 1999
Examine the personal life and working life of NAs
  • Illinois
  • 8 nursing homes
  • 132 nursing assistants
  • (structured interviews)
  • 12 nursing homes
  • 53 nursing assistants
  • (non-structured interviews)
  • Numerous conferences with residents, families, staff, surveyors, etc;
  • Ethnographic observations
  • NA Profiles
  • Endurers live on the edge, some caught in exploitative marriages, some as single parents, some full of dreams but with few skills, others turned cynical.
  • Strivers have triumphed against the cruel odds of their personal circumstances. With sheer effort & singular determination these people seek a way out of an oppressive lifestyle.
  • Institutional culture of the nursing home:
  • Impersonal business - NAs know to keep problems to self, so may feel cynical with management's concern for "caring."
  • Routine indignities - few pats on the back, close supervision & may express their disdain
  • Personalize institutional problems - Residents blame their frustration on the lackadaisical ways of the assistants
Tellis-Nayak & Tellis-Nayak 1989
Identify significant factors that influence NAs ability to implement a change in clinical resident management
  • Oregon
  • 1 nursing home
  • 8 months of observation of 10 NAs
  • New program was met with much resistance from the nursing assistants
  • Identified Barriers:
  • Patient Care "Rounds":
  • work organized in a routine with fewest steps to care for all residents; change interferes
  • Physical Environment:
  • often fosters inflexibility due to the inefficiency of extra steps
  • Organizational Environment:
  • old aides set norms and new aides seen as challenging it
  • Interpersonal Environment:
  • suggested changes seen as challenge to NA's efficiency.
Wagner & Colling, 1993

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References for Tables

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