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Miller VJ, Bell J, Wagner J, Maziarz L, Perry K, Cooke E, Burek M. "I Like the Feeling of Connecting With People": A Mixed-Methods Study of Nursing Assistants Experiences Across the Care Continuum. Gerontol Geriatr Med 2024; 10:23337214241249027. [PMID: 38720940 PMCID: PMC11078086 DOI: 10.1177/23337214241249027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/11/2024] [Accepted: 04/04/2024] [Indexed: 05/12/2024] Open
Abstract
Nursing assistants (NAs) are critical professionals across the long-term care continuum. Despite the demands of NAs, these frontline personnel experience workplace challenges and turnover at a disproportionate rate compared to other professionals. Much research has explored the experiences of nursing assistants using federal survey data and national datasets. Guided by a socio-ecological model and the job-demands resource model, this study utilized a sequential mixed-methods approach to uncover a more nuanced understanding of NA workplace experience. Results from this combined qualitative (N = 17) and quantitative (N = 354) study found that there are several workplace aspects, such as organizational culture and supervisor relationships, that contribute to NA experiences across system levels. Further exploration of direct care tasks directly from nursing assistants is necessary to understand full intentions.
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Miller VJ, Maziarz L, Wagner J, Bell J, Burek M. Nursing assistant turnover in nursing homes: A scoping review of the literature. Geriatr Nurs 2023; 51:360-368. [PMID: 37104907 DOI: 10.1016/j.gerinurse.2023.03.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Nurse aide turnover in long-term care is projected to increase in the coming years. Guided by a social ecological framework, this scoping review systematically searched for peer-reviewed journal articles on nursing assistant or nurse aide turnover in nursing homes. METHODS Using the PICO and PRISMA guidelines, 8 university-based library databases via EBSCOhost were searched to source peer-reviewed journal articles published between 2002 and 2022 on nurse aide turnover in nursing homes. RESULTS The initial article search revealed 997 articles. After a three-stage article screening and removal process, a final sample of 43 articles (N = 43) remained. Guided by levels of influence, nurse aide turnover is found to be influenced by intrapersonal, interpersonal, institutional, community, and public policy level factors. CONCLUSION Findings highlight the need for further research with nursing facility administrators and nurse aides to evaluate the complex interactions within long-term care nursing homes.
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Affiliation(s)
- Vivian J Miller
- College of Health and Human Services, Bowling Green State University, 223 Health and Human Services Bldg, Bowling Green, OH 43403, USA.
| | - Lauren Maziarz
- College of Health and Human Services, Bowling Green State University, 223 Health and Human Services Bldg, Bowling Green, OH 43403, USA
| | - Jennifer Wagner
- College of Health and Human Services, Bowling Green State University, 223 Health and Human Services Bldg, Bowling Green, OH 43403, USA
| | - Julia Bell
- College of Health and Human Services, Bowling Green State University, 223 Health and Human Services Bldg, Bowling Green, OH 43403, USA
| | - Melissa Burek
- College of Health and Human Services, Bowling Green State University, 223 Health and Human Services Bldg, Bowling Green, OH 43403, USA
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Yaraghi N, Henfridsson O, Gopal R. Impact of the COVID-19 pandemic on staff turnover at long-term care facilities: a qualitative study. BMJ Open 2022; 12:e065123. [PMID: 36521894 PMCID: PMC9755903 DOI: 10.1136/bmjopen-2022-065123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The objective of this research was to explore the lived experiences of long-term care facilities' staff during the COVID-19 pandemic and examine if and how the pandemic played a role in their decision to leave their jobs. DESIGN Qualitative study using thematic analysis of semistructured interviews. Interview transcripts were analysed using coding techniques based in grounded theory. PARTICIPANTS A total of 29 staff with various roles across 21 long-term care facilities in 12 states were interviewed. RESULTS The pandemic influenced the staff's decision to leave their jobs in five different ways, namely: (1) It significantly increased the workload; (2) Created more physical and emotional hazards for staff; (3) Constrained the facilities and their staff financially; (4) Deteriorated morale and job satisfaction among the staff and (5) Increased concerns with upper management's commitment to both general and COVID-19-specific procedures. CONCLUSIONS Staff at long-term care facilities discussed a wide variety of reasons for their decision to quit their jobs during the pandemic. Our findings may inform efforts to reduce the rate of turnover in these facilities.
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Affiliation(s)
- Niam Yaraghi
- Miami Herbert Business School, University of Miami, Coral Gables, Florida, USA
- Center for Technology Innovation, The Brookings Institution, Washington, District of Columbia, USA
| | - Ola Henfridsson
- Miami Herbert Business School, University of Miami, Coral Gables, Florida, USA
| | - Ram Gopal
- Warwick Business School, University of Warwick, Coventry, UK
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Teo H, Vadean F, Saloniki EC. Recruitment, retention and employment growth in the long-term care sector in England. Front Public Health 2022; 10:969098. [PMID: 36388378 PMCID: PMC9650477 DOI: 10.3389/fpubh.2022.969098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/10/2022] [Indexed: 01/25/2023] Open
Abstract
This paper studies the relationship between turnover, hiring and employment growth in the long-term care (LTC) sector in England and sheds light on how challenges in both recruitment and retention affect the sector's ability to meet growing demand for care services. Using the Adult Social Care Workforce Data Set (ASC-WDS), a large longitudinal dataset of LTC establishments in England, and fixed effects estimation methods we: (a) quantify the relationship between the in/outflow of care workers and the expansion/contraction of employment within establishments, (b) establish the role of staff retention policy for workforce expansion, and (c) identify the role of recruitment frictions and its impact on hiring and employment contraction. Our analysis indicates that care worker turnover and employment growth are negatively related. A one percentage point increase in employment contraction is associated with a 0.71 percentage point rise in turnover, while a one percentage point increase in employment expansion is associated with a 0.23 percentage point fall in turnover. In contrast, we find that hiring rates and employment growth are positively related. A one percentage point increase in employment expansion is associated with a 0.76 percentage point rise in hiring, while a one percentage point increase in employment contraction is associated with a 0.26 percentage point decrease in hiring. We argue that the negative turnover-employment growth relationship within expanding establishments provides evidence that better staff retention is associated with higher employment growth. Using information on establishments' annual change in vacancies, and controlling for changes in new labor demand, we also find rising year-on-year vacancies amongst establishments with declining employment. This provides evidence that recruitment frictions drive the declining rate of replacement hiring amongst contracting establishments. Across sectors, we find that the employment growth-turnover and the employment decline-hiring relationships are relatively stronger in the private and voluntary sectors compared to the public sector, suggesting that the impact of staff retention and recruitment frictions on employment is more acute in these sectors.
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Affiliation(s)
- Hansel Teo
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, United Kingdom,*Correspondence: Hansel Teo
| | - Florin Vadean
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, United Kingdom
| | - Eirini-Christina Saloniki
- Department of Applied Health Research, University College London, London, United Kingdom,National Institute for Health and Care Research (NIHR) Applied Research Collaboration North Thames, London, United Kingdom
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Zheng Q, Williams CS, Shulman ET, White AJ. Association between staff turnover and nursing home quality - evidence from payroll-based journal data. J Am Geriatr Soc 2022; 70:2508-2516. [PMID: 35524769 DOI: 10.1111/jgs.17843] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/11/2022] [Accepted: 04/10/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Staff turnover is considered an important indicator of nursing home quality. We used auditable staffing data from the Centers for Medicare & Medicaid Services (CMS) Payroll-Based Journal (PBJ) system to calculate turnover measures for nurse staff and administrators and examined the relationship between turnover and nursing home quality. METHODS Our analyses included data from 13,631 nursing homes that submitted complete staffing data through PBJ for 2018Q3 - 2019Q4. We identified turnover based on gaps in days worked by eligible employees, allowing us to calculate turnover measures that do not depend on termination dates reported by nursing homes, which are not captured in PBJ. We linked staff turnover measures to nursing home quality measures and star ratings published on CMS' Care Compare website in January 2020 and examined the relationship between turnover and quality of care. We used ordinary least squared models for continuous outcomes and ordered logit models for categorical outcomes, controlling for facility, and county characteristics. RESULTS Mean annual turnover rates were about 44% for RNs and 46% for total nurse staff. On average, there was one administrator leaving each nursing home during this period although about half of nursing homes had no administrator turnover. Turnover rates varied greatly across nursing homes. For-profit and larger nursing homes had higher turnover rates. Higher turnover was consistently associated with lower quality of care. CONCLUSIONS Our study highlights the importance of staff turnover due to its relationship to nursing home quality. In January 2022, CMS started posting turnover measures on Care Compare to allow consumers to use this information in their assessment of nursing home quality and to motivate nursing homes to implement innovative strategies to retain staff. While these actions are challenging, they are nonetheless warranted for improving the quality of care for nursing home residents.
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Affiliation(s)
- Qing Zheng
- Division of Health and Environment, Abt Associates, Durham, North Carolina, USA
| | | | - Evan T Shulman
- Division of Nursing Homes, Centers for Medicare & Medicaid Services, Baltimore, Maryland, USA
| | - Alan J White
- Division of Health and Environment, Abt Associates, Durham, North Carolina, USA
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White E, Woodford E, Britton J, Newberry LW, Pabico C. Nursing practice environment and care quality in nursing homes. Nurs Manag (Harrow) 2020; 51:9-12. [PMID: 32472854 DOI: 10.1097/01.numa.0000662656.07901.a8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A case study of the Pathway to Excellence in Long-Term Care model.
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Affiliation(s)
- Elizabeth White
- Elizabeth White is a postdoctoral fellow in the Center for Gerontology and Healthcare Research at the Brown University School of Public Health in Providence, R.I. At Genesis Healthcare in Pottsville, Pa. Erin Woodford is the director of population health for division II and III and Julie Britton is the senior vice president of clinical operations. At the American Nurses Credentialing Center in Silver Spring, Md., Lynn Newberry is the education and outreach program manager and Christine Pabico is the director of the Pathway to Excellence program
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Nursing home work environment, care quality, registered nurse burnout and job dissatisfaction. Geriatr Nurs 2019; 41:158-164. [PMID: 31488333 DOI: 10.1016/j.gerinurse.2019.08.007] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/15/2019] [Accepted: 08/19/2019] [Indexed: 12/31/2022]
Abstract
The objective of this cross-sectional study was to examine the relationships between work environment, care quality, registered nurse (RN) burnout, and job dissatisfaction in nursing homes. We linked 2015 RN4CAST-US nurse survey data with LTCfocus and Nursing Home Compare. The sample included 245 Medicare and Medicaid-certified nursing homes in four states, and 674 of their RN employees. Nursing homes with good vs. poor work environments, had 1.8% fewer residents with pressure ulcers (p = .02) and 16 fewer hospitalizations per 100 residents per year (p = .05). They also had lower antipsychotic use, but the difference was not statistically significant. RNs were one-tenth as likely to report job dissatisfaction (p < .001) and one-eighth as likely to exhibit burnout (p < .001) when employed in good vs. poor work environments. These results suggest that the work environment is an important area to target for interventions to improve care quality and nurse retention in nursing homes.
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Hanratty B, Craig D, Brittain K, Spilsbury K, Vines J, Wilson P. Innovation to enhance health in care homes and evaluation of tools for measuring outcomes of care: rapid evidence synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BackgroundFlexible, integrated models of service delivery are being developed to meet the changing demands of an ageing population. To underpin the spread of innovative models of care across the NHS, summaries of the current research evidence are needed. This report focuses exclusively on care homes and reviews work in four specific areas, identified as key enablers for the NHS England vanguard programme.AimTo conduct a rapid synthesis of evidence relating to enhancing health in care homes across four key areas: technology, communication and engagement, workforce and evaluation.Objectives(1) To map the published literature on the uses, benefits and challenges of technology in care homes; flexible and innovative uses of the nursing and support workforce to benefit resident care; communication and engagement between care homes, communities and health-related organisations; and approaches to the evaluation of new models of care in care homes. (2) To conduct rapid, systematic syntheses of evidence to answer the following questions. Which technologies have a positive impact on resident health and well-being? How should care homes and the NHS communicate to enhance resident, family and staff outcomes and experiences? Which measurement tools have been validated for use in UK care homes? What is the evidence that staffing levels (i.e. ratio of registered nurses and support staff to residents or different levels of support staff) influence resident outcomes?Data sourcesSearches of MEDLINE, CINAHL, Science Citation Index, Cochrane Database of Systematic Reviews, DARE (Database of Abstracts of Reviews of Effects) and Index to Theses. Grey literature was sought via Google™ (Mountain View, CA, USA) and websites relevant to each individual search.DesignMapping review and rapid, systematic evidence syntheses.SettingCare homes with and without nursing in high-income countries.Review methodsPublished literature was mapped to a bespoke framework, and four linked rapid critical reviews of the available evidence were undertaken using systematic methods. Data were not suitable for meta-analysis, and are presented in narrative syntheses.ResultsSeven hundred and sixty-one studies were mapped across the four topic areas, and 65 studies were included in systematic rapid reviews. This work identified a paucity of large, high-quality research studies, particularly from the UK. The key findings include the following. (1) Technology: some of the most promising interventions appear to be games that promote physical activity and enhance mental health and well-being. (2) Communication and engagement: structured communication tools have been shown to enhance communication with health services and resident outcomes in US studies. No robust evidence was identified on care home engagement with communities. (3) Evaluation: 6 of the 65 measurement tools identified had been validated for use in UK care homes, two of which provide general assessments of care. The methodological quality of all six tools was assessed as poor. (4) Workforce: joint working within and beyond the care home and initiatives that focus on staff taking on new but specific care tasks appear to be associated with enhanced outcomes. Evidence for staff taking on traditional nursing tasks without qualification is limited, but promising.LimitationsThis review was restricted to English-language publications after the year 2000. The rapid methodology has facilitated a broad review in a short time period, but the possibility of omissions and errors cannot be excluded.ConclusionsThis review provides limited evidential support for some of the innovations in the NHS vanguard programme, and identifies key issues and gaps for future research and evaluation.Future workFuture work should provide high-quality evidence, in particular experimental studies, economic evaluations and research sensitive to the UK context.Study registrationThis study is registered as PROSPERO CRD42016052933, CRD42016052933, CRD42016052937 and CRD42016052938.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Barbara Hanratty
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Dawn Craig
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Katie Brittain
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | | | - John Vines
- Northumbria School of Design, Northumbria University, Newcastle upon Tyne, UK
| | - Paul Wilson
- Alliance Manchester Business School, University of Manchester, Manchester, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester, University of Manchester, Manchester, UK
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Zhang Y, Punnett L, Gore R. Predictors of Nursing Staff Voluntary Termination in Nursing Homes: A Case-Control Study. J Appl Gerontol 2017; 38:1518-1536. [DOI: 10.1177/0733464817724043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Workforce instability in the long-term care sector has raised wide attention about nursing staff turnover. Most attention has been devoted to understanding the relationship between facility’s characteristics and organizational turnover. This case-control study examined the contribution of work characteristics to individual staff turnover. Surveys were collected with nursing staff in 18 for-profit nursing homes on up to five occasions between 2006 and 2012. A list of nursing staff voluntarily terminating jobs was provided by the company. Cases and controls (628 of each) were selected from survey respondents by matching on age, job category, and survey occasion. Multiple predictor conditional logistic regression models showed that evening shift work (hazards ratio [HR] = 2.00, p < .01) and shift length > 8 hr (HR = 1.42, p < .05) were contributing factors to voluntary termination. This study provides different perspectives of nursing staff voluntary termination in nursing homes. Future qualitative research would be valuable to explore and understand nursing staff turnover in the health care industry.
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Hussein S, Ismail M, Manthorpe J. Changes in turnover and vacancy rates of care workers in England from 2008 to 2010: panel analysis of national workforce data. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:547-556. [PMID: 25736156 DOI: 10.1111/hsc.12214] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/21/2014] [Indexed: 06/04/2023]
Abstract
The combination of growing demand for long-term care and higher expectations of care staff needs to be set in the context of long-standing concerns about the sustainability of recruitment and retention of front-line staff in the United Kingdom. Organisational and work environment factors are associated with vacancy levels and turnover rates. The aim of the current analysis was to investigate changes in turnover and vacancy rates over time experienced by a sample of social care employers in England. Taking a follow-up approach offers potentially more accurate estimates of changes in turnover and vacancy rates, and enables the identification of any different organisational characteristics which may be linked to reductions in these elements over time. The study constructed a panel of 2964 care providers (employers) using 18 separate data sets from the National Minimum Data Set for Social Care during 2008-2010. The findings indicate slight reductions in vacancy rates but the presence of enduring, high turnover rates among direct care workers over the study period. However, the experience of individual employers varied, with home-care providers experiencing significantly higher turnover rates than other parts of the sector. These findings raise questions around the quality and motivations of new recruits and methods of reducing specific vacancy levels. At a time of increased emphasis on care at home, it is worthwhile examining why care homes appear to have greater stability of staff and fewer vacancies than home-care agencies.
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Affiliation(s)
- Shereen Hussein
- Social Care Workforce Research Unit, King's College London, London, UK
| | | | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, London, UK
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Hewko SJ, Cooper SL, Huynh H, Spiwek TL, Carleton HL, Reid S, Cummings GG. Invisible no more: a scoping review of the health care aide workforce literature. BMC Nurs 2015; 14:38. [PMID: 26203297 PMCID: PMC4511030 DOI: 10.1186/s12912-015-0090-x] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 07/14/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Healthcare aides (HCAs) are the primary caregivers for vulnerable older persons. They have many titles and are largely unregulated, which contributes to their relative invisibility. The objective of this scoping review was to evaluate the breadth and depth of the HCA workforce literature. METHODS We conducted a search of seven online bibliographic databases. Studies were included if published since 1995 in English, peer-reviewed journals. Results were iteratively synthesized within and across the following five categories: education, supply, use, demand and injury and illness. RESULTS Of 5,045 citations screened, 82 studies met inclusion criteria. Few examined HCA education; particularly trainee characteristics, program location, length and content. Results in supply indicated that the average HCA was female, 36-45 years and had an education level of high school or less. Home health HCAs were, on average, older and were more likely to be immigrants than those working in other settings. The review of studies exploring HCA use revealed that their role was unclear - variation in duties, level of autonomy and work setting make describing "the" role of an HCA near impossible. Projected increased demand for HCAs and high rates of turnover, both at the profession and facility-level, elicit predictions of future HCA shortages. Home health HCAs experienced comparatively lower job stability, earned less, worked the fewest hours and were less likely to have fringe benefits than HCAs employed in hospitals and nursing homes. The review of studies related to HCA illness and injury revealed that they were at comparatively higher risk of injury than registered nurses and licensed practical nurses. CONCLUSIONS This is the largest, most comprehensive scoping review of HCA workforce literature to date. Our results indicate that the HCA workforce is both invisible and ubiquitous; as long as this is the case, governments and healthcare organizations will be limited in their ability to develop and implement feasible, effective HCA workforce plans. The continued undervaluation of HCAs adversely impacts care providers, the institutions they work for and those who depend on their care. Future workforce planning and research necessitates national HCA registries, or at minimum, directories.
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Affiliation(s)
- Sarah J. Hewko
- CLEAR Outcomes Research Program, Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Sarah L. Cooper
- CLEAR Outcomes Research Program, Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Hanhmi Huynh
- CLEAR Outcomes Research Program, Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Trish L. Spiwek
- CLEAR Outcomes Research Program, Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Heather L. Carleton
- CLEAR Outcomes Research Program, Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Shawna Reid
- CLEAR Outcomes Research Program, Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Greta G. Cummings
- CLEAR Outcomes Research Program, Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
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Sharman Z. Recruitment and Retention of Home Support Workers in Rural Communities. Home Health Care Serv Q 2014; 33:229-43. [DOI: 10.1080/01621424.2014.964897] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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An assessment of cultural values and resident-centered culture change in U.S. nursing facilities. Health Care Manage Rev 2014; 38:295-305. [PMID: 22936002 DOI: 10.1097/hmr.0b013e3182678fb0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Culture change initiatives propose to improve care by addressing the lack of managerial supports and prevalent stressful work environments in the industry; however, little is known about how culture change facilities differ from facilities in the industry that have not chosen to affiliate with the resident-centered care movements. PURPOSE The aim of this study was to evaluate representation of organizational culture values within a random sample of U.S. nursing home facilities using the competing values framework and to determine whether organizational values are related to membership in resident-centered culture change initiatives. DESIGN AND METHODS We collected reports of cultural values using a well-established competing values framework instrument in a random survey of facility administrators and directors of nursing within all states. We received responses from 57% of the facilities that were mailed the survey. Directors of nursing and administrators did not differ significantly in their reports of culture and facility measures combined their responses. FINDINGS Nursing facilities favored market-focused cultural values on average, and developmental values, key to innovation, were the least common across all nursing homes. Approximately 17% of the facilities reported that all cultural values were strong within their facilities. Only high developmental cultural values were linked to participation in culture change initiatives. Culture change facilities were not different from non-culture change facilities in the promotion of employee focus as organizational culture, as emphasized in group culture values. Likewise, culture change facilities were also not more likely to have hierarchical or market foci than non-culture change facilities. PRACTICE IMPLICATIONS Our results counter the argument that culture change facilities have a stronger internal employee focus than facilities more generally but do show that culture change facilities report stronger developmental cultures than non-culture change facilities, which indicates a potential to be innovative in their strategies. Facilities are culturally ready to become resident centered and may face other barriers to adopting these practices.
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Banaszak-Holl J, Castle NG, Lin MK, Shrivastwa N, Spreitzer G. The role of organizational culture in retaining nursing workforce. THE GERONTOLOGIST 2013; 55:462-71. [PMID: 24218146 DOI: 10.1093/geront/gnt129] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 09/24/2013] [Indexed: 11/15/2022] Open
Abstract
PURPOSE OF THE STUDY We examined how organizational culture in nursing homes affects staff turnover, because culture is a first step to creating satisfactory work environments. DESIGN AND METHODS Nursing home administrators were asked in 2009 to report on facility culture and staff turnover. We received responses from 419 of 1,056 administrators contacted. Respondents reported the strength of cultural values using scales from a Competing Values Framework and percent of staff leaving annually for Registered Nurse (RN), Licensed Practice Nurse (LPN), and nursing aide (NA) staff. We estimated negative binomial models predicting turnover. RESULTS Turnover rates are lower than found in past but remain significantly higher among NAs than among RNs or LPNs. Facilities with stronger market values had increased turnover among RNs and LPNs, and among NAs when turnover was adjusted for facilities with few staff. Facilities emphasizing hierarchical internal processes had lower RN turnover. Group and developmental values focusing on staff and innovation only lowered LPN turnover. Finally, effects on NA turnover become insignificant when turnover was adjusted if voluntary turnover was reported. IMPLICATIONS Organizational culture had differential effects on the turnover of RN, LPN, and NA staff that should be addressed in developing culture-change strategies. More flexible organizational culture values were important for LPN staff only, whereas unexpectedly, greater emphasis on rigid internal rules helped facilities retain RNs. Facilities with a stronger focus on customer needs had higher turnover among all staff.
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Affiliation(s)
- Jane Banaszak-Holl
- Department of Health Management and Policy, University of Michigan School of Public Health, Institute of Gerontology, University of Michigan Medical School, Ann Arbor.
| | - Nicholas G Castle
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
| | | | - Nijika Shrivastwa
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
| | - Gretchen Spreitzer
- Department of Management and Organizations, University of Michigan Ross Business School, Ann Arbor
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Lopez C, White DL, Carder PC. Direct Care Worker’s Perceptions of Job Satisfaction Following Implementation of Work-Based Learning. J Appl Gerontol 2012; 33:97-120. [DOI: 10.1177/0733464812463982] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The purpose of this study was to understand the impact of a work-based learning program on the work lives of Direct Care Workers (DCWs) at assisted living (AL) residences. The research questions were addressed using focus group data collected as part of a larger evaluation of a work-based learning (WBL) program called Jobs to Careers. The theoretical perspective of symbolic interactionism was used to frame the qualitative data analysis. Results indicated that the WBL program impacted DCWs’ job satisfaction through the program curriculum and design and through three primary categories: relational aspects of work, worker identity, and finding time. This article presents a conceptual model for understanding how these categories are interrelated and the implications for WBL programs. Job satisfaction is an important topic that has been linked to quality of care and reduced turnover in long-term care settings.
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Registered nurse retention strategies in nursing homes: a two-factor perspective. Health Care Manage Rev 2012; 37:246-56. [PMID: 22037647 DOI: 10.1097/hmr.0b013e3182352425] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND As the American population ages and the proportion of individuals over the age of 65 expands, the demand for high-quality nursing home care will increase. However, nursing workforce instability threatens care quality and sustainability in this sector. Despite increasing attention to nursing home staff turnover, far less is known about registered nurse (RN) retention. PURPOSE In this study, the relationships between retention strategies, employee benefits, features of the practice environment, and RN retention were explored. Further, the utility of Herzberg's two-factor theory of motivation as a framework for nursing home retention studies was evaluated. METHODOLOGY This study was a secondary analysis of the nationally representative 2004 National Nursing Home Survey. The final sample of 1,174 participating nursing homes were either certified by Medicare or Medicaid or licensed by state agencies. We used a weighted multinomial logistic regression using an incremental approach to model the relationships. FINDINGS Although most nursing homes offered some combination of retention programs, the majority of strategies did not have a significant association with the level of RN retention reported by facilities. Director of nursing tenure and other extrinsic factors had the strongest association with RN retention in adjusted analyses. PRACTICE IMPLICATIONS To improve RN retention, organizations may benefit greatly from stabilizing nursing home leadership, especially the director of nursing position. Second, managers of facilities with poor retention may consider adding career ladders for advancement, awarding attendance, and improving employee benefits. As a behavioral outcome of motivation and satisfaction, retention was not explained as expected using Herzberg's two-factor theory.
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Gilmartin MJ. Thirty years of nursing turnover research: looking back to move forward. Med Care Res Rev 2012; 70:3-28. [PMID: 22679280 DOI: 10.1177/1077558712449056] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite the substantial amount of useful prior work on turnover among nurses, our understanding of the causal mechanisms explaining why nurses voluntarily leave their jobs is limited. The purpose of this article is to promote the development of stronger conceptual models of the causes of voluntary turnover among nurses. The author compares the nursing-specific literature to research on voluntary turnover from the general management field over the past 30 years and examines the evolution of key theories used in the nursing literature. Results of this review comparing nursing research with that in the broader field suggest that, over time, nursing research has not kept pace with conceptualizations from general management explaining why people either remain at or quit their jobs. The author argues that conceptual models of turnover among nurses can benefit significantly from drawing more effectively on particular models and concepts available in general management studies of turnover.
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Zhang Y, Punnett L, Gore R. Relationships Among Employees’ Working Conditions, Mental Health, and Intention to Leave in Nursing Homes. J Appl Gerontol 2012; 33:6-23. [DOI: 10.1177/0733464812443085] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Employee turnover is a large and expensive problem in the long-term care environment. Stated intention to leave is a reliable indicator of likely turnover, but actual predictors, especially for nursing assistants, have been incompletely investigated. This quantitative study identifies the relationships among employees’ working conditions, mental health, and intention to leave. Self-administered questionnaires were collected with 1,589 employees in 18 for-profit nursing homes. A working condition index for the number of beneficial job features was constructed. Poisson regression modeling found that employees who reported four positive features were 77% less likely to state strong intention to leave (PR = 0.23, p < .001). The strength of relationship between working conditions and intention to leave was slightly mediated by employee mental health. Effective workplace intervention programs must address work organization features to reduce employee intention to leave. Healthy workplaces should build better interpersonal relationships, show respect for employee work, and involve employees in decision-making processes.
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Affiliation(s)
- Yuan Zhang
- University of Massachusetts Lowell, Lowell, MA, USA
| | | | - Rebecca Gore
- University of Massachusetts Lowell, Lowell, MA, USA
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Choi J, Johantgen M. The importance of supervision in retention of CNAs. Res Nurs Health 2012; 35:187-99. [PMID: 22262015 DOI: 10.1002/nur.21461] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2011] [Indexed: 11/06/2022]
Abstract
Certified nursing assistants (CNAs) provide the majority of direct care in nursing homes, yet recruiting and retaining CNAs has been difficult. Retaining CNAs is important because it has been linked to the better quality of resident care in nursing homes. In this study, the investigators examined the relationships of work-related and personal factors to CNA job satisfaction and intent to leave. Linked data from the 2004 National Nursing Home Survey and the 2004 National Nursing Assistant Survey were analyzed using multilevel logistic regression. Personal factors such as age, education, and job history, were related to intent to leave but not to job satisfaction. Supportive supervision was a significant predictor of both job satisfaction and intent to leave.
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Affiliation(s)
- JiSun Choi
- National Database of Nursing Quality Indicators, University of Kansas Medical Center, School of Nursing, Kansas City, Kansas 66160, USA
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22
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Nakanishi M, Imai H. Job role quality and intention to leave current facility and to leave profession of direct care workers in Japanese residential facilities for elderly. Arch Gerontol Geriatr 2012; 54:102-8. [PMID: 21227517 DOI: 10.1016/j.archger.2010.12.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 12/14/2010] [Accepted: 12/15/2010] [Indexed: 11/28/2022]
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Rantz MJ, Zwygart-Stauffacher M, Hicks L, Mehr D, Flesner M, Petroski GF, Madsen RW, Scott-Cawiezell J. Randomized multilevel intervention to improve outcomes of residents in nursing homes in need of improvement. J Am Med Dir Assoc 2012; 13:60-8. [PMID: 21816681 PMCID: PMC3379965 DOI: 10.1016/j.jamda.2011.06.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 06/24/2011] [Accepted: 06/24/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVES A comprehensive multilevel intervention was tested to build organizational capacity to create and sustain improvement in quality of care and subsequently improve resident outcomes in nursing homes in need of improvement. DESIGN/SETTING/PARTICIPANTS Intervention facilities (N = 29) received a 2-year multilevel intervention with monthly on-site consultation from expert nurses with graduate education in gerontological nursing. Attention control facilities (N = 29) that also needed to improve resident outcomes received monthly information about aging and physical assessment of elders. INTERVENTION The authors conducted a randomized clinical trial of nursing homes in need of improving resident outcomes of bladder and bowel incontinence, weight loss, pressure ulcers, and decline in activities of daily living. It was hypothesized that following the intervention, experimental facilities would have higher quality of care, better resident outcomes, more organizational attributes of improved working conditions than control facilities, higher staff retention, similar staffing and staff mix, and lower total and direct care costs. RESULTS The intervention did improve quality of care (P = .02); there were improvements in pressure ulcers (P = .05) and weight loss (P = .05). Organizational working conditions, staff retention, staffing, and staff mix and most costs were not affected by the intervention. Leadership turnover was surprisingly excessive in both intervention and control groups. CONCLUSION AND IMPLICATIONS Some facilities that are in need of improving quality of care and resident outcomes are able to build the organizational capacity to improve while not increasing staffing or costs of care. Improvement requires continuous supportive consultation and leadership willing to involve staff and work together to build the systematic improvements in care delivery needed. Medical directors in collaborative practice with advanced practice nurses are ideally positioned to implement this low-cost, effective intervention nationwide.
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Affiliation(s)
- Marilyn J Rantz
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri 65211, USA.
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Coogle CL, Parham IA, Rachel CA. Job satisfaction and career commitment among Alzheimer's care providers: addressing turnover and improving staff empowerment. Am J Alzheimers Dis Other Demen 2011; 26:521-7. [PMID: 22207693 PMCID: PMC10871718 DOI: 10.1177/1533317511429322] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
This study investigated the relation between job satisfaction and career commitment among 262 Alzheimer's care staff working in long-term and community-based care settings. It was anticipated that the results would suggest whether career commitment could be enhanced to positively influence job satisfaction, and conversely, if improvements in job satisfaction might contribute to a deepened sense of vocational empowerment. Participants attended dementia-specific training and completed 2 short work-related questionnaires that measured job satisfaction and career commitment. The results of stepwise regression revealed interrelations between the 2 constructs. Congruence appeared to be reciprocal with respect to the overall scale scores and the intrinsic job satisfaction measure. Unexpected relations appeared in analyses of the extrinsic job satisfaction measure and the career planning subscale. Results are indicative of the fundamental distinction between job satisfaction and career commitment. Implications for efforts to reduce turnover and improve staff empowerment are also considered.
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Affiliation(s)
- Constance L Coogle
- Virginia Commonwealth, University Medical Center, Richmond, VA 23298, USA.
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Abstract
Assisted Living (AL) currently represents one of the most numerous institutional care settings for elders. Very little information exists on abuse in AL. Descriptive information on elder abuse reported by nurse aides working in AL is presented from a survey sent to nurse aides. The questionnaire had items addressing verbal, physical, psychological, caregiving, medication, material, and sexual abuse. The responses to the questions included in the verbal abuse, physical abuse, psychological abuse, caregiving abuse, medication abuse, and material exploitation abuse sections (28 questions) show that suspected abuse is not uncommon. We could not objectively verify the cases of abuse described in the survey, still, they give a first indication that staff abuse may occur in AL. This may be significant given the large number of ALs in the United States and may influence the health, quality of life, and safety of many residents.
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Abstract
Verbal, physical, psychological, caregiving, medication, material, and sexual abuse perpetrated by staff are examined. Information came from nurse aides included in the Pennsylvania nurse aide registry. A total of 4,451 nurse aides returned a 46-item questionnaire (response rate = 64%). A 3-month frame of reference was used, and the questionnaire asked about abuse in the prior nursing home of employment. Nurse aide responses to the verbal abuse and psychological abuse items were higher than for the other categories of abuse examined. For example, 36% of nurse aides observed argumentative behavior with residents and 28% observed intimidation. Lower figures were reported for physical abuse (6% observed pushing, grabbing, or pinching), caregiving abuse (10% observed staff to threaten to stop taking care of a resident), medication abuse (19% observed inappropriate delays in medication administration), material exploitation (10% observed taking assets), and sexual abuse (1% observed unwelcome discussion of sexual activity). These findings clearly show that some types of resident abuse by staff are reported to be a common occurrence by nurse aides. This likely influences the health outcomes, quality of life, quality of care, and the safety of residents.
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Sterns S, Miller SC, Allen S. The complexity of implementing culture change practices in nursing homes. J Am Med Dir Assoc 2010; 11:511-8. [PMID: 20816340 DOI: 10.1016/j.jamda.2009.11.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2009] [Revised: 11/13/2009] [Accepted: 11/13/2009] [Indexed: 11/19/2022]
Abstract
PURPOSE The culture change (CC) movement aims to transform the traditional nursing home (NH) that is institutional in design with hierarchical management structure into a homelike environment that empowers residents and frontline staff. This study examines differences in adoption of CC practices according to a NH's self-reported extent of CC implementation and its duration of CC adoption. Furthermore, it examines differences in adoption by whether a CC practice is considered less versus more complex, using complexity theory as the theoretical framework for this classification. DESIGN AND METHODS Using data from a 2007 Commonwealth-funded study, we analyzed a national sample of 291 US nursing homes that identified as being "for the most part" or "completely" CC facilities for "1 to 3 years" or "3+ years." Also, using a complexity theory framework, we ranked 16 practices commonly associated with CC as low, moderately, or highly complex based on level of agreement needed to actuate the process (number of parties involved) and the certainty of intended outcomes. We then examined the prevalence of CC-associated practices in relation to their complexity and the extent and duration of a NH's CC adoption. RESULTS We found practices ranked as less complex were implemented more frequently in NHs with both shorter and longer durations of CC adoption. However, more complex CC practices were more prevalent among NHs reporting "complete" adoption for 3+ years versus 1 to 3 years. This was not observed in NHs reporting having CC "for the most part." CONCLUSIONS/IMPLICATIONS Less complex practices may be more economical and easier to implement. These early successes may result in sufficient momentum so that more complex change can follow. A nursing home that more completely embraces the culture change movement may be more likely to attempt these complex changes.
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Affiliation(s)
- Samantha Sterns
- Center for Gerontology and Health Care Research, Brown University, Providence, RI 02912, USA.
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Filipova AA. Relationships Among Ethical Climates, Perceived Organizational Support, and Intent-to-Leave for Licensed Nurses in Skilled Nursing Facilities. J Appl Gerontol 2010. [DOI: 10.1177/0733464809356546] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study tests a model that examines the effects of ethical climates and perceived organizational support on licensed nurses’ intent to leave through job satisfaction and organizational commitment. A cross-sectional survey design was implemented. Three hundred and fifty nine skilled nursing facilities were selected in the midwestern United States. While a total of 110 facilities (31%) agreed to participate, responses were received from nurses representing 100 of those facilities (28%). A total of 656 usable questionnaires were returned of the 3,060 distributed—a 21.4% response rate. Descriptive statistics, Pearson correlation, and hierarchical regression analyses were used.The explained variance of intent to leave was 53%, with six major determinants: commitment, job satisfaction, years in facility, instrumental climate, age group, and facility ownership type. Commitment completely mediated the relationship between perceived organizational support and intent to leave. Findings suggest that organizational ethics and support may be used as means to generate positive outcomes such as retention.
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