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How satisfied are nursing home staff?
How Satisfied Are Nursing Home Staff? Use these findings on what RNs, LPNs, and NAs like best-and least-about their jobs to update your recruitment and retention strategies.
D
espite the many problems in long-term care-changing regulations, low salaries, high patient acuity, and staff shortages-nursing home personnel are surprisingly happy in their jobs. That was a key finding in our study of staff in six nursing homes, chosen to represent the variety of environments available in rural and urban Utah. Who and What We Studied
A total of 212 staff-33 registered nurses (RNs), 41 licensed practical nurses (LPNs), and 138 nursing asststants (NAs)-completed a 25-item questionnaire. In the first 4 statements, the respondent was asked to state how many days she had been absent in the prior 12 months, how long she had been employed in the current and other similar facilities, and whether she was an RN, an LPN, or an NA. The remaining 21 items were statements that the respondent was asked to score on a scale of 1 to 5, to indicate how strongly she agreed [5] or disagreed [1]. The first 12 statements were designed to measure the level of job satisfaction and the last 9 to identify reasons for job satisfaction and The authors are at Weber State University in Ogden, UT. MARY ANN ANDERSON, RN, MS, is certified in nursing administration and gerontological nursing and is site project coordinator for the W. K. Kellogg-funded project, Community College Nursing Home Partnership, at the School of Allied Health SciencesNursing. TAMARA R. AIRD, RN, BSN, is program administrator in the Division of Continuing Education. W. BRUCE HASLAM, PhD, is professor of psychology.
dissatisfaction. (See "How Nurses and Assistants Rate Job Satisfaction, " on thenextpage.) A statistical method was used to reverse score items that were stated negatively. Thus, when respondents scored a negative statement low, the low score was translated into a highsatisfaction score. For example, the average RN score for "I do not like my job" (item 12) was 1.85, which translates into a satisfaction score of 4,15. A top score of 60-a 5 on each of the 12 measures of job-satisfaction level-reflects complete satisfaction, a score of 12 complete dissatisfaction, and 36 a neutral response. Split-halfreliability tests were used to determine instrument reliability. The split-half reliability for the RN group was 0.85 (corrected by the SpearmanBrown formula), for LPN group 0.82, and for the NA group 0.89. Alllevels-NAs to RNs-were satisfied.They were not strongly satisfied, but the average score for all respondents was 46.82 out of a possible 60. The LPN group scored their job satisfaction the highest, 48.63; next was the NA group, 46.4; and the RN group a close third with 46.33. No group was overwhelmingly satisfied, yet people in each group were at least moderately satisfiedwith their jobs.
group, even though the lowest scores were barely belowneutral and the high scoreswere not dramatically high. LPNs had worked longest in the facility, an average of just over four years; RNs three to four years; and NAs one to two-and-a-half years. NAs in the high-satisfaction subgroup worked one year longer than those in the low-satisfaction group. Among RNs and LPNs, there were no differences in longevity between the highand low-satisfactionsubgroups. There were differences, however, in the absenteeism: Highly satisfied RNs missed 2 days, and LPNs 2.41 days in the past year, while in the low-satisfaction group, RNs missed 4.32 and LPNs missed 5.24 days. Among the NAs-who had higher absenteeism overall-satisfaction did not improve attendance. Those in the high-satisfaction group missed 4.48 days and those in the lowsatisfaction group 4.27 days. Staff in the high-satisfaction groups had no plans to leave their jobs and in fact, on items 9 and 17, indicated their commitment to remain. On the other hand, individuals with low job satisfaction were more inclined to feel neutral about staying. All staff agreed that in terms of their education and training "this is a good job for me." The lowest score was for the NAs in the low-satisfacStaying Power tion group, who were neutral about Based on responses to items 13 to the statement. The responses contra21,each of the three nursinggroupswas dict the long-held idea that nursing dividedin half.The top halfwas called home employment is not considered the high-satisfaction subgroup and the a good job placement. Long-term bottom half the low-satisfaction sub- care recruiters need to point this out
GcrlatrlcNursing March/April1991 85
to health care providers who negatively stereotype long-term care. Administrators and nurse managers need to recognize that even the least satisfied personnel (in this study, NAs) believe they have good jobs. One way to build on this finding would be to enhance the work setting: Offer t1ex-hours for staff to attend school or take care of family matters, provide in-house day-care centers, schedule car pools, and give mental health or personal need days. If employees already feel good about their job, an administration that works to make it even better on a personal level can have a very positive impact on employee retention. Staff in every subgroup agreed that "this job fits well with my future plans" and disagreed that the job was a short-term commitment. Highly satisfied NAs agreed even more than highly satisfied RNs or LPNs
that the job fit with their future plans. This is a vital resource since NAs give the majority of direct care to residents. Providing career opportunities (NA to LPN, LPN to RN, RN to BSN) and scholarship assistance are logical activities for administrators who want to retain employees who see long-term care as part of their future.
People Who Enjoy People The average score for all staff on the statement "I enjoy working with people who need my help" was over 4 on the S-point scale. This indicates that even people whose job satisfaction is low enjoy giving care to clients who depend on them. This is reassuring. It could be a major problem if responses to this question were not positive. In marketing long-term care to potential employees, nurse managers need to let them know that car-
How
I RNs
LPNs
ing for clients who need their help is very satisfying and that nursing homes provide that opportunity. RNs in the high-satisfaction group agreed weakly (3.62) and NAs even more weakly (2.52) that "pay is satisfactory in relationship to the work." All other subgroups were neutral, except for the NAs with low job satisfaction who clearly were dissatisfied (2.04) with salary. All staff agreed that their coworkers are pleasant to work with, but they split over whether the supervisor contributes positively to job satisfaction. RNs and LPNs generally agreed, while NAs in the lowsatisfaction group were neutral about the supervisor's contribution to job satisfaction. When employees were asked if they felt they received recognition from coworkers for the work they do, all three high-satisfaction sub-
NURSES AND ASSISTANTS
NAs DcEM,O'(; RAPH res
33
41
3.46 2,54 3,41
3,41
3,61
4.03 3.58
3,55
3.88 3.63
3,18 3,52 4,06
3.24 3.73 4.41
3,85 3.64
4,10 3.85
4,15 3.79 4,39 4.48 4,15
4,24 3.73 4,54
4.63 4,44
138 2,14
1.66 4,37
3,67 3,33 3.25 3,39 4.22 3.78
3.69 4,10
3.79 3,99 4.04
4.17
1. Nursing personnel who responded, 2, Average years worked in current facility. 3. Average years worked in similar facilities. 4. Average days absent from work in the past 12 months.
1. As I evaluate my future in my current job, I feel my level of satisfaction will increase, 2. I am somewhat dissatisfied with my lob. * 3. IfI came into enough money so that I could live comfortably without working, I would quit my job, * 4. I often think of changing jobs. * 5. My job gives me a great deal of personal satisfaction. 6. I am satisfied with my job. 7. Most people who dothe same job as I do are more satisfied with their jobs than I am. * 8, I like my job. 9. I wish I could change jobs. There are too many things about this job I do not like. * 10, Giving care to elderly people is something I enjoy doing. 11. I feel pride in the work I do. 12, I do not like my job. *
On items J3to 21 evaluating factors potentially contributing to job satisfaction, salary (in statement 18) received the lowest score. Even RNs in the high-sotisfaction subgroup rated
86 Geriatric Nursing Mnrch/April lsvl
groups agreed with the statement, and all low-satisfaction groups were neutral. This suggests that people who feel they are recognized for their work are more satisfied with their jobs. The importance of supervisor to subordinate and of peer recognition for work skills is without question. It is worth an administrator's time to recognize quality work, frequently and meaningfully. The concept of pride in one's work was significant in this study. On statement 11, "I feel pride in the work I do," the average score from all groups topped 4. Promoting a strong sense of pride among the dedicated nursing personnel who choose to assume such a demanding assignment as long-term care of the chronically ill should be a priority with administrators. Pride is an area where attention can be placed with expected positive outcomes. Do administrators encour-
age and support nurses in attending professional meetings as well as focused educational programs? Is there ever a time NAs are seen as valued enough to send to a workshop or conference out of the facility? Pride comes from within the individual as well as from the "messages" received from esteemed others.
creasingjob satisfaction can help retain current employees, and satisfied employeesare a major assetin recruiting. An article in the American Nurse reported that 51 percent of nursing homes surveyed averaged three months or longer to recruit a registered nurse (RN), and 54 percent had a "moderate to severe" shortage of nursing personnel(I). Another report predicted that the need for RNs in long-term care facilities will rise by 84 percent(2). Today's priority for managers must be to foster changes that will attract a greater number of qualified nursing personnel on all levels to long-term care as well as retain the invaluable staff resources who are already there.
Solving the Shortage Overall, the responses in this survey suggest that nursing staff in longterm care take pride in their work, enjoy caring for the elderly, and like their jobs. They are neutral about their salaries and positive about their fellow employees and supervisors. The most satisfied respondents missed fewer days at work and planned to stay in long-term care. Many nursing homes are mired in a recruitment and retention crisis. In-
REFERENCES I.Selby, T. Long-lenncare poses challenge for nurses. Am. Nurse 20:26. NOV.-Dec. 1988. 2,_ _. Opportunities in long-term care: RNs see growth, challenges ingeriatric care. Am. Nurse 22:10, Apr. 1990.
RATE JOB SATISFACTION RNs
high:4.07 low: 3.65 high:4.23 low: 3.15 high:4.15 low: 3.15 high:4.69 low: 4.25 high:4.54 low: 3.35 high:3.62 low: 3.30 high:4.15 low: 3.90 high:4.31 low: 3.80 high:4.08 low: 3.40
LPNs NAs
4,29 3.82 4.25 3.41 4,04 3.18 4.75 4.35 4.33 3.76 3.00 3.00 4.13 3.76 4,29 3.76 3.71 3.47
4.14 3.23 4.57 3.12 3.94 2.96 4.72 4.42 4.17 2.92 2.52 2.04 4.00 3.67 4.35 3.38 3.86 3.14
13. In terms of my training and education, this job is a good job for me. 14. Realistically Iknow this job fits well with my future plans. 15. This job is a short-term commitment because of my plans for the future. * 16. Ienjoy working with people who need my help. 17. I plan to be working in a long-term care facility, such asthis one, for several years.
18. My pay is satisfactory in relationship to the work I do. 19. The other employees in this facility are pleasant to work with. 20. My supervisor contributes in a positive way to the level of satisfaction I feel about my job.
21. I receive recognition from other employees for the work I do.
* reverse scored-i.e., responses to negative statement statistically treated to translate disagreement into a satisfaction score their contentment with salary just 3.62, which is only marginally positive on a5-paint satisfaction scale. GeriatricNursing March/Aprill991 87
D
espite the many problems in long-term care-changing regulations, low salaries, high patient acuity, and staff shortages-nursing home personnel are surprisingly happy in their jobs. That was a key finding in our study of staff in six nursing homes, chosen to represent the variety of environments available in rural and urban Utah. Who and What We Studied
A total of 212 staff-33 registered nurses (RNs), 41 licensed practical nurses (LPNs), and 138 nursing asststants (NAs)-completed a 25-item questionnaire. In the first 4 statements, the respondent was asked to state how many days she had been absent in the prior 12 months, how long she had been employed in the current and other similar facilities, and whether she was an RN, an LPN, or an NA. The remaining 21 items were statements that the respondent was asked to score on a scale of 1 to 5, to indicate how strongly she agreed [5] or disagreed [1]. The first 12 statements were designed to measure the level of job satisfaction and the last 9 to identify reasons for job satisfaction and The authors are at Weber State University in Ogden, UT. MARY ANN ANDERSON, RN, MS, is certified in nursing administration and gerontological nursing and is site project coordinator for the W. K. Kellogg-funded project, Community College Nursing Home Partnership, at the School of Allied Health SciencesNursing. TAMARA R. AIRD, RN, BSN, is program administrator in the Division of Continuing Education. W. BRUCE HASLAM, PhD, is professor of psychology.
dissatisfaction. (See "How Nurses and Assistants Rate Job Satisfaction, " on thenextpage.) A statistical method was used to reverse score items that were stated negatively. Thus, when respondents scored a negative statement low, the low score was translated into a highsatisfaction score. For example, the average RN score for "I do not like my job" (item 12) was 1.85, which translates into a satisfaction score of 4,15. A top score of 60-a 5 on each of the 12 measures of job-satisfaction level-reflects complete satisfaction, a score of 12 complete dissatisfaction, and 36 a neutral response. Split-halfreliability tests were used to determine instrument reliability. The split-half reliability for the RN group was 0.85 (corrected by the SpearmanBrown formula), for LPN group 0.82, and for the NA group 0.89. Alllevels-NAs to RNs-were satisfied.They were not strongly satisfied, but the average score for all respondents was 46.82 out of a possible 60. The LPN group scored their job satisfaction the highest, 48.63; next was the NA group, 46.4; and the RN group a close third with 46.33. No group was overwhelmingly satisfied, yet people in each group were at least moderately satisfiedwith their jobs.
group, even though the lowest scores were barely belowneutral and the high scoreswere not dramatically high. LPNs had worked longest in the facility, an average of just over four years; RNs three to four years; and NAs one to two-and-a-half years. NAs in the high-satisfaction subgroup worked one year longer than those in the low-satisfaction group. Among RNs and LPNs, there were no differences in longevity between the highand low-satisfactionsubgroups. There were differences, however, in the absenteeism: Highly satisfied RNs missed 2 days, and LPNs 2.41 days in the past year, while in the low-satisfaction group, RNs missed 4.32 and LPNs missed 5.24 days. Among the NAs-who had higher absenteeism overall-satisfaction did not improve attendance. Those in the high-satisfaction group missed 4.48 days and those in the lowsatisfaction group 4.27 days. Staff in the high-satisfaction groups had no plans to leave their jobs and in fact, on items 9 and 17, indicated their commitment to remain. On the other hand, individuals with low job satisfaction were more inclined to feel neutral about staying. All staff agreed that in terms of their education and training "this is a good job for me." The lowest score was for the NAs in the low-satisfacStaying Power tion group, who were neutral about Based on responses to items 13 to the statement. The responses contra21,each of the three nursinggroupswas dict the long-held idea that nursing dividedin half.The top halfwas called home employment is not considered the high-satisfaction subgroup and the a good job placement. Long-term bottom half the low-satisfaction sub- care recruiters need to point this out
GcrlatrlcNursing March/April1991 85
to health care providers who negatively stereotype long-term care. Administrators and nurse managers need to recognize that even the least satisfied personnel (in this study, NAs) believe they have good jobs. One way to build on this finding would be to enhance the work setting: Offer t1ex-hours for staff to attend school or take care of family matters, provide in-house day-care centers, schedule car pools, and give mental health or personal need days. If employees already feel good about their job, an administration that works to make it even better on a personal level can have a very positive impact on employee retention. Staff in every subgroup agreed that "this job fits well with my future plans" and disagreed that the job was a short-term commitment. Highly satisfied NAs agreed even more than highly satisfied RNs or LPNs
that the job fit with their future plans. This is a vital resource since NAs give the majority of direct care to residents. Providing career opportunities (NA to LPN, LPN to RN, RN to BSN) and scholarship assistance are logical activities for administrators who want to retain employees who see long-term care as part of their future.
People Who Enjoy People The average score for all staff on the statement "I enjoy working with people who need my help" was over 4 on the S-point scale. This indicates that even people whose job satisfaction is low enjoy giving care to clients who depend on them. This is reassuring. It could be a major problem if responses to this question were not positive. In marketing long-term care to potential employees, nurse managers need to let them know that car-
How
I RNs
LPNs
ing for clients who need their help is very satisfying and that nursing homes provide that opportunity. RNs in the high-satisfaction group agreed weakly (3.62) and NAs even more weakly (2.52) that "pay is satisfactory in relationship to the work." All other subgroups were neutral, except for the NAs with low job satisfaction who clearly were dissatisfied (2.04) with salary. All staff agreed that their coworkers are pleasant to work with, but they split over whether the supervisor contributes positively to job satisfaction. RNs and LPNs generally agreed, while NAs in the lowsatisfaction group were neutral about the supervisor's contribution to job satisfaction. When employees were asked if they felt they received recognition from coworkers for the work they do, all three high-satisfaction sub-
NURSES AND ASSISTANTS
NAs DcEM,O'(; RAPH res
33
41
3.46 2,54 3,41
3,41
3,61
4.03 3.58
3,55
3.88 3.63
3,18 3,52 4,06
3.24 3.73 4.41
3,85 3.64
4,10 3.85
4,15 3.79 4,39 4.48 4,15
4,24 3.73 4,54
4.63 4,44
138 2,14
1.66 4,37
3,67 3,33 3.25 3,39 4.22 3.78
3.69 4,10
3.79 3,99 4.04
4.17
1. Nursing personnel who responded, 2, Average years worked in current facility. 3. Average years worked in similar facilities. 4. Average days absent from work in the past 12 months.
1. As I evaluate my future in my current job, I feel my level of satisfaction will increase, 2. I am somewhat dissatisfied with my lob. * 3. IfI came into enough money so that I could live comfortably without working, I would quit my job, * 4. I often think of changing jobs. * 5. My job gives me a great deal of personal satisfaction. 6. I am satisfied with my job. 7. Most people who dothe same job as I do are more satisfied with their jobs than I am. * 8, I like my job. 9. I wish I could change jobs. There are too many things about this job I do not like. * 10, Giving care to elderly people is something I enjoy doing. 11. I feel pride in the work I do. 12, I do not like my job. *
On items J3to 21 evaluating factors potentially contributing to job satisfaction, salary (in statement 18) received the lowest score. Even RNs in the high-sotisfaction subgroup rated
86 Geriatric Nursing Mnrch/April lsvl
groups agreed with the statement, and all low-satisfaction groups were neutral. This suggests that people who feel they are recognized for their work are more satisfied with their jobs. The importance of supervisor to subordinate and of peer recognition for work skills is without question. It is worth an administrator's time to recognize quality work, frequently and meaningfully. The concept of pride in one's work was significant in this study. On statement 11, "I feel pride in the work I do," the average score from all groups topped 4. Promoting a strong sense of pride among the dedicated nursing personnel who choose to assume such a demanding assignment as long-term care of the chronically ill should be a priority with administrators. Pride is an area where attention can be placed with expected positive outcomes. Do administrators encour-
age and support nurses in attending professional meetings as well as focused educational programs? Is there ever a time NAs are seen as valued enough to send to a workshop or conference out of the facility? Pride comes from within the individual as well as from the "messages" received from esteemed others.
creasingjob satisfaction can help retain current employees, and satisfied employeesare a major assetin recruiting. An article in the American Nurse reported that 51 percent of nursing homes surveyed averaged three months or longer to recruit a registered nurse (RN), and 54 percent had a "moderate to severe" shortage of nursing personnel(I). Another report predicted that the need for RNs in long-term care facilities will rise by 84 percent(2). Today's priority for managers must be to foster changes that will attract a greater number of qualified nursing personnel on all levels to long-term care as well as retain the invaluable staff resources who are already there.
Solving the Shortage Overall, the responses in this survey suggest that nursing staff in longterm care take pride in their work, enjoy caring for the elderly, and like their jobs. They are neutral about their salaries and positive about their fellow employees and supervisors. The most satisfied respondents missed fewer days at work and planned to stay in long-term care. Many nursing homes are mired in a recruitment and retention crisis. In-
REFERENCES I.Selby, T. Long-lenncare poses challenge for nurses. Am. Nurse 20:26. NOV.-Dec. 1988. 2,_ _. Opportunities in long-term care: RNs see growth, challenges ingeriatric care. Am. Nurse 22:10, Apr. 1990.
RATE JOB SATISFACTION RNs
high:4.07 low: 3.65 high:4.23 low: 3.15 high:4.15 low: 3.15 high:4.69 low: 4.25 high:4.54 low: 3.35 high:3.62 low: 3.30 high:4.15 low: 3.90 high:4.31 low: 3.80 high:4.08 low: 3.40
LPNs NAs
4,29 3.82 4.25 3.41 4,04 3.18 4.75 4.35 4.33 3.76 3.00 3.00 4.13 3.76 4,29 3.76 3.71 3.47
4.14 3.23 4.57 3.12 3.94 2.96 4.72 4.42 4.17 2.92 2.52 2.04 4.00 3.67 4.35 3.38 3.86 3.14
13. In terms of my training and education, this job is a good job for me. 14. Realistically Iknow this job fits well with my future plans. 15. This job is a short-term commitment because of my plans for the future. * 16. Ienjoy working with people who need my help. 17. I plan to be working in a long-term care facility, such asthis one, for several years.
18. My pay is satisfactory in relationship to the work I do. 19. The other employees in this facility are pleasant to work with. 20. My supervisor contributes in a positive way to the level of satisfaction I feel about my job.
21. I receive recognition from other employees for the work I do.
* reverse scored-i.e., responses to negative statement statistically treated to translate disagreement into a satisfaction score their contentment with salary just 3.62, which is only marginally positive on a5-paint satisfaction scale. GeriatricNursing March/Aprill991 87