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Perceived job satisfaction factors of nursing assistants employed in midwest nursing homes
Perceived
Job Satisfaction Factors of Nursing Assistants Employed in Midwest Nursing Homes by Joyce H. Atchison, PhD, RN
ABSTRACT:. The purpose of this study was to determine the perceptions of nursing assistants employed in Midwest nursing homes in relation to job satisfaction. The study population included 283 nursing assistants employed in 24 nursing homes. An analysis of frequencies using chi square at the .05 level of significance was used to examine the significance of the responses. Study results indicated the nursing assistants were most concerned with the security of their jobs, the potential within their jobs for growth and development, socialization, and challenge in their work. (Geriatr Nurs 1998;19:135-8.)
Geriatric Nursing Volume 19, Number 3
135
he performance of nursing assistants has a major impact on the well-being and behavior of nursing home residents, many of whom display behavioral deficits that could be discouraged by knowledgeable nursing staff. Nursing assistants not only provide 90% of routine physical care, but they also are often the only people available to provide personal and emotional support for the frail elderly. Caring for physically and mentally impaired elders often results in chronic emotional strain to nursing assistants, who frequently are burdened with their own personal problems. This combination of complex factors can result in a caregiver poorly equipped to provide basic physical care to the residents, much less be a sounding board for their psychosocial problems. The consequences of this type of situation are reflected in the high turnover rate of these employees in long-term care facilities, a trend that not only affects financial costs through job retraining but also disrupts continuity of care for vulnerable residents. The impact on the resident as a result of this loss does not appear to be a major consideration for regulatory agencies or providers and thus has not been factored in as a qualityof-care issue. Additionally, if caregivers feel powerless with little control over their personal lives, resisting the temptation to exert undue control over the dependent elderly in their care may be difficult. This behavior often results in the home residents becoming more dependent on the caregivers.
T
METHODS
A two-part questionnaire was used in this study, the first of which was composed of eight questions designed to identify demographic data of the study population. The second part of the questionnaire was taken from the job diagnostic survey designed by Hackman and OldhamJ A time frame was established for conducting the survey at each institution for 2 months: June 9 to August 4, 1995. The survey instrument was administered by the researcher or research assistant to 283 nursing assistants employed in 24 nursing homes in east-central Illinois and west-central Indiana. The summary of demographic data is shown in Table 1. The job diagnostic survey items were ranked by the 283 nursing assistants on a five-point Likert scale. An analysis of frequencies using chi square at the .05 level of significance was used to examine the importance of
Table 1. of Nursing,
124 124
3 Q ~ 4g
34
Gender Fema~
1 to 5 years 100 More than 5 years 73
265 18
Ma~ Marital status
PURPOSE
This study had two main purposes: to look at selected characteristics of nursing assistants employed in Midwest nursing homes and determine the job-related factors important to job satisfaction for these nursing assistants.
254 29
No ,
56
,,,,
132
78
9z 44
113
48
/1:37
48
137
107 92
60
20
Amount of independent thought/action I can exercise
11
25
85
112
49
Chance to help other people while at work
0 2
18 0
75 28
it9 124
61 128
27
73
123
51
136
Geriatric Nursing Volume 19, Number 3
the responses shown in Table 2. RESULTS
The responses of the nursing assistants found to be significant at the .05 level included the job satisfaction factors of personal growth and development (factor 3), job security (factor 11), and job challenge (factor 13). Although not significant at the .05 level, the analysis revealed that fair treatment and respect (factor 5) was rated as either satisfactory or extremely satisfactory by 180 assistants (63.6%). DISCUSSION
Because these front-line health workers are so essential to the quality of care given to the frail, institutionalized elderly, selecting and screening potential employees is important. One approach might be to use job fairs to encourage candidates with an interest in working with the elderly. Caudill and Patrick 2 recommend targeting specific applicants, such as a 35-yearold woman who is a high school graduate. Another recruitment method could be using a screening tool to assess and identify the potential employee's motivational factors. Creating new job opportunities with the chance for upward mobility could be an incentive for this type of health care worker. Offering tuition reimbursement after a designated period of employment also would be a powerful motivating factor to assist employees in achieving their goal of advancement up the career ladder in the health care arena. Nursing home administrators and directors could be provided with the opportunity to fine-tune their management and motivational skills, which are important job satisfaction factors. A pre- and posttest statistical approach might be used to analyze administrators' abilities before and after an abbreviated skills course. Comparison studies could be conducted to determine how the nursing home administrator's perception of the importance of the job satisfaction factors used in this study differ from the nursing assistants'. CONCLUSION
In summary, periodic in-services are important to help nursing assistants already employed in a long-term setting to reduce stress on the job and in their own homes. Support groups should be a significant part of ongoing employee relations. The unique problems of many institutionalized elders lend themselves to discussion groups and the sharing of possible solutions to
Geriatric Nursing Volume 19, Number 3
these problems. Nursing assistant salaries emerged as a critical issue in this study and must be analyzed in light of the intense task-oriented work expected of them, most of which rarely is ever observed. Because their job provided the only source of income for almost 80% of the participants, their incomes were close to the poverty level. In institutions at which wages and benefits are best, turnover was much lower. Because socialization emerged as a very important factor for most nursing assistants in the study, perhaps it could be assumed that their socialization at work provides a major portion of their social lives. This area could be enhanced if management provided more social opportunities within the groups and their families or some special activities that included residents and their families as well. E v e r y o n e - - w h e t h e r educators, administrators, caregivers, or average citizens--should be concerned with what goes on in the nation's nursing homes. Some interest must be taken in the quality of life for nursing assistants if the care provided to the elderly is truly a concern. As much as possible must be done to ensure a safe, comfortable, caring environment for the aides who serve the most vulnerable segment of society. Someday we may be part of that vulnerable segment. What kind of care do we want to receive? REFERENCES 1. Hackman R, Oldham G. Development of the job diagnostic survey. J Appl Psychol 1975;60:159-70. 2. Caudill M, Patrick M. Turnover among nursing assistants: why they leave and why they stay. J Long-Term Care Administration 1991-92;19:29-32. BIBLIOGRAPHY Chappell N, Novak M. The role of support in alleviating stress among nursing assistants. Gerontologist 1992;32:351-9. Genevay B. Roses and onions: the fruits of helping old and dying people. Generations 1994;18:13-15. Heiselman T, Noelker L. Enhancing mutual respect among nursing assistants, residents, and residents' families. Gerontologist 1991;31:552-5. Monahan R, McCarthy S. Nursing home employment: the nurse's aide's perspective. J Gerontological Nursing 1992;18:13-6. Sheridan J, White J, Fairchild T. Ineffective staff, ineffective supervision, or ineffective administration? Why some nursing homes fail to provide adequate care. Gerontologist 1992;32:334-41. Smyer M, Brannon D, Cohn M. Improving nursing home care through training and job redesign. Gerontologist 1992;32:327-33. Wilner M. Working it out: support groups for nursing assistants. Generations 1994;18:41-2.
JOYCE H. ATCHISON, PhD, RN, is the vice president and dean of the Lakeview College of Nursing in Danville, III. Copyright © 1998 by Mosby, Inc. 0197-4572/98/$5.00 + 0
34/1/90809
137
1. What were the nursing assistants more concerned with in this study? a. Job security b. Fair treatment c. Recognition d. Supervision 2. Which assumption was made about nursing assistants and socialization? a. They usually are younger and need peer support. b. Their work provided a major portion of their social life. c. Conditions determine happiness. d.They have a need for independence. 3. What were the demographics for this study population? a. Most assistants were married women employed more than 5 years. b. Most assistants were women, this job was their only source of income, and they worked more than 35 hours per week. c. The assistants were employed more than 5 years, were certified, and most were men. d. Most assistants were men, age 30 to 50 years, with single-income families. 4. The respondents were most satisfied with: a. A chance to help others at work b. The degree of fair payment c. Respect and fair treatment d. A feeling that their jobs were worthwhile 5. The greatest dissatisfaction was with: a. Fair p a y m e n t b. A chance to help others c. Challenges d. Supervision
138
. The author focused on nursing assistants' job satisfaction for the following reason: a. Nursing assistants are untrained and need to be watched. b. Nursing assistants provide 90% of the care and are with patients the most. c. Nursing assistants are emotionally unstable. d. Little turnover occurs among this group. . Suggested selection and screening processes for potential employees mentioned in this article included the following EXCEPT: a. Job fairs b. P r e e m p l o y m e n t screening tools c. Tuition reimbursement d. Patient interview . Suggestions for nursing h o m e administrators and directors included all of the following EXCEPT: a. A team approach to goal setting b. I m p r o v e d m a n a g e m e n t skills c. I m p r o v e d motivational skills d. Comparison between nursing h o m e administrators and nursing assistants 9. Suggestions to m a n a g e m e n t about nursing assistants need to include all of the following EXCEPT: a. Salary readjustment b. Social opportunities c. Support groups d.Increased responsibility and autonomy 10. The author concludes that an emphasis should be placed on: a. Recognizing the problem that nursing assistants may be causing m o r e dependent behaviors in the elderly patients b. Increasing the quality of life for the nursing assistants c. Increasing the quality of life for the elderly patients d. Identifying nursing assistants who are most vulnerable in this work environment
Geriatric Nursing Volume 19, Number 3
Job Satisfaction Factors of Nursing Assistants Employed in Midwest Nursing Homes by Joyce H. Atchison, PhD, RN
ABSTRACT:. The purpose of this study was to determine the perceptions of nursing assistants employed in Midwest nursing homes in relation to job satisfaction. The study population included 283 nursing assistants employed in 24 nursing homes. An analysis of frequencies using chi square at the .05 level of significance was used to examine the significance of the responses. Study results indicated the nursing assistants were most concerned with the security of their jobs, the potential within their jobs for growth and development, socialization, and challenge in their work. (Geriatr Nurs 1998;19:135-8.)
Geriatric Nursing Volume 19, Number 3
135
he performance of nursing assistants has a major impact on the well-being and behavior of nursing home residents, many of whom display behavioral deficits that could be discouraged by knowledgeable nursing staff. Nursing assistants not only provide 90% of routine physical care, but they also are often the only people available to provide personal and emotional support for the frail elderly. Caring for physically and mentally impaired elders often results in chronic emotional strain to nursing assistants, who frequently are burdened with their own personal problems. This combination of complex factors can result in a caregiver poorly equipped to provide basic physical care to the residents, much less be a sounding board for their psychosocial problems. The consequences of this type of situation are reflected in the high turnover rate of these employees in long-term care facilities, a trend that not only affects financial costs through job retraining but also disrupts continuity of care for vulnerable residents. The impact on the resident as a result of this loss does not appear to be a major consideration for regulatory agencies or providers and thus has not been factored in as a qualityof-care issue. Additionally, if caregivers feel powerless with little control over their personal lives, resisting the temptation to exert undue control over the dependent elderly in their care may be difficult. This behavior often results in the home residents becoming more dependent on the caregivers.
T
METHODS
A two-part questionnaire was used in this study, the first of which was composed of eight questions designed to identify demographic data of the study population. The second part of the questionnaire was taken from the job diagnostic survey designed by Hackman and OldhamJ A time frame was established for conducting the survey at each institution for 2 months: June 9 to August 4, 1995. The survey instrument was administered by the researcher or research assistant to 283 nursing assistants employed in 24 nursing homes in east-central Illinois and west-central Indiana. The summary of demographic data is shown in Table 1. The job diagnostic survey items were ranked by the 283 nursing assistants on a five-point Likert scale. An analysis of frequencies using chi square at the .05 level of significance was used to examine the importance of
Table 1. of Nursing,
124 124
3 Q ~ 4g
34
Gender Fema~
1 to 5 years 100 More than 5 years 73
265 18
Ma~ Marital status
PURPOSE
This study had two main purposes: to look at selected characteristics of nursing assistants employed in Midwest nursing homes and determine the job-related factors important to job satisfaction for these nursing assistants.
254 29
No ,
56
,,,,
132
78
9z 44
113
48
/1:37
48
137
107 92
60
20
Amount of independent thought/action I can exercise
11
25
85
112
49
Chance to help other people while at work
0 2
18 0
75 28
it9 124
61 128
27
73
123
51
136
Geriatric Nursing Volume 19, Number 3
the responses shown in Table 2. RESULTS
The responses of the nursing assistants found to be significant at the .05 level included the job satisfaction factors of personal growth and development (factor 3), job security (factor 11), and job challenge (factor 13). Although not significant at the .05 level, the analysis revealed that fair treatment and respect (factor 5) was rated as either satisfactory or extremely satisfactory by 180 assistants (63.6%). DISCUSSION
Because these front-line health workers are so essential to the quality of care given to the frail, institutionalized elderly, selecting and screening potential employees is important. One approach might be to use job fairs to encourage candidates with an interest in working with the elderly. Caudill and Patrick 2 recommend targeting specific applicants, such as a 35-yearold woman who is a high school graduate. Another recruitment method could be using a screening tool to assess and identify the potential employee's motivational factors. Creating new job opportunities with the chance for upward mobility could be an incentive for this type of health care worker. Offering tuition reimbursement after a designated period of employment also would be a powerful motivating factor to assist employees in achieving their goal of advancement up the career ladder in the health care arena. Nursing home administrators and directors could be provided with the opportunity to fine-tune their management and motivational skills, which are important job satisfaction factors. A pre- and posttest statistical approach might be used to analyze administrators' abilities before and after an abbreviated skills course. Comparison studies could be conducted to determine how the nursing home administrator's perception of the importance of the job satisfaction factors used in this study differ from the nursing assistants'. CONCLUSION
In summary, periodic in-services are important to help nursing assistants already employed in a long-term setting to reduce stress on the job and in their own homes. Support groups should be a significant part of ongoing employee relations. The unique problems of many institutionalized elders lend themselves to discussion groups and the sharing of possible solutions to
Geriatric Nursing Volume 19, Number 3
these problems. Nursing assistant salaries emerged as a critical issue in this study and must be analyzed in light of the intense task-oriented work expected of them, most of which rarely is ever observed. Because their job provided the only source of income for almost 80% of the participants, their incomes were close to the poverty level. In institutions at which wages and benefits are best, turnover was much lower. Because socialization emerged as a very important factor for most nursing assistants in the study, perhaps it could be assumed that their socialization at work provides a major portion of their social lives. This area could be enhanced if management provided more social opportunities within the groups and their families or some special activities that included residents and their families as well. E v e r y o n e - - w h e t h e r educators, administrators, caregivers, or average citizens--should be concerned with what goes on in the nation's nursing homes. Some interest must be taken in the quality of life for nursing assistants if the care provided to the elderly is truly a concern. As much as possible must be done to ensure a safe, comfortable, caring environment for the aides who serve the most vulnerable segment of society. Someday we may be part of that vulnerable segment. What kind of care do we want to receive? REFERENCES 1. Hackman R, Oldham G. Development of the job diagnostic survey. J Appl Psychol 1975;60:159-70. 2. Caudill M, Patrick M. Turnover among nursing assistants: why they leave and why they stay. J Long-Term Care Administration 1991-92;19:29-32. BIBLIOGRAPHY Chappell N, Novak M. The role of support in alleviating stress among nursing assistants. Gerontologist 1992;32:351-9. Genevay B. Roses and onions: the fruits of helping old and dying people. Generations 1994;18:13-15. Heiselman T, Noelker L. Enhancing mutual respect among nursing assistants, residents, and residents' families. Gerontologist 1991;31:552-5. Monahan R, McCarthy S. Nursing home employment: the nurse's aide's perspective. J Gerontological Nursing 1992;18:13-6. Sheridan J, White J, Fairchild T. Ineffective staff, ineffective supervision, or ineffective administration? Why some nursing homes fail to provide adequate care. Gerontologist 1992;32:334-41. Smyer M, Brannon D, Cohn M. Improving nursing home care through training and job redesign. Gerontologist 1992;32:327-33. Wilner M. Working it out: support groups for nursing assistants. Generations 1994;18:41-2.
JOYCE H. ATCHISON, PhD, RN, is the vice president and dean of the Lakeview College of Nursing in Danville, III. Copyright © 1998 by Mosby, Inc. 0197-4572/98/$5.00 + 0
34/1/90809
137
1. What were the nursing assistants more concerned with in this study? a. Job security b. Fair treatment c. Recognition d. Supervision 2. Which assumption was made about nursing assistants and socialization? a. They usually are younger and need peer support. b. Their work provided a major portion of their social life. c. Conditions determine happiness. d.They have a need for independence. 3. What were the demographics for this study population? a. Most assistants were married women employed more than 5 years. b. Most assistants were women, this job was their only source of income, and they worked more than 35 hours per week. c. The assistants were employed more than 5 years, were certified, and most were men. d. Most assistants were men, age 30 to 50 years, with single-income families. 4. The respondents were most satisfied with: a. A chance to help others at work b. The degree of fair payment c. Respect and fair treatment d. A feeling that their jobs were worthwhile 5. The greatest dissatisfaction was with: a. Fair p a y m e n t b. A chance to help others c. Challenges d. Supervision
138
. The author focused on nursing assistants' job satisfaction for the following reason: a. Nursing assistants are untrained and need to be watched. b. Nursing assistants provide 90% of the care and are with patients the most. c. Nursing assistants are emotionally unstable. d. Little turnover occurs among this group. . Suggested selection and screening processes for potential employees mentioned in this article included the following EXCEPT: a. Job fairs b. P r e e m p l o y m e n t screening tools c. Tuition reimbursement d. Patient interview . Suggestions for nursing h o m e administrators and directors included all of the following EXCEPT: a. A team approach to goal setting b. I m p r o v e d m a n a g e m e n t skills c. I m p r o v e d motivational skills d. Comparison between nursing h o m e administrators and nursing assistants 9. Suggestions to m a n a g e m e n t about nursing assistants need to include all of the following EXCEPT: a. Salary readjustment b. Social opportunities c. Support groups d.Increased responsibility and autonomy 10. The author concludes that an emphasis should be placed on: a. Recognizing the problem that nursing assistants may be causing m o r e dependent behaviors in the elderly patients b. Increasing the quality of life for the nursing assistants c. Increasing the quality of life for the elderly patients d. Identifying nursing assistants who are most vulnerable in this work environment
Geriatric Nursing Volume 19, Number 3