The availability of nursing staff is an increasingly important issue in the long-term care sector, and staffing issues such as morale and turnover are thought to have a direct bearing on the quality of the resident experience. This study examines the relationship between individual characteristics, work demands, work resources, and conflict resolution styles on the one hand, and nursing staff outcomes such as morale, burnout, and job satisfaction on the other. Morale and job satisfaction were found to depend more on variables that can be controlled by managers - such as shift scheduling and allocation, conflict resolution training, and ensuring adequate resources - than on individual characteristics that are beyond managers' control. The results indicate potential for improving the workplace experience of nursing home staff, and thus improving the human resources issues that confront the sector.

Background: Much has been written on the satisfaction of residents and family members with the care received in nursing homes. In contrast, little research has been done on the satisfaction of nursing staff and related outcomes such as morale, burnout, and stress. Yet there is an important link between the satisfaction of care recipients and that of caregivers, and both need to be well understood in order to improve outcomes. The availability of nursing staff is an increasingly important issue in the long-term care sector, and staffing issues such as morale and turnover are thought to have a direct bearing on the quality of the resident experience. This study examines the relationship between individual characteristics, work demands, work resources, and conflict resolution styles on the one hand, and nursing staff outcomes such as morale, burnout, and job satisfaction on the other.

Methods: A sample of 117 nursing staff professionals at three nursing homes in the Cleveland, Ohio area and 44 professionals at two homes in the Vancouver area completed a self-administered questionnaire. The questionnaire assessed items in the following areas: individual characteristics, including age, gender, education, length of time working in facility, and personal views about nursing home residents; conflict resolution styles, broken down into cooperative, confrontational, or avoidance; work demands, including average number of residents assigned per shift, the number of care-intensive individuals per shift, and observed past conflict among staff and residents; work resources, including frequency of care planning team meetings, average number of in-service training hours, and level of facility care resources; and outcomes, including morale, burnout, and job satisfaction. The relationship between outcomes and the other four variable areas was then examined.

Findings: Staff morale and burnout were significantly affected by all aspects of work demand. The number of assigned residents per shift, frequency of shift rotation and frequency of change in assigned residents each reduced morale and reduced the degree to which respondents considered their work a positive experience. The number of care-intensive residents assigned to nursing staff, however, had the reverse effect and was positively associated with overall morale and the assessment of work as a positive experience. With respect to job satisfaction, only one component of work demand had an influence: frequency of shift rotation, in a negative direction. Resources available on the job and conflict resolution styles had a more significant effect on job satisfaction. In particular, the adequacy of facility supplies and frequency of team care planning meetings were associated with improved satisfaction, as was a preference for a cooperative style of conflict resolution. Adequacy of facility supplies was positively associated with all aspects of job satisfaction and morale and negatively associated with all aspects of burnout. Morale was weak among staff preferring confrontational or avoidance styles of conflict resolution. Individual characteristics in general had very little effect on the outcome variables.

Conclusions: The results of this study indicate significant potential for policy makers and nursing home administrators to improve morale among staff, and indirectly improve the overall care experience of nursing home residents. Morale and job satisfaction were shown to depend more on variables that can be controlled by managers - such as shift scheduling and allocation and adequate resources - than on individual characteristics that are beyond managers' control. The preferred style of conflict resolution, while to some extent an individual characteristic, is also a product of workplace culture, and can be influenced through training and teambuilding exercises. The self-selection of respondents to this study suggests some caution in applying the results to the larger nursing staff population. Nevertheless, results indicate potential for improving the workplace experience of nursing home staff, and thus improving the human resources issues that confront the long-term care sector.

Reference: Montoro-Rodriguez, J, Small, JA. "The Role of Conflict Resolution Styles on Nursing Staff Morale, Burnout, and Job Satisfaction in Long-Term Care." Journal of Aging and Health, 2006; 18(3) 385-406.

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