Home and Community Care Digest

Home and Community Care Digest 5(4) December 2006 : 0-0

Nurses need more contact with long-term care residents for improved job satisfaction


This study explores the effect of job design on nursing and certified nursing assistant (CNA) employee satisfaction in long-term care (LTC) facilities. Quantitative and qualitative methods were used to determine which characteristics of nursing jobs contribute most to job satisfaction. Findings suggest that the factors contributing to satisfaction differ between nurses and CNAs (indicating different retention strategies are needed), and that CNAs report higher levels of overall job satisfaction. Isolation among nurses was a key contributor to dissatisfaction, suggesting that changes in job design to increase nurses' time with residents and staff may improve nurse satisfaction.
Background: Retaining nurses in long-term care (LTC) facilities has been a consistent challenge with some facilities reporting annual turnover rates exceeding 100 percent. While previous studies have shown macro-level (e.g., profit status) and micro-level (e.g., employee characteristics) factors that affect nursing employee job satisfaction, less is known about the impact of mid-level organizational factors - which tend to be more under the control of facility managers - on job satisfaction. Job design (defined below) is a key mid-level factor that has been suggested to affect both employee satisfaction and care quality. This study explores the effect of job design on nursing and certified nursing assistant (CNA) employee satisfaction in LTC facilities.

Methods: A sample of 20 LTC facilities of varying sizes, profit status and locations (i.e., proximity to an urban centre) in eastern Massachusetts participated in the study. Job design and satisfaction were assessed using the Job Diagnostic Survey, which uses a 7-point scale to measure five core job characteristics: skill variety, task identity (e.g., completion of task from beginning to end with an identifiable outcome), task significance (e.g., impact on lives of other individuals), autonomy, and workplace feedback received while carrying out work duties. Data on job design were collected through interviews, 25-30 minutes in length, with managers at each facility and through job surveys of the staff at each facility. Staff were also observed, typically for 3 to 5 hours, followed by interviews with nurse and CNA participants to obtain more detailed information about job design. Following data collection, a detailed analysis was conducted to highlight characteristics of nursing jobs that contribute most to employee satisfaction.

Findings: Facilities ranged in size from 75-200 beds, and varied in profit status: 11 were for-profit, 9 were not-for-profit. Job surveys were collected from 1146 employees; 144 employees were interviewed; and 37 observations of nurses and CNAs were conducted. Differences between nurses and CNAs on all five job characteristics, and on overall satisfaction, were found. While nurses reported higher levels of skill variety and task significance, CNAs reported higher levels of workplace feedback and greater satisfaction with their work. Analysis revealed that the factors explaining job satisfaction differed between nurses and CNAs. While job satisfaction among CNAs was influenced by multiple factors, nurse satisfaction was affected only by workplace feedback. Interviews and observations revealed two key findings: 1) feelings of isolation contributed substantially to job dissatisfaction among nurses, who commented on a lack of interaction with residents and other employees; and 2) workplace feedback in the LTC setting results most often from interaction with residents.

Conclusions: The finding of lower job satisfaction among nurses relative to CNAs is surprising insofar as job design theory predicts that jobs involving higher autonomy, task significance and skill variety (all true for nursing jobs compared to CNA jobs) result in greater satisfaction. Given that nursing satisfaction was only influenced by workplace feedback, and drawing on the results from the interviews, one improvement might be to alter job design in order to increase nurses' interaction time with residents and staff. This would likely decrease feelings of isolation and increase opportunities for workplace feedback, potentially leading to greater satisfaction (and better retention). The authors suggest that alternative models of care, such as primary care models where nurses are permanently assigned to certain residents (thus providing an opportunity for relationship building and interaction with residents), should be explored.

Reference: Tyler DA, Parker VA, Engle RL, Brandeis GH, Hickey EC, Rosen AK, Wang F, Berlowitz DR. "An exploration of job design in long-term care facilities and its effect on nursing employee satisfaction." Health Care Management Review, 2006; 31(2), 137-144.


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