Journal of Gerontological Nursing

Feature Article 

CNA Empowerment: Effects on Job Performance and Work Attitudes

Cynthia M. Cready, PhD; Dale E. Yeatts, PhD; Melissa M. Gosdin, MA; Helen F. Potts, PhD

Abstract

In this analysis, the effects of empowerment were examined among a sample of certified nursing assistants (CNAs) representing a wide range of empowerment levels. On the basis of survey responses from 298 CNAs and 136 nurses in five nursing homes where CNA-empowered work teams had been implemented and five nursing homes with more traditional management approaches, the results indicated that CNA empowerment had a variety of effects. CNAs with high empowerment and the nurses who worked with them tended to report better CNA performance and work-related attitudes. Both were also less likely to be thinking about leaving their jobs. With the help of lessons learned from new culture change initiatives, and with commitment, effort, and attention, nursing homes and other health care providers can reap the benefits associated with employee empower-ment strategies, such as CNA-empowered work teams.

Abstract

In this analysis, the effects of empowerment were examined among a sample of certified nursing assistants (CNAs) representing a wide range of empowerment levels. On the basis of survey responses from 298 CNAs and 136 nurses in five nursing homes where CNA-empowered work teams had been implemented and five nursing homes with more traditional management approaches, the results indicated that CNA empowerment had a variety of effects. CNAs with high empowerment and the nurses who worked with them tended to report better CNA performance and work-related attitudes. Both were also less likely to be thinking about leaving their jobs. With the help of lessons learned from new culture change initiatives, and with commitment, effort, and attention, nursing homes and other health care providers can reap the benefits associated with employee empower-ment strategies, such as CNA-empowered work teams.

Dr. Cready is Assistant Professor, Dr. Yeatts is Professor and Chair, and Ms. Gosdin is Teaching Fellow, University of North Texas, Department of Sociology, Denton, Texas; and Dr. Potts is Lecturer, University of North Texas Dallas Campus, Sociology, Dallas, Texas.

This research was supported by The Commonwealth Fund. The views presented in this article are those of the authors and not necessarily those of The Commonwealth Fund, its directors, officers, or staff. The authors thank C.C. Young; Christian Care Centers, Inc.; Evangelical Lutheran Good Samaritan Society; Mariner Health Care; Nexion Health, Inc.; and Pacific Retirement Services, Inc. for participating in this adventure. They also thank those who participated in an advisory group that helped direct the research, including Dr. Barbara Bowers, Dr. Susan Cohen, Dr. Susan Eaton, Dr. Linda Noelker, and Dr. Robyn Stone.

Address correspondence to Cynthia M. Cready, PhD, Assistant Professor, University of North Texas, Department of Sociology, PO Box 311157, Denton, TX 76203-1157; e-mail: cready@unt.edu.

Many providers of nursing home care are shifting their focus from a medical model of care to a person-centered model. This change in focus is the result of a desire among nursing home managers to make their nursing homes more attractive, enjoyable, and beneficial places to live (Kane, 2001; Kane et al., 1997). To achieve this new focus, a variety of initiatives are being used to change the culture of nursing homes. Among these are the Eden Alternative® (Thomas, 1994), the Green House® Project (The Green House®Concept, n.d.), the LEAP: Learn, Empower, Achieve, Produce training program (Hollinger-Smith, 2003), the Wellspring Model (Fagan, 2003), and others (Gilster, Accorinti, & Dalessandro, 2002; Pillemer, Suitor, & Wethington, 2003; Shields, 2004). Most of these include, in part, the empowerment of certified nursing assistants (CNAs). Because CNAs provide the overwhelming majority of the one-on-one, day-to-day care of nursing home residents (Institute of Medicine, 1986), their empowerment is considered by many in the culture change movement to be key to affecting such change (Barba, Tesh, & Courts, 2002; Beck, Ortigara, Mercer, & Shue, 1999; Eaton, 2000).

However, although most of these new culture change efforts emphasize the importance of empowering CNAs, little empirical research has examined the job performance and attitudes associated with their empowerment. This analysis addressed this gap by using data from 10 nursing homes located in North Central Texas. Specifically, in this analysis, the job performance and attitudes of highly empowered CNAs were compared with those of less empowered CNAs. The perceptions, performance, and attitudes of the nurses with whom the CNAs worked were also examined. In addition, comparisons were made among CNAs representing a wide range of empowerment levels, as approximately half of the CNAs and nurses worked in nursing homes with CNA-empowered work teams, and the other half worked in nursing homes with more traditional, management approaches.

Employee Empowerment and Its Effects

The idea of empowering workers for the purpose of improving their job performance and attitudes is not new. In fact, as early as the 1980s in the manufacturing industry, employee empowerment motivated the adoption of “quality circles,” in which laborers were asked by managers to share opinions on how to improve the work process (Lawler, 1986). These quality circles soon evolved into “empowered work teams” (also known as self-directed work teams, self-managed work teams, and autonomous work groups), which promised to take fuller advantage of what laborers had to offer (Wellins, Byham, & Dixon, 1994; Yeatts & Hyten, 1998).

No longer a novelty in the work-place, empowered work teams consist of employees with similar job titles and responsibilities. Team members typically make decisions about some aspects of their jobs and recommendations about others. However, employee empowerment is more than having autonomy in decision making; it is also perceiving one’s work as having important effects and meaning and feeling competent to do it (Ford & Fottler, 1995; Kirkman & Rosen, 1999; Spreitzer, 1995; Thomas & Velthouse, 1990). Team participation is expected to empower employees in each of these dimensions and have other beneficial effects.

Studies of empowered work teams in the manufacturing industry have found a variety of such beneficial effects, including better performance, higher job satisfaction, and less turnover (Kirkman & Rosen, 1999; Lawler, 1986; Pasmore, Francis, Haldeman, & Shani, 1982; Wellins et al., 1994; Yeatts & Hyten, 1998). In addition, studies have observed that the decisions of team members can be more ingenious than those of managers, as team members tend to be more intimately familiar with the work process (Hitchcock & Willard, 1995). Nevertheless, studies have also shown that the effects of empowered work teams depend on how well they are implemented. Indeed, where teams are poorly implemented (e.g., inadequately supported by management), performance may occasionally worsen and turnover may actually increase (Lawler, 1986; Yeatts & Hyten, 1998).

The few studies of empowered work teams in health care settings, primarily hospitals (e.g., Becker-Reems, 1994), have reported similar findings. Only recently have empowered work teams been implemented in the nursing home industry (Robinson & Rosher, 2006; Yeatts & Seward, 2000). Yeatts, Cready, and colleagues have described the implementation of 21 such teams among CNAs in five nursing homes and examined their effects (Yeatts & Cready, 2007; Yeatts, Cready, & Noelker, in press; Yeatts, Cready, Ray, DeWitt, & Queen, 2004). As in other environments, members of the empowered work teams in the five nursing homes all had the same job; that is, all were CNAs. The CNA teams in a nursing home tended to be organized by shift and service area. Thus, the largest nursing home in the study had approximately 200 residents and 7 teams, and the smallest had approximately 50 residents and 2 teams.

Each CNA-empowered work team held a scheduled “sit-down” meeting once per week for approximately 30 minutes, as well as impromptu “stand-up” meetings lasting approximately 5 minutes, as needed, during the week. The scheduled weekly meetings typically followed a set agenda and included discussions of work procedures, reviews of and recommendations for resident health conditions, and consideration of other work-related issues. In some cases, issues to be addressed were identified by nursing management, and in others, by the team members themselves (Yeatts et al., 2004). For example, in one nursing home, a family member complained and one of its teams was subsequently asked by nursing management to recommend a solution to avoid future complaints. In another instance, a CNA was concerned that a particular resident seemed agitated and used the team meeting as an opportunity to seek advice on how to help the resident. Each week, the team provided written notes from its scheduled weekly meeting, including any CNA suggestions, recommendations, and concerns, to nursing management. Members of nursing management, in turn, reviewed the team’s notes and provided written feedback. Impromptu stand-up team meetings were used to discuss issues of immediate concern, such as when a CNA became ill and decisions had to be made about how to distribute his or her work responsibilities until another CNA could be called in.

More than 270 of the scheduled weekly meetings of the CNA work teams were observed, and the minutes from these meetings were examined, as well as corresponding written responses from the members of nursing management (Yeatts & Cready, 2007). In addition, the CNAs, nurses, and family members of residents in the five nursing homes were surveyed before the teams were established (Time 1) and again approximately 16 months after their implementation (Time 2). Survey responses from the five “experimental” or “team” nursing homes were compared with those of CNAs, nurses, and family members of residents in the five comparison nursing homes in which CNA work teams were not implemented.

Analysis of both qualitative/observation data and quantitative/survey data revealed that the CNA work teams had positive effects (Yeatts & Cready, 2007; Yeatts et al., in press). Most significantly, they increased CNA empowerment. For example, according to the survey data, both the CNAs and the nurses in the experimental nursing homes perceived more CNA empowerment and its dimensions of autonomy, impact/meaningfulness, and competence at Time 2 than at Time 1, whereas the CNAs and nurses in the comparison nursing homes did not perceive any change in CNA empowerment. Other beneficial effects of the CNA-empowered work teams included better resident care; enhanced CNA performance; improved CNA procedures, coordination, and cooperation with nurses; higher resident empowerment; and some evidence of reduced CNA turnover.

The teams appeared to have somewhat mixed effects on job attitudes (Yeatts & Cready, 2007). On the positive side, analysis of the observation data indicated the CNAs in empowered work teams were often able to realize their work preferences. In addition, many of the CNAs appeared to appreciate the nurses’ listening to and sometimes implementing their team’s suggestions. On the negative side, some CNAs were worried that the weekly 30-minute team meeting kept them from completing their work. Some CNAs had difficulty attending a meeting when it was scheduled before or after their regular shift, and others expressed frustration when a team member repeatedly brought up an issue or personal problem or when, on occasion, members of nursing management failed to read and respond to the team’s notes.

Thus, on the one hand, given these opposing effects of the teams, it is not surprising that the survey data showed no differences between Time 1 and Time 2 for either the experimental or comparison nursing homes with regard to a number of work-related attitudes, including general job satisfaction. In addition, it is reasonable to suspect that the relatively modest increase in CNA empowerment, found between Time 1 and Time 2, was not sufficient to improve work-related attitudes. On the other hand, it seems somewhat premature to conclude that CNA empowerment per se does not have an effect on the work-related attitudes of CNAs and nurses in nursing homes. Further examination is needed.

Therefore, the purpose of this analysis was to examine the relationship between self-perceived CNA empowerment and work-related attitudes, as well as its relationship with CNAs’ views of their job performance. In addition, the analysis examined the relationships between nurse perceptions of CNA empowerment and job performance and work attitudes. On the basis of previous studies in manufacturing settings, higher empowerment among CNAs in nursing homes should be associated with higher levels of performance, better work attitudes, lower absenteeism, and less turnover among both CNAs and nurses (Kirkman & Rosen, 1999; Lawler, 1986; Pasmore et al., 1982; Wellins et al., 1994; Yeatts & Hyten, 1998).

Method

Sample and Data Collection

Data for this analysis were obtained from the Time 2 self-administered questionnaires of CNAs and nurses in the larger study conducted by Yeatts and Cready (2007), described briefly above and in detail elsewhere. These questionnaires typically were distributed and collected by the research team at an all-staff meeting. Absentees were later contacted by a member of the research team and invited to participate. Response rates were 78% for CNAs and 71% for nurses. Samples for the analysis were 298 CNAs and 136 nurses.

The questionnaires primarily contained statements to which CNAs and nurses indicated their agreement using a 5-point, Likert-type scale ranging from strongly disagree (1) to strongly agree (5). When available, the statements were taken from previous studies (see Yeatts & Cready, 2007, for details). Statements were sometimes modified to reflect the uniqueness of the nursing home environment (e.g., changing “recipients” to “residents” in burnout items [Maslach, Jackson, & Leiter, 1996]). A pretest at a nursing home not included in the study was used to assist with developing reliable statements not taken from previous studies.

Data Analysis

The majority of concepts in this analysis were based on multiple survey items. For example, one of the independent variables (CNAs’ perceptions of their global empowerment) is represented by an index constructed from 19 items, including those measuring its dimensions of autonomy (e.g., “I sometimes provide solutions to problems at work that are used.”), competence (e.g., “I am given regular updated information on any changes that have occurred with the residents.”), and impact/meaningfulness (e.g., “The charge nurses listen to the suggestions of CNAs.”).

The other independent variable (nurses’ perceptions of CNA global empowerment) is also represented by an index composed of a smaller, although similar set of items. Each of the indexes was constructed by taking the average of its items’ responses, thus keeping scores on the index in the original response range of its items (1 to 5), with higher scores indicating higher empowerment. Cronbach’s alpha coefficients were 0.84 for the CNA index and 0.85 for the nurse index. These figures are well over the usually recommended cutoff of 0.70.

To examine differences between high, medium, and low CNA empowerment, CNAs with the highest scores on the CNA index (scores at the 75th percentile value or higher) were placed in one group, those with the lowest scores (scores at the 25th percentile value or lower) were placed in a second group, and the remaining CNAs were placed in a third, middle group. The highest empowerment group was subsequently compared with each of the other groups with regard to demographic characteristics, perceived job performance, work attitudes, self-reported absenteeism, and intent to quit. All of the CNA variables except absenteeism were indexes and were constructed in the same manner as the empowerment indexes, with higher scores indicating more of the characteristic. Cronbach’s alpha coefficients typically were greater than 0.70, with the lowest being 0.55 (for the CNA Time for Care index).

Similar procedures were used to examine differences between high, medium, and low CNA empowerment from the nurses’ perspective. Using the nurse index of CNA empowerment, nurses were placed into three groups on the basis of how empowered they perceived the CNAs they worked with to be. As for the CNAs, nurses in the highest group (scores at the 75th percentile value or greater) were compared with each of the other groups. Like the CNAs, the nurses were compared on their perceptions of CNA job performance in the nursing home. The nurses were also compared on their perceptions of their own job performance, satisfaction, absenteeism, and intent to quit. Like the CNA variables, all of the nurse variables except absenteeism were indexes and were constructed in the same manner as the empowerment indexes. Cronbach’s alpha coefficients were greater than 0.70 for all of the nurse indexes except one (0.66 for the CNA Time for Care index).

For almost all of the comparisons between the highest empowerment group and each of the other two groups, independent t tests were used and reported in the tables to evaluate statistical significance. The only exceptions were the comparisons on CNA gender and CNA race/ethnicity. Chi-square tests were used and reported for these comparisons.

As a “check” for the large number of comparisons being made, a multivariate analysis of variance (MANOVA) was also performed for each related set of job performance and work attitude outcomes (e.g., CNA perceptions of CNA job performance, nurse perceptions of CNA job performance). Results of each of the MANOVAs (not shown) indicated a significant empowerment effect (p < 0.05).

Results

CNA Empowerment and Demographic Characteristics

The top portion of Table 1 presents the samples and mean scores on the indexes measuring CNA perceptions of CNA empowerment (i.e., global empowerment and each of its dimensions of autonomy, competence, and impact/meaningfulness) for the three CNA empowerment groups (i.e., low, medium, high). As expected, with mean scores from 3.9 to 4.3, CNAs in the high empowerment group tended to “agree” that they were empowered. CNAs in the medium empowerment group tended to be relatively “uncertain” that they were empowered. CNAs in the low empowerment group tended to be more “uncertain” or to even “disagree” that they were empowered.

Levels of Certified Nursing Assistant (CNA) Empowerment and Demographic Characteristics

Table 1: Levels of Certified Nursing Assistant (CNA) Empowerment and Demographic Characteristics

Examination of the demographic characteristics in the bottom portion of Table 1 reveals no differences between the three CNA empowerment groups related to gender, race/ethnicity, education, and difficulty paying bills (p > 0.05). However, significant differences were found related to age (p < 0.01) and tenure (p < 0.05). CNAs with high empowerment tended to be somewhat older and have longer tenure at the nursing home than did less-empowered CNAs.

CNA Empowerment and Job Performance

A comparison of the three groups of CNAs with regard to CNA perceptions of job performance found many differences (top portion of Table 2). CNAs with high empowerment scored significantly higher on all three of the performance measures than did those with lower empowerment. Highly empowered CNAs were more likely to “agree” that they have effective work procedures (p < 0.001); enough time to feed, turn, and assist residents (p < 0.01); and support for each other (p < 0.001) than were CNAs with lower empowerment.

Levels of Certified Nursing Assistant (CNA) Empowerment and Job Performance

Table 2: Levels of Certified Nursing Assistant (CNA) Empowerment and Job Performance

A similar pattern was observed among the nurses. As shown in the bottom portion of Table 2, the nurses’ assessments of CNA job performance tended to differ depending on how empowered they perceived the CNAs in their nursing home to be. Nurses who perceived the CNAs in their nursing home to be highly empowered tended to rate them higher on five different aspects of their performance than did nurses who perceived the CNAs in their nursing home to have relatively low empowerment (p < 0.001). Nurse ratings for CNAs with high empowerment were higher on average regarding their staffing levels and time available to provide resident care. Nurses also tended to rate these CNAs slightly higher on the effectiveness of their work procedures, their coordination with other CNAs, and their cooperation with other nursing staff.

The nurses were also asked about their own job performance. Specifically, they were asked to share their opinions about having enough time to complete their paperwork. As shown in the bottom portion of Table 2, nurses who perceived that they worked with CNAs with the lowest levels of empowerment tended to “disagree” (2.4) that there was enough time for them to complete their paperwork. Nurses who perceived that they worked with highly empowered CNAs were less certain (3) about the lack of time for this task. However, this difference was not statistically significant (p > 0.05). Therefore, according to the nurses, working with highly empowered CNAs did not tend to free up more of the nurses’ time, at least not related to completing their paperwork.

CNA Empowerment and Job Attitudes, Absenteeism, and Intention to Quit

Table 3 presents job attitudes, absenteeism, and intention to quit among CNAs and nurses by levels of CNA empowerment. As predicted, CNA empowerment was strongly associated with both CNAs’ and nurses’ attitudes toward their jobs. For example, CNAs with high empowerment tended to feel more strongly than did CNAs with medium or low empowerment that they had high self-esteem, experienced less burnout, were satisfied with their job and schedule, and were committed to the nursing home (p < 0.01) (top portion of Table 3). CNAs with high empowerment were also less likely to be thinking of leaving their job (p < 0.01).

Levels of Certified Nursing Assistant (CNA) Empowerment and Job Attitudes, Absenteeism, and Intention to Quit

Table 3: Levels of Certified Nursing Assistant (CNA) Empowerment and Job Attitudes, Absenteeism, and Intention to Quit

Results were similar for the nurses. Nurses who viewed the CNAs in their nursing home as highly empowered appeared to be the happiest. As shown in the bottom panel of Table 3, these nurses tended to score higher on job satisfaction than did nurses working with medium or low empowered CNAs (p < 0.01). In addition, the nurses in the high CNA empowerment group were the least likely to be thinking of leaving their job (p < 0.01).

The only variable that showed no significant difference between the three empowerment groups was self-reported absenteeism (p > 0.05). Regardless of their perceptions of the levels of CNA empowerment in their nursing home, both CNAs and nurses tended to respond “about 1 day every 2 months or more” when asked how often they missed work for reasons other than vacation. However, it is important to note that of all the survey questions used in this analysis, this question was the one with the lowest response rate among the CNAs. In addition, the response rate for this question was lowest among the CNAs with the lowest empowerment and highest among those with the highest empowerment. Therefore, it is possible that lower absenteeism was associated with higher levels of CNA empowerment, at least among the CNAs, but that this was obscured by the differential response rates.

Discussion

The purpose of this analysis was to examine the effects of CNA empowerment on job performance and work attitudes among a sample of CNAs representing a wide range of empowerment levels. On the basis of survey responses from CNAs and nurses in five nursing homes where CNA-empowered work teams had been implemented and five nursing homes with more traditional management approaches, the results indicated that CNA empowerment had a variety of effects.

According to the perceptions of both CNAs and nurses, highly empowered CNAs tended to perform their jobs better than did other CNAs. Compared with less empowered CNAs, highly empowered CNAs were perceived to have effective work procedures, to have enough time and staff to provide care, to support and work well with other CNAs, and to cooperate with the nurses. However, these higher levels of CNA performance did not seem to increase the amount of time available for the nurses to complete their paperwork.

Collectively, both highly empowered CNAs and the nurses who worked with them seemed to be happier on the job. Highly empowered CNAs reported higher self-esteem, less burnout, more satisfaction, and more commitment to the nursing home. The nurses who worked with these CNAs also reported more satisfaction. Both were less likely to be thinking about leaving their jobs.

Although the job performance findings of this analysis were consistent with the results of a pretest to posttest study of CNA-empowered work teams (Yeatts & Cready, 2007), the job attitude findings were not. It is reasonable to suspect that the teams’ lack of effect on job attitudes in the pretest to posttest study were because the modest increases in CNA empowerment observed after the teams were implemented were not large enough to cause significant improvements in job attitudes. In addition, review of the teams’ weekly scheduled meeting minutes and nurse managers’ responses revealed mixed effects on satisfaction and related attitudes. The CNAs were happy with the fulfillment of CNA preferences related to resident care that the teams made possible. This result is especially significant because CNAs tend to consider the role they play in the lives of the residents they serve as one of the most valued aspects of their jobs (Castle, 2007). However, some CNAs expressed concern about the time the team meetings took away from direct care and disappointment with inadequate feedback from members of nursing management.

Limitations

This analysis had some limitations. First, because the CNAs and nurses in the sample were employed by 10 volunteer nursing homes in North Central Texas, the results may not apply to all nursing homes. Second, although the data for the analysis were drawn from a larger study that included Time 1 and Time 2 surveys of CNAs and nurses, the analysis used only the Time 2 surveys. This decision was made to ensure a larger sample and a wider range of CNA empowerment. Only approximately 52% of the CNAs surveyed at Time 1 still worked at the same nursing home at Time 2. Because the analysis was cross-sectional, the associations between CNA empowerment and job performance and attitudes may not reflect underlying causal effects. Finally, it would have been useful to compare staff self-reports of absences from work with nursing home records.

Conclusion and Implications

Despite the limitations described above, it is clear from this analysis that CNA empowerment is associated with positive work-related attitudes among CNAs and nurses. These findings, together with those of earlier studies (e.g., Yeatts & Cready, 2007), suggest that CNA empowerment can be used as a management approach to increase morale and job performance among CNAs and nurses, lower their intent to quit their jobs, and improve quality of care and life for nursing home residents. However, as noted above, the effectiveness of an employee empowerment strategy, such as CNA-empowered work teams, depends on how well it is implemented. Like other empowering strategies, CNA-empowered work teams will be most effective when they have the necessary support from management (Robinson & Rosher, 2006; Yeatts & Cready, 2007). One challenge for members of nursing management who are seeking to improve their nursing home’s work and care environment by implementing such teams is finding the time to ask for and listen to CNAs’ suggestions about how to modify the work and to provide consistent feedback. Another challenge is involving CNAs in the decision making process in situations that require immediate attention, such as when a complaint must be addressed quickly. Still other challenges include allowing CNAs time to learn how to work together in a team meeting, accepting the possibility that they will sometimes make mistakes, and ensuring their direct care responsibilities are covered while they attend the weekly scheduled team meetings.

Thus, nursing homes and other health care providers, such as assisted living facilities (Sikorska-Simmons, 2006), interested in empowering their workers face some significant challenges. Fortunately, they can learn from the successes and problems experienced by the few who have pioneered various empowerment strategies, including empowered work teams, in nursing homes. Yeatts et al. (2004) provided some preliminary findings on how to effectively establish CNA-empowered work teams in nursing homes, and both Hollinger-Smith (2003) and the Eden Alternative® (n.d.) provide training on how to empower nursing home staff. Yeatts et al. (in press) provide training materials and a detailed description of what must go right and what can go wrong when establishing empowered work teams in long-term care settings, such as nursing homes. With the help of lessons learned from the new culture change initiatives, and with commitment, effort, and attention, nursing homes and other health care providers can reap the benefits associated with employee empowerment strategies, such as CNA-empowered work teams.

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Levels of Certified Nursing Assistant (CNA) Empowerment and Demographic Characteristics

CNA Perceptions of Their Empowerment
Low (n = 100) Medium (n = 140) High (n = 58)
Variable Mean (SD) Mean (SD) Mean (SD)
CNA Perceptions of Their Empowerment
  Global empowerment 2.7 (0.3) 3.5 (0.2) 4.1 (0.3)
     Autonomy in doing work 2.7 (0.5) 3.2 (0.4) 3.9 (0.4)
    Competence in doing work 3 (0.5) 3.7 (0.5) 4.3 (0.4)
     Impact/meaningfulness of work 2.6 (0.4) 3.5 (0.3) 4.2 (0.4)
Demographic Characteristics of CNAs
  % Women 91.9 88.6 86.2
  % Non-Anglo 66.7 52.2 62.1
  Education level (in years completed) 12 (1.9) 12.1 (1.6) 11.9 (1.7)
  Difficulty paying bills 3.6 (1.2) 3.4 (1.2) 3.2 (1.1)
  Age (years) 36.8b (11.7) 35.3f (11) 43.2 (11.9)
  Number of months at nursing home 38.2 (55.7) 37d (43.9) 59.3 (79.5)

Levels of Certified Nursing Assistant (CNA) Empowerment and Job Performance

CNA Perceptions of Their Empowerment
Low (n= 100) Medium (n = 140) High (n = 58)
Variable Mean (SD) Mean (SD) Mean (SD)
CNA Perceptions of Their Job Performance
  CNAs have effective work procedures 3.4c (0.6) 3.7f (0.5) 4.2 (0.5)
  CNAs have enough time to provide care 3.4b (0.8) 3.7 (0.8) 3.9 (0.9)
  CNAs support each other 3.3c (0.8) 3.7f (0.5) 4.1 (0.6)
Nurse Perceptions of CNA Empowerment
(n= 32) (n= 72) (n= 32)
Variable Mean (SD) Mean (SD) Mean (SD)
Nurse Perceptions of CNA Job Performance
  CNAs have effective work procedures 3.6c (0.6) 3.9f (0.5) 4.3 (0.5)
  CNAs work well together 3.3c (0.6) 3.7e (0.7) 4.2 (0.6)
  Adequate CNA staffing to do a good job 2.7c (1.1) 3.3f (0.9) 4.1 (0.8)
  CNAs have enough time to provide care 2.9c (1.1) 3.4e (0.8) 4 (0.8)
  CNAs cooperate with nurses 3.7c (0.9) 4.1f (0.6) 4.5 (0.5)
Nurse Perceptions of Nurse Job Performance
  Nurses have enough time to complete paperwork 2.4 (1.2) 2.9 (1.1) 3 (1.2)

Levels of Certified Nursing Assistant (CNA) Empowerment and Job Attitudes, Absenteeism, and Intention to Quit

CNA Perceptions of Their Empowerment
Low (n = 100) Medium (n = 140) High (n = 58)
Variable Mean (SD) Mean (SD) Mean (SD)
CNA attitudes, absenteeism, and intention to quit
  Self-esteem 4c (0.6) 4.1f (0.5) 4.5 (0.4)
  Experiencing burnout on the job 2.4c (0.6) 2.2f (0.6) 1.7 (0.7)
    Emotional exhaustion 2.8c (0.8) 2.5f (0.7) 1.9 (0.8)
    Depersonalization 2c (0.5) 1.9f (0.5) 1.5 (0.6)
  Generally satisfied with job 3.5c (0.9) 3.8f (0.7) 4.6 (0.4)
  Satisfied with schedule 3a (1.5) 3.2 (1.2) 3.6 (1.3)
  Committed to job 3.5c (0.9) 3.8f (0.7) 4.5 (0.5)
  Self-reported absenteeism 1.5 (0.9) 1.3 (0.8) 1.4 (0.9)
  Planning to quit job 2.7c (1) 2.3f (0.9) 1.7 (0.7)
Nurse Perceptions of CNA Empowerment
(n= 32) (n= 72) (n= 32)
Variable Mean (SD) Mean (SD) Mean (SD)
Nurse satisfaction, absenteeism, and intention to quit
  Generally satisfied with job 3.6c (0.7) 4.0e (0.6) 4.4 (0.8)
  Self-reported absenteeism 1.1 (0.2) 1.1 (0.3) 1.1 (0.4)
  Planning to quit job 2.4b (1.1) 1.9 (0.9) 1.8 (1)

Empowered CNAs

Cready, CM, Yeatts, DE, Gosdin, MM & Potts, HF. 2008. CNA Empowerment: Effects on Job Performance and Work Attitudes. Journal of Gerontological Nursing, 343, 26–35.

  1. Employee empowerment strategies, such as empowered work teams, are designed to allow direct care workers to participate in decisions related to their work so work processes may be improved, employee performance and attitudes enhanced, and turnover reduced.

  2. This study found that feelings of high empowerment among certified nursing assistants (CNAs) were associated with more positive assessments of personal performance by CNAs, more positive assessments of CNA performance by nurses, and better work-related attitudes of both CNAs and nurses, including increased job satisfaction and less intent to quit.

  3. CNA-empowered work teams are effective only when given routine attention and support from nursing management. Without routine attention, empowerment—and its positive effects— is reduced.

Authors

Dr. Cready is Assistant Professor, Dr. Yeatts is Professor and Chair, and Ms. Gosdin is Teaching Fellow, University of North Texas, Department of Sociology, Denton, Texas; and Dr. Potts is Lecturer, University of North Texas Dallas Campus, Sociology, Dallas, Texas.

Address correspondence to Cynthia M. Cready, PhD, Assistant Professor, University of North Texas, Department of Sociology, PO Box 311157, Denton, TX 76203-1157; e-mail: .cready@unt.edu

10.3928/00989134-20080301-02

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