Journal of Gerontological Nursing

Feature Article 

Reassessing Nurse Aide Job Satisfaction in a Texas Nursing Home

Mark A. Thompson, PhD; Kathleen K. Horne, MBA; Timothy R. Huerta, PhD

Abstract

This article reports a study that replicates and extends Castle’s 2007 study by examining factors related to satisfaction of nurse aides at Carillon House, a 120-bed nonprofit skilled nursing facility in Lubbock, Texas. The Nursing Home Nurse Aide Job Satisfaction Questionnaire was adapted to allow for the collection of qualitative responses and administered to the nursing staff. The results suggest that satisfaction among nurse aides is related to rewards, workload, and the team environment created among coworkers. These findings differ from what is generally found in the literature and may be related to the higher-than-average satisfaction rating of nurse aides at this facility. The study provides evidence that large-scale surveys may have ignored a stratified effect where higher satisfaction organizations have different driving forces than what has been demonstrated in the literature to date.

Abstract

This article reports a study that replicates and extends Castle’s 2007 study by examining factors related to satisfaction of nurse aides at Carillon House, a 120-bed nonprofit skilled nursing facility in Lubbock, Texas. The Nursing Home Nurse Aide Job Satisfaction Questionnaire was adapted to allow for the collection of qualitative responses and administered to the nursing staff. The results suggest that satisfaction among nurse aides is related to rewards, workload, and the team environment created among coworkers. These findings differ from what is generally found in the literature and may be related to the higher-than-average satisfaction rating of nurse aides at this facility. The study provides evidence that large-scale surveys may have ignored a stratified effect where higher satisfaction organizations have different driving forces than what has been demonstrated in the literature to date.

Dr. Thompson is Associate Professor, Health Organization Management Program, Ms. Horne is Research Associate, and Dr. Huerta is Assistant Professor and Director, Center for Healthcare Innovation, Education, and Research, Rawls College of Business, Texas Tech University, Lubbock, Texas.

Dr. Thompson and Dr. Huerta have no significant financial interests in any product or class of products discussed directly or indirectly in this activity, including research support. Ms. Horne worked as an intern for Carillon when the survey was being administered. The remaining work (i.e., analysis, writing) was completed after her internship.

Address correspondence to Mark A. Thompson, PhD, Associate Professor, Health Organization Management Program, Rawls College of Business, Texas Tech University, 15th Street and Flint Avenue, Lubbock, TX 79409; e-mail: mark.thompson@ttu.edu.

Received: February 22, 2010
Accepted: February 10, 2011
Posted Online: May 18, 2011

As the aging population continues to grow, the health care system will rely more heavily on nursing homes and long-term care (LTC) facilities. Currently, nursing facilities experience difficulty recruiting and retaining nursing staff. Studies have reported the average annual nurse aide (NA) turnover rate to be between 74% and 100%, with California having rates as high as 400% (Castle & Engberg, 2006; Cohen-Mansfield, 1997). The American Health Care Association (2003) has estimated the turnover rate for direct care staff is at 71% in the nation’s nursing homes. In addition, the Institute for the Future of Aging Services (2007) has reported the current vacancy rate is 12% for NAs in nursing homes, and future shortages are predicted as the demand for services increase with the aging population. While studies vary in their assessment of the scope of the turnover problem, they are unanimous in their recognition of the concern.

To meet the demands we expect these facilities will face, the health care industry must address the challenge of high turnover rates and low levels of job satisfaction among nursing home staff. Nursing staff turnover results in higher financial costs and lower productivity, quality of care, and employee morale (Brannon, Zinn, Mor, & Davis, 2002). The direct costs of replacing NAs have been estimated to range from $2,200 to $2,500 (Castle, 2006; Seavey, 2004). Furthermore, the facilities incur indirect costs in the form of both resident and family dissatisfaction and lower staff morale (Riggs & Rantz, 2001). Therefore, assessing job satisfaction and turnover is important to providing quality care in LTC facilities.

The purpose of this article is to examine factors related to NA job satisfaction and turnover in a nursing home and compare these factors to a large-scale survey of NA satisfaction conducted by Castle (2007). With few exceptions, results similar to Castle’s (2007) were obtained. However, these exceptions potentially raise issues with large-scale studies that may have ignored a key component in NA satisfaction: Higher satisfaction organizations may have differing driving forces than lower satisfaction organizations.

Nursing Assistant Satisfaction Factors

Several factors impact NA satisfaction. Parsons, Simmons, Penn, and Furlough (2003) identified four factors closely associated with NA satisfaction: personal opportunity, supervision, benefits, and coworker support. Further, Castle (2006) proposed that NA satisfaction is associated with promotional opportunities, superiors, and compensation. A study exploring NAs’ intent to stay at a facility (Bishop et al., 2008) determined that tangible rewards; satisfaction with benefits, wages, and opportunities for advancement; and fair, attentive supervision were the basic factors that influenced commitment. The role of supervision, promotion and growth opportunities, compensation and rewards, and work quality are discussed below in more detail.

Supervision

Ineffective supervision can affect employees’ level of satisfaction and desire to remain with an organization (Riggs & Rantz, 2001). Previous research has proposed that positive relationships between supervisors and staff can minimize job-related stress and increase job satisfaction. One study investigating the relationship between immediate supervisors and NAs’ job stress and satisfaction found that supervisory support is an important determinant of NAs’ job satisfaction (McGilton, Hall, Wodchris, & Petroz, 2007). Other research has also shown that the quality of the NA-supervisor relationship affects NAs’ commitment to the facility (Parsons et al., 2003). When NAs view their supervisors as respectful, helpful, and providing good feedback, they are more likely to be committed to their jobs (Bishop et al., 2008).

In addition to supervisor support, top management turnover can influence NAs’ loyalty to the organization. Castle and Engberg (2006) found that higher top management turnover is associated with higher nursing staff turnover. These findings suggest that nursing facilities could directly and indirectly affect NA job satisfaction if nursing supervisors received more leadership training.

Promotional and Growth Opportunities

Several studies have explored job satisfaction among NAs and concluded that promotional and growth opportunities were the most significant factors related to both overall satisfaction and turnover (Castle & Engberg, 2006; Parsons et al., 2003). MacDonald and Walton (2007) showed that after NAs participated in an online education program, staff turnover decreased more than 20%, suggesting greater job satisfaction after participating in the program. Parsons et al. (2003) found that, in general, NAs are frustrated about lack of career growth opportunities and poor communication with management.

Compensation and Rewards

Compensation is a major source of job dissatisfaction among NAs but is not significantly related to turnover (Parsons et al., 2003). Direct caregivers identify that the most important component of their job is their ability to care for residents; however, tangible rewards are also important to NAs. Bishop et al. (2008) found that satisfaction with tangible rewards, wages, and benefits was significantly related to NAs’ intent to stay. In his 2007 study, Castle concluded that dissatisfaction with a lack of rewards was strongly associated with both intent to leave and turnover. In addition, satisfaction with pay declines sharply after 1 year of employment, signaling that NAs expect to be rewarded for their time spent at the organization (Castle & Engberg, 2006).

Quality

Nursing staff retention is a key managerial concern because of the documented connection between staffing levels and quality of care provided. In addition, facilities with a high turnover rate experience lower employee job satisfaction and provide lower quality of care to residents (Castle & Engberg, 2005). A study conducted by Castle, Degenholtz, and Rosen (2006) demonstrated that quality improvement projects may have an impact on caregiver morale: Staff who perceive the quality of care to be high report higher job satisfaction. Growing evidence indicates that satisfaction can be increased if efforts are made to improve the quality of care. Further, Schnelle et al. (2004) provided evidence that the highest-staffed homes (7.6 residents per NA) performed better on 13 of 16 care processes implemented by NAs compared with lower-staffed homes.

Although high staffing ratios are desirable, research also suggests that the composition of the workforce can have a negative effect on quality of care and employee satisfaction. Castle, Engberg, and Men (2007) found that higher levels of agency NAs are associated with lower quality of care. Results indicated that the use of 14 full-time agency NAs per 100 beds had little effect on quality; however, use of 25 full-time agency NAs per 100 beds had a significant, positive effect on quality. In addition, higher use of agency NAs was associated with a decrease in teamwork and employee satisfaction. In conclusion, it is unclear whether staffing levels affect quality of care or if quality of care affects job satisfaction. The findings do verify a connection between levels of staffing, employee satisfaction, and better quality of care provided.

Studies have shown an association between job satisfaction, turnover, and intent to quit (Parsons et al., 2003). Grieshaber, Parker, and Deering (1995) defined job satisfaction as “the favorable or unfavorableness with which employees view their work” (p. 18). Dissatisfied employees will often exhibit signs of withdrawal, unreliable work ethic, absenteeism, tardiness, and aggression toward coworkers and residents (Parsons et al., 2003). Given the chronic degree of staff turnover and its impact on the nursing home environment, it is important to explore factors associated with job satisfaction.

Setting: Carillon House

Carillon House is a 120-bed, not-for-profit skilled nursing facility in Lubbock, Texas. It is part of Carillon Senior LifeCare Community, which includes the skilled nursing facility, assisted living, and independent living for older adults. The facility is run by 10 directors who contract management services from the parent company. Carillon House has three floors with two nursing units per floor. During the 7:00 a.m. to 7:00 p.m. shift, each unit is staffed by one RN or licensed vocational nurse (LVN) and two certified NAs. During the day, the resident-to-staff ratio is 6.6 to 1. In the evening, there is one RN or LVN per floor and two NAs per unit, resulting in a resident-to-staff ratio of 8 to 1.

In the fall of 2008, Carillon House experienced an 84% voluntary turnover rate among NAs. As a result, a survey was conducted at the facility to examine nursing staff satisfaction. In this study, job satisfaction of NAs was evaluated using an adapted version of the Nursing Home Nurse Aide Job Satisfaction Questionnaire (NHNA-JSQ). This specific survey was chosen with the objective to compare our results against national scores of NA satisfaction from a previous study conducted by Castle (2007). Castle’s (2007) study used the NHNA-JSQ to examine job satisfaction of NAs employed at 72 nursing homes in six states (n = 1,579 returned surveys of 2,872 sent, 55% response rate). The main findings were that NAs enjoyed working with residents and coworkers but were unsatisfied with pay. According to Castle (2007), there may be ways other than monetary compensation to improve job satisfaction among NAs through other rewards (e.g., advancement opportunities).

Method

The original NHNA-JSQ is a 22-question survey that consists of eight subscales: coworkers, work demands, work content, workload, training, rewards, quality of care, and a global rating. All questions use a 10-point visual analogue format ranging from 1 (very little/very poor) to 10 (very much/excellent). A review of the existing literature, a panel of experts, and cognitive testing were used in constructing the NHNA-JSQ (Castle, 2007). The cognitive testing method verified that NAs understand the question being asked, which ensures face and content validity. The final instrument was validated with robust psychometric properties. Detailed information about the instrument is available in Castle (2007).

Based on suggestion from the health center administrator, a supervisor subscale was added to the original NHNA-JSQ, which measures the perceived level of support, leadership, communication, and competency of the supervisors. The adapted survey also included five open-ended items, presented with space for the respondent to complete:

  • How can Carillon House support the nursing staff and ensure quality care is provided to the residents?
  • What characteristics do you think make a good nursing manager?
  • Describe the ideal boss or supervisor.
  • What do you think makes an employee loyal to an organization?
  • If you had the opportunity to increase your nursing education/degree, would you do it?

Finally, two questions concerning specific educational opportunities available at the facility were appended to the survey to determine awareness of programs available for continuing education. The organization offers both tuition reimbursement and scholarship opportunities to support employees’ personal and professional development and well-being; reimbursement for continuing nursing training is also available. Respondents were asked whether they were aware of these programs, and if they were unaware, they were further asked if they would be interested in learning more. It should be again noted that because the survey was anonymous, it was not a specific request for more information, rather a request for greater communication about such programs.

The survey was prepackaged and included a letter describing the study and directions for completing and returning the survey. The letter came from the facility director and informed the nursing staff that the survey would be anonymous and voluntary. To increase the number of surveys completed, an incentive was provided: Participants who completed the survey could enter their name into a drawing for a $50 gas card. Follow-up letters were sent twice: once at 7 days and the other at 2 weeks. A total of 40 surveys were returned using interoffice mail, for a facility response rate of 53%. The research protocols were reviewed and approved by the University’s Institutional Review Board.

Each survey item was analyzed, and the subscale means and distributions were also compiled and compared with Castle’s (2007) results. Responses to the open-ended items were subjectively analyzed, and reoccurring ideas and words were recorded to monitor frequency.

Results and Discussion

Regarding age of facility NAs, 36% were 18 to 29, 23% were 30 to 40, 23% were 41 to 50, and 18% were 51 to 60. Their average length of employment at the facility was 2.67 years (range = 2 months to 11 years). On average, these NAs had worked at 3.02 facilities before working at Carillon House.

The descriptive statistics of the current satisfaction survey, as well as the original satisfaction survey conducted by Castle (2007), are presented in the Table. The current average survey score for each subscale was higher than the average score from the 2007 survey, indicating a possible higher level of job satisfaction at Carillon compared with the general population of NAs. While the sample obtained from Carillon House may be a limitation that affects the reliability of the results, it should be noted that the pattern is consistent across most survey items.

Nursing Home Nurse Aide Job Satisfaction Questionnaire: Current and Original Study Results

Table: Nursing Home Nurse Aide Job Satisfaction Questionnaire: Current and Original Study Results

Excluding the supervisor subscale from the analysis, the three lowest scoring subscales found at Carillon matched those reported by Castle (2007). In both cases, NAs were most dissatisfied with the reward system, work demands, and workload. However, if we include the supervisor subscale from the current survey, supervisory interaction becomes the second lowest scoring subscale, followed by work demands. The three highest scoring subscales reported in the current survey were quality of care, work content, and training, which differed slightly from the 2007 survey where the three highest subscales reported were work content, quality of care, and global rating.

In addition to analyzing the subscale means, this study focused on each score for an item question within a subscale. For example, in the current study, the following items received the highest scores: enjoyment working with the residents, effect they have on the residents’ lives, and their skill level. The lowest scoring items were fair pay, supervisors’ ability to resolve complaints, and how often supervisors recognized them for a job well done. These findings tend to support much of the previous literature as it relates to supervisors and job satisfaction (e.g., Bishop et al., 2008; Riggs & Rantz, 2001).

Results from the open-ended items were compiled by observing the frequency of a word or concept. For example, in response to “How can Carillon House support the nursing staff and ensure quality care is provided to the residents?,” staffing concerns were mentioned 15 times. Further, the most predominant answers to the prompts “What characteristics do you think make a good nursing manager?” and “Describe the ideal boss or supervisor” consisted of concepts addressing communication, teamwork, fairness, and respect. The results of the open-ended items are consistent with the link between supervisors being respectful and providing good feedback and improved job satisfaction (Bishop et al., 2008). The Figure shows the frequency of concepts mentioned in response to the open-ended items.

Nurse aides’ responses to the open-ended items.

Figure. Nurse aides’ responses to the open-ended items.

The current, adapted survey also included a section used to measure interest in continuing education and knowledge of existing education programs offered by the organization. In general, 34 of 40 respondents expressed interest in increasing their nursing education/degree. This finding, if pursued, may lead to higher job satisfaction, as evident from MacDonald and Walton’s (2007) finding that an online education program may reduce staff turnover. Regarding tuition reimbursement and scholarship opportunities available from the organization, 4 respondents indicated they had never heard of the program, while 21 remembered hearing about the program but did not know details. When asked whether they would be interested in the program, 20 requested additional information, and 6 indicated they were not interested.

The second program at Carillon provides reimbursement for nursing training. In this case, 9 employees indicated they had never heard of the program, and 14 remembered hearing about the program but did not know details. In this case, 18 wanted to know more, and 5 indicated they were not interested.

A multivariate regression analysis was conducted to examine which factors (including the supervisory questions) may be associated with overall satisfaction. In particular, job satisfaction scores were associated with the coworkers (p = 0.011), workload (p = 0.018), and rewards subscales (p = 0.010) scores. The regression model explained 63% of the total variation in overall job satisfaction; interestingly for this Texas nursing home, satisfaction may not be linked to those factors identified as the weakest or strongest. Full regression results and diagnostics are available on request from the first author.

Overall, our results replicate the findings of Castle (2007) and much of the previous literature related to job satisfaction of NAs. The rankings of the subscales were similar if the supervisory questions are excluded. While Carillon House had higher than average satisfaction ratings relative to Castle (2007), these findings may be due to distinct differences between this sample and Castle’s. However, we adapted the questionnaire with the addition of the supervisor subscale, qualitative responses, and information on education. As such, practical implications may want to account for this additional element along with others that have been previously documented in the literature. We discuss the implications of our findings below.

Practice Implications

While understanding what NAs were least satisfied with is a good start, it is also important to know the various solutions and trends that have been used successfully in the industry. Our findings from this survey closely echo those found in previous research. We identify four recommendations to improve satisfaction that are indicated by the data presented in this study.

The first recommendation to improve job satisfaction among nursing staff is to encourage leadership training for supervisors. In a study of NA retention in LTC facilities, direct care workers often reported that they are more inclined to stay in a position if their supervisor is fair minded and showed interest in their lives (Paraprofessional Healthcare Institute & North Carolina Department of Health and Human Services, Office of Long Term Care, 2002). While the survey supports NAs’ desire for fair-minded and supportive supervisors, the more pressing concerns for facilities are the development of cohesive teams.

Leadership training for supervisors that is focused on team development and management may lead to higher job satisfaction. The majority of NAs in LTC facilities lack the training to resolve interpersonal conflicts or communicate effectively and can benefit from the support of a well-trained supervisor (Riggs & Rantz, 2001). In addition, NAs experience frustration in the work environment because they deliver 90% of the care to residents and report that they are rarely asked to give their opinions concerning a resident (Petterson, Donnersvärd, Lagerström, & Toomingas, 2006). As such, supervisors can facilitate the development of a culture of collaboration. Such training should have an empowerment focus—providing supervisors with the skills necessary to move from command and control to a collaborative decision-making process in which the NAs are part of the process. Petterson et al. (2006) reported that empowerment gives employees a greater sense of job control and self-confidence. In addition, when staff encounter problems in their work environment, they participate in the decision-making process. As Sikma (2006) pointed out, the supportive environment may also be important to staff perceptions of being valued in the organization.

Another study noted that NAs involved in empowered teams learned more about the health conditions of residents and grew more competent compared with the control group (Cready, Yeatts, Gosdin, & Potts, 2008). NAs in the empowered work teams reported a higher level of job satisfaction, commitment, and self-esteem. The study also found no significant impact on absenteeism, but NAs in the experimental group were less likely to quit or be fired. The authors noted a possible consequence of empowered work teams is that NAs are required to attend weekly 30-minute meetings, which may result in negative effects on resident care (Cready et al., 2008). However, this issue could be overcome with appropriate scheduling and staffing.

Further, NAs linked a desire for career growth to job satisfaction. Facilities might consider offering incentives to NAs for completing educational training, as well as additional training on resident care, to establish opportunities for NA growth and promotion. In the current study, 34 of 40 participants indicated they were interested in increasing their nursing education/degree. Currently, NAs are required to complete only 75 hours of initial training. Continuing education has been associated with quality improvement and job satisfaction, but it is challenging to plan education programs for health care workers in LTC facilities. For example, increased workloads, shift work, and high staff turnover are just a few of the challenges to providing continuing education. As a result, one program, Online Solutions: Quality Education for Quality Care in Long-Term Care (MacDonald & Walton, 2007), has developed an innovative solution to provide education to caregivers in LTC facilities. The study reported a learner improvement in pre-and posttest scores in excess of 10% and an increase in employee retention. Nursing facilities could explore the use of e-learning to provide continuing education and career development. However, it should be noted that even in the presence of such programs, our data demonstrate that organizations need to ensure proper dissemination of information about these educational programs. For example, while Carillon currently offers funding for continuing education in the form of an Education Assistance Program and an Education Reimbursement Program, the survey indicates that a majority of nursing staff are unfamiliar with these programs.

Some organizations have attempted to boost employee morale through incentive programs. Considering that NAs are most dissatisfied with rewards, incentives may be useful. For example, a 160-bed, not-for-profit facility in Haverhill, Massachusetts initiated an incentive program designed by the Life Enhancement and Empowerment Principles (LEEP) Committee (Hrehocik, 2007). The committee is composed of residents, staff, and family members who want to reward employees for going above and beyond their job function. When an employee earns 10 LEEP dollars, he or she can redeem them for gas or supermarket gift cards. Employees are also rewarded with LEEP dollars when they fill in for an employee who has called in sick. The director of human resources claims that since the inception of the program more than 150 employees have redeemed LEEP dollars and employee morale has improved (Hrehocik, 2007). Thus, a final recommendation for LTC facilities is to implement a rewards and recognition program. In fact, 27% of Carillon House employees who participated in the survey indicated a desire to be recognized and acknowledged for going above and beyond their duties. A rewards and recognition program, using similar concepts as those used in the LEEP program, may provide a better systematic structure for addressing the issue.

Conclusion

This article reports a study replicating Castle’s (2007) study assessing NA job satisfaction at a facility in Texas. The higher than average satisfaction rating of the current NAs may demonstrate a stratified effect missing in some of the previous large-scale studies. Due to the strong association between employee satisfaction and turnover, nursing facilities should be cognizant of the level of satisfaction among their direct care workers. A better understanding of the forces behind NA job satisfaction is critical to improving NA turnover. This is of greater importance considering that the majority of resident care is delivered by NAs and the demand for their services will only increase as the aging population grows.

References

  • American Health Care Association. (2003). Results of the 2002 AHCA survey of nursing staff vacancy and turnover in nursing homes. Retrieved from http://www.ahcancal.org/research_data/staffing/Documents/Vacancy_Turnover_Survey2002.pdf
  • Bishop, C.E., Weinberg, D.B., Leutz, W., Dossa, A., Pfefferle, S.G. & Zincavage, R.M. (2008). Nursing assistants’ job commitment: Effect of nursing home organizational factors and impact on resident well-being. The Gerontologist, 48(Special No. 1), 36–45. doi:10.1093/geront/48.Supplement_1.36 [CrossRef]
  • Brannon, D., Zinn, J.S., Mor, V. & Davis, J. (2002). An exploration of job, organizational, and environmental factors associated with high and low nursing assistant turnover. The Gerontologist, 42, 159–168. doi:10.1093/geront/42.2.159 [CrossRef]
  • Castle, N.G. (2006). Measuring staff turnover in nursing homes. The Gerontologist, 46, 210–219. doi:10.1093/geront/46.2.210 [CrossRef]
  • Castle, N.G. (2007). Assessing job satisfaction of nurse aides in nursing homes: The Nursing Home Nurse Aide Job Satisfaction Questionnaire. Journal of Gerontological Nursing, 33(5), 41–47.
  • Castle, N.G. & Engberg, J. (2005). Staff turnover and quality of care in nursing homes. Medical Care, 43, 616–626. doi:10.1097/01.mlr.0000163661.67170.b9 [CrossRef]
  • Castle, N.G. & Engberg, J. (2006). Organizational characteristics associated with staff turnover in nursing homes. The Gerontologist, 46, 62–73.
  • Castle, N.G., Engberg, J. & Men, A. (2007). Nursing home staff turnover: Impact on Nursing Home Compare quality measures. The Gerontologist, 47, 650–661. doi:10.1093/geront/47.5.650 [CrossRef]
  • Cohen-Mansfield, J. (1997). Turnover among nursing home staff: A review. Nursing Management, 28(5), 59–62, 64.
  • Cready, C.M, Yeatts, D.E., Gosdin, M.M. & Potts, H.F. (2008). CNA empowerment: Effects on job performance and work attitudes. Journal of Gerontological Nursing, 34(3), 26–35. doi:10.3928/00989134-20080301-02 [CrossRef]
  • Grieshaber, L.D., Parker, P. & Deering, J. (1995). Job satisfaction of nursing assistants in long-term care. The Health Care Supervisor, 13(4), 18–28.
  • Hrehocik, M. (2007). Thanking employees for a job well done. Nursing Homes, 56(12), 29–31.
  • Institute for the Future of Aging Services. (2007). The long-term care workforce: Can the crisis be fixed? Retrieved from the LeadingAge website: http://www.aahsa.org/uploadedFiles/IFAS/Publications_amp;_Products/LTCCommissionReport2007.pdf
  • MacDonald, C.J. & Walton, R. (2007). E-learning education solutions for caregivers in long-term care (LTC) facilities: New possibilities. Education for Health, 20, 85.
  • McGilton, K.S., Hall, L.M., Wodchris, W.P. & Petroz, U. (2007). Supervisory support, job stress, and job satisfaction among long-term care nursing staff. Journal of Nursing Administration, 37, 366–372. doi:10.1097/01.NNA.0000285115.60689.4b [CrossRef]
  • Paraprofessional Healthcare Institute, & North Carolina Department of Health and Human Services, Office of Long Term Care. (2002). Results of the 2002 National Survey of State Initiatives on the Long-Term Care Direct Care Workforce. Retrieved from the National Clearinghouse on the Direct Care Workforce website: http://www.directcareclearinghouse.org/download/2002_Nat_Survey_State_Initiatives.pdf
  • Parsons, S.K., Simmons, W.P., Penn, K. & Furlough, M. (2003). Determinants of satisfaction and turnover among nursing assistants: The results of a statewide survey. Journal of Gerontological Nursing, 29(3), 51–58.
  • Petterson, I.-L., Donnersvärd, H.A., Lagerström, M. & Toomingas, A. (2006). Evaluation of an intervention programme based on empowerment for eldercare nursing staff. Work & Stress, 20, 353–369. doi:10.1080/02678370601070489 [CrossRef]
  • Riggs, C.J. & Rantz, M.J. (2001). A model of staff support to improve retention in long-term care. Nursing Administration Quarterly, 25, 43–54.
  • Schnelle, J.F., Simmons, S.F., Harrington, C., Cadogan, M., Garcia, E. & Bates-Jensen, B.M. (2004). Relationship of nursing home staffing to quality of care. Health Services Research, 39, 225–250. doi:10.1111/j.1475-6773.2004.00225.x [CrossRef]
  • Seavey, D. (2004). The cost of frontline turnover in long-term care. Retrieved from the National Clearinghouse on the Direct Care Workforce website: http://www.directcareclearinghouse.org/download/TOCostReport.pdf
  • Sikma, S.K. (2006). Staff perceptions of caring: The importance of a supportive environment. Journal of Gerontological Nursing, 32(6), 22–29.

Nursing Home Nurse Aide Job Satisfaction Questionnaire: Current and Original Study Results

Current Study (N= 40) Castle (2007) (N= 1,579)
Item by Subscale Subscale Mean Item Mean (SD) Subscale Mean Item Mean (SD)
Work content 9.1 7.8
  Rate how much you enjoy working with the residents 9.6 (1.5) 7.1 (1.7)
  Rate how your role influences the lives of residents 9.1 (1.3) 8.6 (1.2)
  Rate your closeness to residents and families 8.7 (1.3) 8.0 (1.2)
Quality of care 9.2 7.5
  Rate the care given to residents 9.1 (1.3) 6.4 (1.4)
  Rate the effect you have on residents’ lives 9.2 (1.3) 8.2 (1.6)
Training 8.7 6.9
  Rate whether your skills are adequate for the job 9.5 (1.0) 6.5 (2.1)
  Rate the training you have had to perform your job 8.8 (2.0) 7.4 (1.3)
  Rate the chances you have for more training 7.8 (2.3) 6.8 (1.5)
Coworkers 7.9 6.8
  Rate the people you work with 8.1 (2.0) 7.5 (1.2)
  Rate whether you feel part of a team effort 8.0 (2.4) 6.2 (1.8)
  Rate the cooperation among staff 7.2 (2.5) 6.9 (2.4)
Supervisorsa 6.6
  Rate how often your supervisor gave recognition for a job well done 6.4 (3.0)
  Rate how well your supervisor resolved complaints and problems 6.4 (3.1)
  Rate how well your supervisor communicated to the team 8.5 (3.0)
  Rate how well your supervisor knew his/her job 8.5 (2.7)
Work demands 7.0 5.7
  Rate the support you get when doing your job 7.3 (2.6) 6.8 (1.2)
  Rate the chances you have to talk about your concerns 6.5 (2.6) 5.2 (1.6)
  Rate the demands residents and families place on you 7.3 (2.2) 5.8 (2.4)
Workload 7.8 5.5
  Rate your workload 7.4 (2.3) 5.9 (2.8)
  Rate your schedule 7.9 (2.6) 5.3 (2.5)
  Rate the amount of time you have to do your job 8.1 (2.2) 5.1 (2.0)
Rewards 6.2 5.3
  Rate how fairly you are paid 5.7 (2.7) 6.6 (2.4)
  Rate your chances for further advancement 6.7 (3.0) 4.3 (1.1)
Global rating 8.3 7.4
  Rate your overall satisfaction with your job 8.0 (2.1) 7.6 (1.7)
  Would you recommend working at this facility to a friend? 8.6 (2.0) 7.3 (1.1)

Thompson, M.A., Horne, K.K. & Huerta, T.R. (2011). Reassessing Nurse Aide Job Satisfaction in a Texas Nursing Home. Journal of Gerontological Nursing, 37(9), 42–49.

  1. This article reports a study that replicates and extends Castle’s 2007 study by examining factors related to satisfaction of nurse aides at a 120-bed nonprofit skilled nursing facility in Lubbock, Texas.

  2. This study provides evidence that large-scale surveys may have ignored a stratified effect where higher satisfaction organizations have different driving forces than what has been demonstrated in the literature to date.

  3. Evidence suggests that job satisfaction among nursing aides is related to rewards, workload, and team environment among coworkers.

Keypoints

Authors

Dr. Thompson is Associate Professor, Health Organization Management Program, Ms. Horne is Research Associate, and Dr. Huerta is Assistant Professor and Director, Center for Healthcare Innovation, Education, and Research, Rawls College of Business, Texas Tech University, Lubbock, Texas.

Dr. Thompson and Dr. Huerta have no significant financial interests in any product or class of products discussed directly or indirectly in this activity, including research support. Ms. Horne worked as an intern for Carillon when the survey was being administered. The remaining work (i.e., analysis, writing) was completed after her internship.

Address correspondence to Mark A. Thompson, PhD, Associate Professor, Health Organization Management Program, Rawls College of Business, Texas Tech University, 15th Street and Flint Avenue, Lubbock, TX 79409; e-mail: .mark.thompson@ttu.edu

10.3928/00989134-20110503-04

Sign up to receive

Journal E-contents