• Work stress/strain, low job satisfaction, and intent to leave home health care nursing among Home Health Care Registered Nurses (HHC RNs)

      Barker, Dorothy Paxson; Lipscomb, Jane (2011)
      Background: The U.S. shortage of Home Health Care (HHC) Registered Nurses (RNs) is growing and the demand for HHC RNs is estimated to increase 109% by 2020. Factors associated with this shortage of HHC nurses include job stress/strain and low job satisfaction. Predictors of intent to leave their present HHC nursing position are not clear. To date, no published studies have been found that apply the effort-reward imbalance (ERI) model to HHC RNs. Purpose: The purpose of this study was to measure the level of job stress/strain associated with a low job satisfaction and intent to leave reported by HHC RNs practicing in the state of Maryland. Methods: This is a secondary analysis of the data collected from 794 HHC RNs participating in a 2006 study exploring hazard exposures in homecare. A mixedmethods analysis was conducted including quantitative and qualitative analysis. Results: Of the 206 HHC RNs that provided a narrative, 27.2% (n=56) reported an intent to leave or had already left their HHC positions. The six most frequent categories reported in the HHC RNs narratives included; negative organizationaltraits, work stress, love homecare, overwhelming paperwork, inadequate financial compensation, nurse attrition/intent to leave. Logistic regression analysis demonstrated reward as a significant predictor of good job satisfaction for all groups. Overcommitment and effort were significant predictors of low job satisfaction. Elevated ERI scores were reported for respondents with (77.2%) and without (35.0%) narratives indicating the respondents with narratives reported a higher incidence of elevated ERI scores compared to those without narratives. Conclusions: Many HHC RNs noted improvement is needed in their work environment. Job strain/stress is evident among HHC RNs and aspects of effort, reward, and overcommitment were found to be associated with low job satisfaction but no association with intent to leave.
    • Work-related and personal factors influencing job satisfaction and intent to leave among certified nursing assistants in nursing homes

      Choi, JiSun; Johantgen, Mary E. (2010)
      Background: In response to the rapid growth of the aging population and the decline of the nuclear family, varied levels of long-term care have developed. Yet, it has been difficult to recruit and retain the "pink collar" workers who care for the residents. Moreover, there has been little methodologically strong research to try and understand the complex factors influencing job satisfaction and intent to leave. Aim: The aims of this study were: 1) to examine the influence of relevant work-related and personal factors on job satisfaction among Certified Nursing Assistants (CNAs) working in nursing homes, 2) to examine the influence of relevant work-related and personal factors, and job satisfaction on intent to leave among CNAs working in nursing homes, and 3) to identify the latent groups of CNAs that have different relationships among the factors and intent to leave. Methods: A descriptive correlational design was used to conduct a secondary data analysis from two linked databases: the 2004 National Nursing Home Survey and the 2004 National Nursing Assistant Survey. Two-level logistic regression modeling and two-level mixture modeling were performed using Stata 10.0/IC and Mplus 5.0. Results: Job satisfaction was significantly associated with intent to leave. Supportive supervision was a significant predictor of both CNAs' job satisfaction and intent to leave. While personal factors (age, education, and job history) were related to intent to leave, but not to job satisfaction. The mixture models explored the latent classes for intent to leave. Distinct differences in the relationships among the factors and CNA intent to leave were found between two classes; one class reflected CNAs where supportive supervision was a significant effect on intent to leave while for the other group, there was no significant relationship. Conclusion: Findings corroborate the results from previous studies that showed supportive supervision or compensation significantly contribute to higher job satisfaction and less intent to leave among CNAs working in nursing homes. Yet this study found that all CNAs do not respond to the motivators in the same way. Multilevel mixture modeling is a promising analytical technique that would provide more useful data.