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Elderly/Long-term Care

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Increasing the time that nurses spend with nursing home residents is key to improving their job satisfaction

The work of nurses and certified nursing assistants (CNAs) at U.S. long-term care (LTC) facilities is physically difficult and emotionally exhausting with a turnover rate of more than 100 percent among these frontline workers. Increasing the time that nurses spend with nursing home residents is key to improving their job satisfaction, concludes a study supported by the Agency for Healthcare Research and Quality (HS12031). Researchers found that nurse satisfaction was primarily influenced by intrinsic feedback from nursing home residents: for example, when residents tell them how much their care has helped them or meant to them or when nurses are able to see the tangible results of their efforts (such as the satisfaction of seeing a resident eat well at a meal as a result of patient coaching).

The researchers conducted job design and satisfaction surveys of 1,146 employees of 20 Massachusetts LTC facilities. They also interviewed 144 employees representing all staffing levels from nursing directors to CNAs, and observed 37 frontline nurses and CNAs. Contrary to expectations, CNAs were more satisfied with their jobs than nurses and reported significantly higher levels of intrinsic feedback from residents, with whom they worked more closely than nurses. Nurses spent more time coordinating patient care than tending to patients.

For CNAs, satisfaction was influenced by task identity, autonomy, and intrinsic feedback. However, satisfaction among nurses was influenced only by intrinsic feedback from residents. In fact, nurses described lack of interaction with residents as the worst part of their jobs, along with the burden of paperwork they had to complete. The LTC administrators interviewed in this study said that retaining nurses was their main concern. The researchers suggest that managers may improve nurse retention rates by hiring nurses who are seeking less direct patient care and more managerial positions. Another approach would be to permanently assign individual nurses to certain residents with whom they could build relationships.

See "An exploration of job design in long-term care facilities and its effect on nursing employee satisfaction," by Denise A. Tyler, M.A., Victoria A. Parker, D.B.A., Ryann L. Engle, M.P.H., and others, in the April 2006 Health Care Management Review 31(2), pp. 137-144.

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