Nursing assistant's perceptions of the good work environment in municipal elderly care in Sweden -a focus group study.

Per-Ola Maneschiöld,Diana Lucaci-Maneschiöld

doi:10.1108/jhom-07-2020-0290

Per-Ola Maneschiöld, Diana Lucaci-Maneschiöld

Open Access

https://doi.org/10.1108/jhom-07-2020-0290

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Abstract

The purpose of this paper is to investigate aspects related to difficulty to retain nursing assistants at nursing homes in Sweden related to perceived work environment characteristics. To reveal aspects related to difficulty to retain nursing assistants, the paper uses the BIKVA model, sense of coherence and New Public Management (NPM). In total, three focus groups with nursing assistants at three nursing homes are interviewed with corresponding individual interviews with their senior managers and users. The purpose is to analyze the situation from the affected group of nursing assistants. The focus of this study is how nursing assistants discuss related to recruit and retain nursing assistants at nursing homes and elderly care and the response from senior management related to those aspects. The main conclusions are that nursing assistants consider their job as meaningful, but limited latitude and direct involvement in managing their daily tasks in a continuous communication with management affect negatively. Furthermore and combined with wage levels, aspects related to scheduling, working hours, shift work, split shifts and understaffing generate a burdensome and stressful environment affecting the possibility to retain staff in a negative direction. The research uses a new approach utilizing the BIKVA model, sense of coherence and NPM. The study shows that central in retaining nursing assistants at nursing homes relates to aspects such as wages, staffing, shift work and split shifts and continuous communication between nursing assistants and management.

Highlights

Certified nursing assistants in elderly care, being the direct care staff, are difficult to recruit and retain with high turnover rates (Decker et al, 2003)
As public policy has to achieve adequate staffing levels and lower turnover rates, it is of interest to analyze aspects related to the interest for nursing assistants to remain employed at nursing homes other than staffing standards to address these problems
The nursing assistants at all nursing homes in the study consider their job as meaningful, and that belonging to a team of colleagues creates a significant feeling of safety in the job situation and workplace

Summary

Introduction

Certified nursing assistants in elderly care, being the direct care staff, are difficult to recruit and retain with high turnover rates (Decker et al, 2003). A more decentralized control of resources in the organization generates latitude to decide how services should be performed and produced, e.g. by involving nursing assistants in that process This adds to give good care related to interaction between staff and user as the central aspect (Lauri, 2016). NPM includes an auditing function at both the financial and professional levels using transparent means to review performances, setting benchmarks, using protocols to ameliorate professional behavior with greater customer orientation and responsiveness to user demands (Hood, 1991) As a result, this can decrease the sense of coherence, focusing on cost-efficient production, budget awareness and lack of resources limiting aspects such as predictability and understandability of governing with negative impact on engagement and motivation. An outcome is that it devalues and deters the surfacing of emotions, reducing the amount of time available to meet users with distancing from users’ dependency and needs (Lauri, 2016)

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