National Nursing Assistant Survey Research Articles

THE IMPACT OF WORKPLACE DEMANDS AND RESOURCES ON THE JOB SATISFACTION OF MINORITY AND IMMIGRANT CNAS

Abstract This study examines the association between occupational stress (job resources and demands) and job satisfaction among nursing assistants (NAs) in the long-term care (LTC) sector, considering differences based on race/ethnicity and immigration status. Data from 2,763 NAs were retrieved from the National Nursing Assistant Survey (NNAS). Guided by the JD-R model, our findings indicate that higher job resources, including organizational support, personal development opportunities, benefits, and peer support, are associated with greater job satisfaction among NAs. Conversely, higher job demands, such as structural, physical, and emotional demands, are linked to lower job satisfaction. Importantly, significant differences in occupational stress were observed based on race/ethnicity and immigration status. Hispanic NAs reported the lowest benefits, Black NAs reported the lowest levels of residents’ respect, and White NAs reported the lowest peer support. Naturalized NAs experienced higher job satisfaction with greater job resources, while resident NAs had lower satisfaction associated with higher job demands. These findings highlight the need for tailored support mechanisms to address disparities in job rewards and recognition among different racial/ethnic and immigration groups.

Occupational Stress and Job Satisfaction: Differences Among Racial/Ethnic and Immigration Groups.

The current study aimed to investigate the factors contributing to long-term care workers' job satisfaction by examining the association between occupational stress (including job resources and job demands) and job satisfaction, and the differences among racial/ethnic and immigration groups. Data of 2,763 nursing assistants were retrieved from the National Nursing Assistant Survey. Guided by the job demands-resources model, we found that high job resources and low job demands contributed to job satisfaction. Our findings also suggest that occupational stress works differently based on race/ethnicity and immigration status. Long-term care providers looking to recruit and retain workers should include multiple job resources tailored to their diverse workforce. Designing existing workplace environments to promote job resources and reduce job demands is a useful way to lessen the adverse effects of occupational stress within the workplace. [Journal of Gerontological Nursing, 49(11), 42-52.].

The Impact of Supervisor Support on the Job Satisfaction of Immigrant and Minority Long-Term Care Workers.

Previous research has demonstrated the effect of supervisor support on the job satisfaction of long-term care workers (LTCW); however, much less is known about how this effect differs among race/ethnicity or immigration groups. We examined how supervisor support mediates the associations between race/ethnicity, immigration status, and job satisfaction among nursing assistants (NAs). Data of 2749 NAs were extracted from the National Nursing Assistant Survey (2004). Findings indicated that NAs of non-Hispanic Black and other races and immigrant workers were more likely to be satisfied with their jobs compared to White and non-immigrant workers, and the associations were mediated by NAs' perceived supervisor support. Minority or immigrant LTCW may be more sensitive to supervisory support and more grateful if they received support from supervisors. Managers should be aware of these racial differences and by being supportive they may improve NAs job satisfaction and reduce turnover rates.

The Impact of Supervisor Support on the Job Satisfaction of Immigrant and Minority Long-Term Care Workers

The need for long-term care workers (LTCW) will grow significantly as the American population ages. Understanding the factors that impact job satisfaction of this workforce has important implications for policy and practice. Previous research has demonstrated the effect of supervisor support on the job satisfaction of these workers; however, much less is known about how this effect differs among different race/ethnicity or immigration groups. This study examined how supervisor support mediates the associations between race/ethnicity, immigration status, and job satisfaction among nursing assistants (NAs). Data of 2,763 NAs were extracted from the National Nursing Assistant Survey (2004). Race/ethnicity groups included White (54%), African American (30%), Asian (2%), Hispanic (10%), and others (4%). Immigration status included U.S.-born citizens (87%), naturalized (7%) and resident/alien (6%). Bivariate analyses showed that Asian NAs perceived higher levels of supervisory support than other races, whereas U.S.-born NAs reported lower levels of supervisory support than naturalized and residents/aliens. Findings from multivariate analyses indicated that non-Hispanic Asians and Resident/Alien workers reported significantly higher levels of job satisfaction than their counterparts, and the associations were fully mediated by NAs’ perceived supervisor support. These findings support prior research that supervisor support is important to improving job satisfaction and contribute to the literature that Asians/Residents/Aliens long-term care workers may be more sensitive to supervisory support and may be more grateful if they received support from supervisors. Managers should be aware of these racial differences and by being supportive they may improve NAs job satisfaction and reduce turnover rates.

PERCEIVED SUPERVISOR RESPECT, JOB SATISFACTION, AND WORD OF MOUTH RECRUITMENT AMONG CERTIFIED NURSING ASSISTANTS

Long-term care (LTC) facilities across the United States are suffering from a shortage of Certified Nursing Assistants (CNAs). These direct care workers are vital to the success of the LTC facilities, as they provide the majority of the hands-on care needed by facility residents. Implementing new methods of recruitment is a possible solution to this shortage. One unexplored avenue for CNA recruitment is through word of mouth (WOM) communication. Past research identifies positive WOM communication about an organization as an effective method for increasing potential applicants’ degree of attraction to an organization (Van Hoye & Lievens, 2009). A commonly cited antecedent to positive WOM behavior is job satisfaction. Because the perception that one is respected by one’s supervisors is an important element of CNAs’ job satisfaction, we hypothesized that perceived respect may mediate the association of job satisfaction with WOM. Specifically, the current study utilized self-report measures from the 2004 National Nursing Assistant Survey (n = 2466) to test the indirect effect of job satisfaction on the relationship between CNAs’ perceived supervisor respect and WOM communication (operationalized as willingness to recommend the facility as a place to work). Analyses using a bootstrapping method and PROCESS macro (Hayes, 2013) and controlling for relevant covariates indicated that job satisfaction partially mediates the relationship between perceived supervisor respect and WOM communication. Results suggest that interventions to improve CNAs’ job satisfaction, and particularly perceived respect by supervisors, may lead to an increase in positive WOM communication about LTC facilities to potential employees.

Associations between state regulations, training length, perceived quality and job satisfaction among certified nursing assistants: Cross-sectional secondary data analysis

BackgroundIn the U.S., there are federal requirements on how much training and annual continuing education a certified nursing assistant must complete in order to be certified. The requirements are designed to enable them to provide competent and quality care to nursing home residents. Many states also require additional training and continuing education hours as improved nursing home quality indicators have been found to be related to increased training. ObjectivesThis study investigated the associations among state level regulations, initial training quality and focus, and job satisfaction in certified nursing assistants. DesignCross-sectional secondary data analysis. SettingsThis study used the National Nursing Home Survey and National Nursing Assistant Survey as well as data on state regulations of certified nursing assistant training. Participants2897 certified nursing assistants in 580 nursing homes who were currently working at a nursing home facility, who represented 680,846 certified nursing assistants in US. MethodsState regulations were related to initial training and job satisfaction among certified nursing assistants using chi square tests and binomial logistic regression models. Analyses were conducted using SAS-callable SUDAAN to correct for complex sampling design effects in the National Nursing Home Survey and National Nursing Assistant Survey. Models were adjusted for personal and facility characteristics. ResultsCertified nursing assistants reporting high quality training were more likely to work in states requiring additional initial training hours (p=0.02) and were more satisfied with their jobs (OR=1.51, 95% CI=1.09–2.09) than those with low quality training. In addition, those with more training focused on work life skills were 91% more satisfied (OR=1.91, 95% CI=1.41–2.58) whereas no relationship was found between training focused on basic care skills and job satisfaction (OR=1.36, 95% CI=0.99–1.84). ConclusionsCertified nursing assistants with additional initial training were more likely to report that their training was of high quality, and this was related to job satisfaction. Job satisfaction was also associated with receiving more training that focused on work life skills. Federal training regulations should reconsider additional hours for certified nursing assistant initial training, and include work life skills as a focus. As job satisfaction has been linked to nursing home turnover, attention to training may improve satisfaction, ultimately reducing staff turnover.

Training of Home Health Aides and Nurse Aides: Findings From National Data

Training and satisfaction with training were examined using data from nationally representative samples of 2,897 certified nursing assistants (CNAs) from the National Nursing Assistant Survey and 3,377 home health aides (HHAs) from the National Home Health Aide Survey conducted in 2004 and 2007, respectively. This article focuses on the commonalities and differences in the perceptions of CNAs and HHAs regarding the initial and continuing education they received to prepare them for their job. More than 80% of HHAs and all CNAs received some initial training. Of these, significantly more HHAs compared to CNAs felt that training had prepared them “very well” for their jobs. The two groups also differed in their assessments of the content of the initial training; for example, more CNAs believed that their training was “excellent” in helping them address patients' limitations in activities of daily living compared to HHAs. The vast majority of HHAs and CNAs received continuing education, and about three fourths in each group assessed this training as being “very useful.” In light of the increasing demands for HHAs and CNAs with the aging of America, findings from these national studies could be used to inform educational and training initiatives for this critical workforce.

The importance of supervision in retention of CNAs

Certified nursing assistants (CNAs) provide the majority of direct care in nursing homes, yet recruiting and retaining CNAs has been difficult. Retaining CNAs is important because it has been linked to the better quality of resident care in nursing homes. In this study, the investigators examined the relationships of work-related and personal factors to CNA job satisfaction and intent to leave. Linked data from the 2004 National Nursing Home Survey and the 2004 National Nursing Assistant Survey were analyzed using multilevel logistic regression. Personal factors such as age, education, and job history, were related to intent to leave but not to job satisfaction. Supportive supervision was a significant predictor of both job satisfaction and intent to leave.

Transformational leadership and workplace injury and absenteeism

Transformational leadership (TL) has long been popular among management scholars and health services researchers, but no research studies have empirically tested the association of TL with workplace injuries and absenteeism among nursing assistants (NAs). This cross-sectional study seeks to explore whether TL is associated with workplace injuries and absenteeism among NAs. We analyzed the 2004 National Nursing Assistant Survey data (n = 2,882). A multivariate logistic regression analysis was performed to test the role of TL in the context of workplace performances. Results reveal that the TL model was positively linked to workplace injury in the level of NAs. Injury-related absenteeism was also associated with the TL style, indicating that TL behaviors may help address workplace absence among NAs. Findings suggest that introducing TL practices may benefit NAs in improving workplace performances.

Do assistive devices, training, and workload affect injury incidence? Prevention efforts by nursing homes and back injuries among nursing assistants.

This paper is a report of a study of association between workplace injuries experienced by nursing assistants in nursing homes in the United States and four factors that may affect injury rates: initial nursing assistant training, training at the current facility, lifting devices, and time to execute daily duties. High injury rates among nursing personnel have been reported in multiple settings across countries. The existing literature is divided on the effectiveness of training and assistive devices in reducing injury rates among nursing assistants. We examined associations between whether or not the nursing assistant has experienced an injury and four key factors: quality of initial injury prevention training, injury prevention training at current facility, lift availability and whether or not the nursing assistant has sufficient time to complete resident activities of daily living. We estimated a survey-weighted logit model using 2004 National Nursing Assistant Survey data. The odds of an injury in the past year were lower among nursing assistants who reported always having a lift available when needed (41% lower odds), available facility training to reduce workplace injuries (39%), and sufficient time to complete resident activities of daily living (35%). Quality of initial training to prevent work injuries was not significantly associated with injury status. Regions without widespread access to lifting devices may be able to reduce injury rates by increasing the availability of lifting devices. The potential for reductions in injury rates in the United States is greatest from improving training and ensuring adequate time for resident care, as most facilities currently have lifts available.

Influenza Vaccination Coverage Among US Nursing Home Nursing Assistants: The Role of Working Conditions

To estimate influenza vaccination coverage among nursing assistants (NAs) working in US nursing homes, and to identify demographic and occupational predictors of vaccination status among NAs. Cross-sectional analysis of data on 2873 NAs from the 2004 National Nursing Assistant Survey. Multivariable-adjusted vaccination coverage (prevalence) ratios for demographic and occupational characteristics were calculated using Poisson regression. Outcome variable was NAs' influenza vaccination status, yes or no, based on the question, "During the past 12 months, did you receive a flu shot?" Coverage for all NAs working in US nursing homes was estimated to be 37.1%. NAs 45 or older were more likely to be vaccinated than younger NAs (prevalence ratio [PR] = 1.23, 95% confidence interval [CI]: 1.07-1.41). Significant negative associations with vaccination status were found for NAs who were non-Hispanic blacks (PR = 0.82, 95% CI: 0.70-0.97), disagreed that they were respected/rewarded for their work (PR = 0.85, 95% CI: 0.71-1.00), worked at for-profit facilities (PR = 0.83, 95% CI: 0.72-0.95), and reported receiving fewer than 7 of 15 nonwage job benefits (PR = 0.77, 95% CI: 0.67-0.90). Influenza coverage among nursing home NAs appears to be similar to nationally reported coverage estimates among health care providers in the United States in general. In addition to individual characteristics, occupational characteristics reflective of working conditions are associated with vaccination status among NAs, suggesting that further research into these types of associations may be useful in identifying which institutions may benefit from outreach efforts and types of interventions to increase vaccination coverage.

Racial and ethnic disparities in work-related injuries and socio-economic resources among nursing assistants employed in US nursing homes

We aimed to estimate the proportion of nursing assistants (NAs) in the US with work-related injuries and insufficient socio-economic resources by race/ethnicity. Data from the 2004 National Nursing Assistant Survey (NNAS), a nationally representative sample survey of NAs employed in United States nursing homes, were analyzed accounting for the complex survey design. Among 2,880 participants, 44% reported "scratch, open wounds, or cuts" followed by "back injuries" (17%), "black eyes or other types of bruising" (16%), and "human bites" (12%). When compared to non-Hispanic white NAs, the adjusted rate ratio (RR) for wound/cut was 0.74 for non-Hispanic black NAs (95% confidence interval [CI]: 0.65-0.85). RRs for black eyes/bruises were 0.18 for non-Hispanic black NAs (95% CI: 0.12-0.26), and 0.55 for Hispanic NAs (95% CI: 0.37-0.82). Minority racial and ethnic groups were less likely to report having experienced injuries compared with non-Hispanic white NAs. Future research should focus on identifying preventable risk factors, such as differences by race and ethnicity in the nature of NA jobs and the extent of their engagement in assisting patients with activities of daily living.

A National Overview of the Training Received by Certified Nursing Assistants Working in U.S. Nursing Homes

A few geographically limited studies have indicated that training of direct care workers may be insufficient. Using the first-ever nationally representative sample of certified nursing assistants (CNAs) from the 2004 National Nursing Assistant Survey (NNAS), this descriptive article provides an overview of the type of initial training and continuing education received by CNAs working in nursing homes, reports CNAs' assessments of the adequacy of their training, and identifies perceived training needs from the points of view of CNAs. Findings could be used to inform changes to the initial training and continuing education curriculum for this essential labor workforce.

Workplace Assaults on Nursing Assistants in US Nursing Homes: A Multilevel Analysis

We examined risk factors for injuries to nursing assistants from assaults by nursing home residents at both the individual and the organizational level. We analyzed data from the 2004 National Nursing Assistant Survey that were linked to facility information from the 2004 National Nursing Home Survey by use of multilevel modeling that accounted for the complex survey design effect. Thirty-four percent of nursing assistants surveyed reported experiencing physical injuries from residents' aggression in the previous year. Mandatory overtime (odds ratio [OR] = 1.65; 95% confidence interval [CI] = 1.22, 2.24) and not having enough time to assist residents with their activities of daily living (OR = 1.49; 95% CI = 1.25, 1.78) were strongly associated with experiencing injuries from assaults. Nursing assistants employed in nursing homes with Alzheimer care units were more likely to experience such injuries, including being bitten by residents. Reducing mandatory overtime and having a less demanding workload may reduce the risk of workplace violence. In particular, prevention activities should be targeted at those nursing homes that care for cognitively impaired patients.

Immigrant and Non-Immigrant Certified Nursing Assistants in Nursing Homes: How Do They Differ?

This study analyzes the 2004 National Nursing Assistant Survey and other survey data to examine the characteristics and experiences of immigrant and non-immigrant certified nursing assistants (CNAs) in nursing facilities. Descriptive results focus on differences in personal characteristics, working conditions, extrinsic rewards, work experiences, job satisfaction, and workplace discrimination. The findings indicate that immigrant CNAs are older, better educated, and somewhat more highly paid than their non-immigrant counterparts but also experience substantial levels of discrimination and language-related communication barriers at work. The paper discusses major policy issues that arise from the increase in immigrant labor in long-term care.

The Relationship Between Workplace Environment and Job Satisfaction Among Nursing Assistants: Findings From a National Survey

To identify supervisory factors related to job satisfaction among certified nursing assistants (CNAs). Although this topic has been studied at the facility and state levels, it has not previously been addressed in a nationally representative sample. Cross-sectional analysis of data from the 2004 National Nursing Assistant Survey, conducted by the National Center for Health Statistics. Nationally representative sample of nursing homes (n = 790). Eight randomly selected CNAs from each nursing home, 4 who had been at that job for less than 1 year and 4 at the job for a year or more (n = 3011). Analysis was limited to 2897 individuals working at the same facility when interviewed. Job satisfaction was measured by a 6-item score addressing workplace morale, challenging work, benefits, salary or wages, learning new skills, and overall satisfaction. Characteristics of the work environment included supervisor behavior, time pressures, organizational climate, perception that the CNA's work was valued, and whether the CNA principally cared for the same residents. In adjusted analysis, organizational climate, supervisor behavior, sufficient time for tasks, and being valued were positively associated with job satisfaction, as were hourly earnings. Clear communication from supervisors and evidence that the CNA function is valued were associated with job satisfaction. Specific strategies, such as merit raises and job design, may increase job satisfaction.

Prevalence of Nursing Assistant Training and Certification Programs Within Nursing Homes, 1997-2007

The purpose of this study was to describe how the prevalence of nurse aide training and competency evaluation programs (NATCEPs) provided in the nursing home (NH) setting changed between 1997 and 2007, to explore the environmental factors that may be influencing the prevalence of these programs, and to examine how the changing prevalence of NH-based NATCEPs may be affecting those considering certified nursing assistant (CNA) work. We used the Online Survey Certification and Reporting (OSCAR) data to generate descriptive statistics for 3 groups of NHs from 1997 to 2007: NHs that never provided an NATCEP, those that provided the program throughout the study period, and those that provided the program intermittently. We gathered information on states' policies regarding CNA training by telephone and Internet. Data from the National Nursing Assistant Survey were also utilized to describe where CNAs are receiving their training and what proportion of costs they are paying. Prevalence of NH-based programs dropped throughout the study period. It is likely that most CNAs are now receiving their preemployment training outside the NH setting and paying a greater share of their training costs. The shifting of CNA training to venues other than NHs raises important questions about the quality of training and states' ability to monitor training programs. In addition, CNAs receiving training outside NHs pay a greater share of their training costs, possibly creating a disincentive to enter the field.

Intrinsic Job Satisfaction, Overall Satisfaction, and Intention to Leave the Job Among Nursing Assistants in Nursing Homes

We examined predictors of intrinsic job satisfaction, overall satisfaction, and intention to leave the job among nursing assistants (NAs). The study focused on NAs who worked 30 or more hours per week in a nursing home. Data on 2,146 NAs meeting this criterion came from the 2004 National Nursing Assistant Survey, the first telephone interview survey of NAs nationwide. Regression equations were calculated in which intrinsic satisfaction, overall satisfaction, and intention to leave were dependent variables. NA attributes (e.g., job tenure and education) and extrinsic job factors (e.g., assessment of supervisor behavior, pay satisfaction, and benefits) were exogenous variables. A positive assessment of the supervisor's behavior had the strongest association with intrinsic satisfaction. Pay satisfaction had the second strongest association with intrinsic satisfaction. Predictors with the strongest associations with intention to leave were overall and intrinsic satisfaction. Assessment of the supervisor was not associated directly with intention to leave. Assessments of the supervisor and pay may affect overall satisfaction and intention to leave in part through their direct effects on intrinsic satisfaction. Some facility and NA attributes were related to intrinsic satisfaction but not to overall satisfaction, suggesting that intrinsic satisfaction may be an intervening variable in the impact of these attributes on overall satisfaction. Intrinsic satisfaction and extrinsic job factors amenable to change appear central to NAs' overall satisfaction and intention to leave. A facility may be able to improve extrinsic job factors that improve NAs' job-related affects, including intrinsic satisfaction.

Nursing Home Work Practices and Nursing Assistants' Job Satisfaction

To estimate the impact of nursing home work practices, specifically compensation and working conditions, on job satisfaction of nursing assistants employed in nursing homes. Data are from the 2004 National Nursing Assistant Survey, responses by the nursing assistants' employers to the 2004 National Nursing Home Survey, and county-level data from the Area Resource File. Multinomial logistic regression was used to estimate effects of compensation and working conditions on nursing assistants' overall job satisfaction, controlling for personal characteristics and local labor market characteristics. Wages, benefits, and job demands, measured by the ratio of nursing assistant hours per resident day, were associated with job satisfaction. Consistent with previous studies, job satisfaction was greater when nursing assistants felt respected and valued by their employers and had good relationships with supervisors. Nursing assistants were more satisfied when they had enough time to complete their work, when their work was challenging, when they were not subject to mandatory overtime, and where food was not delivered to residents on trays. This is the first investigation of nursing assistant job satisfaction using a nationally representative sample of nursing assistants matched to information about their employing nursing homes. The findings corroborate results of previous studies in showing that compensation and working conditions that provide respect, good relationships with supervisors, and better staffing levels are important to nursing assistant job satisfaction.

Characteristics and Recruitment Paths of Certified Nursing Assistants in Rural and Urban Nursing Homes

Most nursing home care is provided by certified nursing assistants (CNAs), but little is known about rural CNAs. To develop a representative geographic profile of the CNA workforce, focusing on paths leading to present job. Cross-sectional analysis of data from the 2004 National Nursing Assistant Survey (NNAS), a nationally representative survey of 3,017 CNAs; analysis was restricted to 2,897 currently working CNAs. Location was categorized as metropolitan, micropolitan, or neither (other rural county). Demographics included age, sex, race, education, income, and years at present job. Analyses were weighted to reflect the complex sampling design. CNAs in micropolitan and other rural nursing homes were more likely to be white and US citizens than were urban CNAs. Rural or micropolitan CNAs were more likely to note "job close to home" as a reason for becoming a CNA than were urban CNAs (70.8%, 66.3%, and 43.6%, respectively; P < .001). Over half of CNAs (52.2%) entered the field from a different job category. CNAs in micropolitan and small rural counties were more likely than urban CNAs to report being trained at a nursing facility (61.4%, 65.4%, 52.5%; P < .001) rather than community college or other site. Informal means (family and friends) were the most common recruitment path. Career-changers (individuals entering the CNA role from another job) represent a major recruitment target. The prevalence of informal networks in CNA recruitment history suggests that nursing homes seeking to become "employers of choice" will be advantaged when recruiting.