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1 – 10 of 876Kim Price-Glynn and Carter Rakovski
This chapter explores variation in direct care workers’ health risks within institutional and home-based settings, according to the demographic composition of workers and the…
Abstract
Purpose
This chapter explores variation in direct care workers’ health risks within institutional and home-based settings, according to the demographic composition of workers and the gendered, raced, and citizenship-based expressions of their work roles.
Methodology/Approach
This quantitative intersectional study draws on two nationwide datasets from the US National Center for Long-term Care Statistics, a division of the Centers for Disease Control and Prevention, the National Nursing Assistant Study (NNAS), and National Home Health Aide Survey (NHHAS).
Findings
Workplace context was the strongest predictor of workers’ health risks and working conditions. Physical injuries affected more than half of facility-based workers annually compared to less than 10% of home-based workers. Facility-based workers are more likely to report insufficient time for tasks, lower job satisfaction, and less respect and appreciation from patients. Home-based workers may be more likely to experience emotional distress, be offered fewer benefits, but experience fewer injuries, due to the better relative health of their patients and having more time for client care. Women reported more injuries and more time pressure than men across racial and citizenship groups within the same work setting.
Research Limitations/Implications
There are limitations to the NHHAS and NNAS public-release data file data. We are unable to fully capture citizenship, some racial/ethnic categories, workers over age 65, supervisory workers, facilities with fewer than three residents, and facilities not certified with Medicare or Medicaid. The exclusion of these questions, workers, and contexts is a weakness of the present study.
Originality/Value of Paper
Analyses draw on data from the first nationally representative sample surveys of home health aides and nursing assistants in the United States. Direct care workers are an important population to capture through intersectional research since care work is done predominantly by multiracial women and immigrants. This research also underscores the importance of workplace contexts in shaping the labor performed and the workers’ experiences.
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Per-Ola Maneschiöld and Diana Lucaci-Maneschiöld
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…
Abstract
Purpose
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.
Design/methodology/approach
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.
Findings
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.
Originality/value
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.
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Harun Sesen and Senay Sahil Ertan
This study aims to mediate the impact of workplace stress and job satisfaction on nurses’ perception of training. It sheds light on the links between job satisfaction, Certified…
Abstract
Purpose
This study aims to mediate the impact of workplace stress and job satisfaction on nurses’ perception of training. It sheds light on the links between job satisfaction, Certified Nursing Assistants’ perception of training and workplace stress in nursing homes.
Design/methodology/approach
A cross-sectional questionnaire was distributed in 12 different elderly home care centres in Northern Cyprus during September to October 2017. The sampling frame consists of 317 full-time Certified Nursing Assistants who completed measures of perception of training, job satisfaction and workplace stress. This paper used structural equation modelling to test a theoretical model and hypothesis.
Findings
The findings emphasize that Certified Nursing Assistants’ perception of training has a positive impact on their job satisfaction and negative impact on workplace stress while workplace stress mediates the relationship between their perception of training and job satisfaction. The results indicate that while the motivation for training and support for training have an effect on job satisfaction, access to training and benefits for training do not yield any significant impact on it and workplace stress plays a mediating role.
Originality/value
This study confirms that the CNAs’ perception of training and job stress affect the emergence of job satisfaction, and workplace stress mediated the relation between training and satisfaction posited by social exchange theory.
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Robert Weech-Maldonado, Akbar Ghiasi, Justin Lord, Ganisher Davlyatov, Larry Hearld, Ferhat Devrim Zengul and Kent Rondeau
Nursing homes experience high nursing staff turnover. Nursing staff in nursing homes is comprised of gray and blue collar workers that include registered nurses (RNs), licensed…
Abstract
Nursing homes experience high nursing staff turnover. Nursing staff in nursing homes is comprised of gray and blue collar workers that include registered nurses (RNs), licensed practical nurses (LPNs), and certified nurse assistants (CNAs). The relationship between human resource management (HRM)practices, organizational culture, and nursing staff turnover is examined in underresourced (high Medicaid) nursing homes. Survey data from 348 nursing home administrators (NHAs) of USA high Medicaid (85% or higher) facilities were merged with secondary data sources for 2017–2018. The dependent variables (nursing staff turnover rates) consisted of the percentages of RNs, LPNs, and CNAs that had voluntarily quit the organization during the past year. The independent variables were: (1) HRM practices (employee-centered and high involvement practices); and (2) organizational culture: clan, market, hierarchical, and non-dominant. Organizational and market variables were controlled for. Data were modeled using Poisson log-linear regression, and propensity score weights were used to adjust for potential survey non-response bias. Results show high involvement HRM practices and having a clan culture are associated with lower RN, LPN, and CNA staffing turnover. Study findings suggest that organizational culture and HRM practices may be instrumental in reducing nursing turnover in underresourced nursing homes.
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Over 3 million intermittently employed and socially disadvantaged workers receive low wages and limited benefits in diverse long-term care settings and employment arrangements as…
Abstract
Over 3 million intermittently employed and socially disadvantaged workers receive low wages and limited benefits in diverse long-term care settings and employment arrangements as they try to become a positively valued unified occupation: “direct care workers.” Before this occurs, these workers must overcome negative definitions imposed by three powerful institutions: professional guilds, employers, and states. Care workers’ legitimacy is challenged as nursing labels them “unlicensed, assistive personnel,” defining them in terms of their task relationship to nurses rather than their social relationship to clients. Care workers’ identity is obscured as corporate rationalization nullifies their unique contributions with task unbundling, part-time work, short staffing, and turnover undermining bonding with colleagues and clients. State regulation impedes care workers’ integration, segmenting similar workers under different regulatory regimes, defining workers negatively rather than by their educational attainments and competencies. Overcoming this triple negation will require not just cultural change, but also real structural changes, and can occur only through concerted actions involving coalitions. Labor market intermediaries, public authorities, labor unions, workforce investment boards, philanthropic organizations, and government interagency groups are among those supporting direct care workers’ advancement by strategically coordinating licensing, purchasing, and developing the workforce. Recent federal policy changes and health reform legislation have enhanced recognition of this occupation and are providing new resources for its development.
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David B. Lipsky and Ariel C. Avgar
This chapter presents an overview of our evaluation of the introduction of electronic medical records (EMR) in 20 nursing homes located in the New York City region. These…
Abstract
This chapter presents an overview of our evaluation of the introduction of electronic medical records (EMR) in 20 nursing homes located in the New York City region. These organizations were part of an EMR demonstration project cosponsored by the for-profit segment of the nursing home industry in the region and 1199SEIU United Health Care Workers East, the union that represented frontline staff in these organizations. We report central lessons from our evaluation, which took place over the course of four years and included multiple data sources. The primary purpose of our research was to examine the effects of EMR adoption on employment and labor relations in the participating organizations. Findings are based on a longitudinal study of EMR adoption in 15 of the 20 organizations that received the EMR technology and five “control” organizations, which did not receive the technology, employing a mixed methodological design with both quantitative and qualitative data collection methods. Results from our research inform the existing EMR adoption discussion in two ways. First, we find mixed evidence associated with EMR implementation. The adoption of this new technology enhances certain organizational outcomes, but it seems to hinder others. Second, findings from our research highlight the importance of preexisting organizational factors as predictors of EMR-associated outcomes. EMR-associated outcomes, positive or negative, are likely to be contingent on key organizational characteristics and on managerial adoption strategies. Our study's findings imply that the meaningful use of EMR needs to take into account not only the technical specifications of EMR but also the organizational characteristics of the physician practices and healthcare facilities adopting the technology. Healthcare organizations vary in their capacity and ability to make optimal use of health information technology, which should be incorporated into public policy and organizational practices designed to increase adoption.
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Kelly Noe and Dana A. Forgione
We examine the association of for-profit (FP) and nonprofit (NP) economic incentives in hospice care providers with financial and nonfinancial metrics of management performance…
Abstract
We examine the association of for-profit (FP) and nonprofit (NP) economic incentives in hospice care providers with financial and nonfinancial metrics of management performance. Controlling for quality of patient care and differences in cost-efficiency, we find that FP providers (1) selectively admit patients with longer life-prognoses and billable days and hence lower average costs per day, (2) employ a lower average cost/skill mix of workers, and (3) have higher CEO compensation and profit. The NP providers admit more patients with the less profitable life-prognoses attributes, have lower CEO compensation, and reinvest their net earnings under the non-distribution constraint. While the profit incentive may be needed to attract providers into this rapidly growing and underserved market, the NP providers return a lower cost per patient served from the taxpayer's perspective.
Extant research has shown the positive effects of value congruence on individual attitudes, behaviors and performance. However, very few studies have been conducted to examine the…
Abstract
Purpose
Extant research has shown the positive effects of value congruence on individual attitudes, behaviors and performance. However, very few studies have been conducted to examine the difference in the relationship between value congruence and attitudinal outcomes across people of different attributes. The purpose of this paper is to examine how the relationships between employee-organization value congruence and job attitudes vary across different occupational groups, with the focus on different levels of nurses. The study provides evidence to organizations to adopt better approaches to harness the benefit from employees’ spontaneous work motivation.
Design/methodology/approach
Nursing homes provide a unique research context because of the different nursing occupations with varying degree of identifying characteristics including educational attainment, skill level, income and decision-making power. The present study thus examines how the relationships between nurses-home value congruence and nurses’ job attitudes vary across different nursing occupations, instrumented by a survey of nursing staff of nursing homes in a Midwestern state in the USA.
Findings
Consistent with prior research, value congruence is found positively associated with nurses’ job satisfaction and organizational commitment, but negatively with turnover intention. Consistent with the “diminishing marginal effect” argument, the relationships between value congruence and job satisfaction and organizational commitment are found more pronounced among nurses of lower occupational level.
Originality/value
The extant literature does not explicitly compare the effect of within-occupation value congruence on various attitudinal and behavioral outcomes across different occupations. As values have individual and social foundations, in a specific workplace context, it is impractical, if not impossible, to gain a comprehensive view of employees’ value profile and work-related consequences without looking further into the differences across types of employee. Although without sufficient existing literature to compare to, the present study does provide consistent results with theoretical predictions, and display a relatively clear picture of how the relationships between value congruence and job attitudes are unwrapped along the occupational dimension.
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Kechinyere C. Iheduru-Anderson and Monika M. Wahi
This chapter proposes a global agenda to eliminate racism in nursing by targeting reform at nursing education administration internationally. First, the history of racism in…
Abstract
This chapter proposes a global agenda to eliminate racism in nursing by targeting reform at nursing education administration internationally. First, the history of racism in nursing is reviewed, along with two models – the diversity model and the cultural competence model – that were applied unsuccessfully to counteract racism in nursing. Second, a description of how racism is entrenched in nursing leadership globally is presented. Third, the recalcitrant structures that serve to maintain institutionalized racism (IR) in the international nursing education system are carefully examined. Specifically, the components and constructs involved in IR in nursing education are delineated, and the way in which these negatively impact both ethnic minority (EM) students and faculty are explained. Based on this, a global agenda to eliminate racism in nursing education internationally is proposed. Eliminating racism in higher education in nursing is a mandatory social responsibility if global healthcare is ever to be equitable. Five actionable recommendations are made to eliminate racism in higher education are summarized as follows: (1) components of nursing programs which are designed to eliminate racism in nursing education should be governed at the country level, (2) to design and implement a system of surveillance of the global nursing community to enable standardized measurement to ensure nursing education programs in all countries are meeting anti-racism benchmark targets, (3) nursing education programs should be established worldwide to provide individual pipeline and mentorship programs to ensure the career success of EM nursing students and faculty, (4) nursing education programs should be conducted to reduce barriers to EM participation in these individual support programs, and (5) nursing education programs are required to teach their nursing faculty skills in developing anti-racist curricula that seeks to eliminate implicit bias.
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High turnover of staff in the long-term dementia care sector contributes to poor quality care and lack of continuity of care in the UK and many other countries. The purpose of…
Abstract
Purpose
High turnover of staff in the long-term dementia care sector contributes to poor quality care and lack of continuity of care in the UK and many other countries. The purpose of this paper is to explore the research evidence on what care assistants report they enjoy when working in front-line dementia care jobs in long-term care facilities.
Design/methodology/approach
An integrative analysis was used to study research findings focusing on the front-line workforce in care homes. The literature review sought to capture key findings, including overviews of research, from studies from 1990 to mid-2014 that have considered the positive experiences of front-line care home staff working with people with dementia.
Findings
There is a great deal of research investigating care home staff's job satisfaction. Much of this highlights the importance of personal, social and managerial relationships. Common themes continue to be reported. There is potential for work on improving care assistant experiences in care homes but also a need to address long-standing inequities affecting the care home sector.
Research limitations/implications
Some studies are not precise about which staff groups they are investigating in studies about care homes and many concentrate on the problems staff report. Measures of job satisfaction vary. When exploring dementia-related care not all studies are clear if care home residents have dementia or not.
Practical implications
Many studies have investigated the views of care assistants working with people with dementia in care homes that address happiness in their work, often reported as job or work satisfaction, and these should be consulted when developing dementia services or managing care homes. As with other parts of the social care workforce, employers and managers need to be aware of effective and acceptable workforce reforms and ways to reduce turnover.
Originality/value
This review suggests the value of investigating positive aspects of care work with people with dementia living in care homes. Greater attention could be paid to job satisfaction in social care more widely.
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