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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.

This chapter deals with a long and intense conflict between nurses and nursing assistants within the context of the Norwegian health care system. Caring work is culturally coded as female. A major issue embedded in the conflict concerns the definition of knowledge. The issue, it is argued, is not so much what constitutes knowledge, but what counts as professional expertise and theoretical knowledge when it comes to women’s work, which is devalued. As a middle‐class women’s occupation, nurses have strong aspirations that their work be acknowledged as a full profession. Their knowledge base is a combination of practical and theoretical knowledge, profoundly different from medicine they themselves argue. Such a “professionalisation” of care work is, however, threatened by the mere presence of nursing assistants and the overlapping work they do. For various reasons – not least strategic – the concept of basic care was introduced more than ten years ago. The term was rather vaguely defined, but seems to comprise all personal care for the patient and the patient’s body, including intimate tasks such as washing, dealing with bodily waste products, feeding, etc. Making basic care the exclusive preserve of nurses and delegating the more “housewifely” tasks to nursing assistants effectively excludes the latter from caring work and, not surprisingly, they strongly oppose existing working boundaries and the redistribution of tasks. We investigate the power relationship between the two occupational groups and examine dual closure strategies. Interestingly, nurses have invested in a precarious strategy by reclaiming the hands‐on bodywork that is often labelled “dirty work”. In Western societies these tasks are commonly left to working‐class women. The conflict is thus about both gender and class in an androgynous professional world. The aim is to explore the occupational conflict and to trace some of its implications for theorising professions. Professional tasks, knowledge claims, and the concept of dirty work are addressed, and professional projects and strategies discussed from a gender perspective.

Considerable research on the experiences of contemporary workers theorizes everyday acts of resistance as inconsequential, emphasizing their limited impact on overarching structures of inequality. This chapter offers a different perspective. Drawing on a feminist interpretivist paradigm, I argue that such characterizations of everyday resistance fail to account for the ways in which workers themselves make sense of power dynamics at work. Incorporating such accounts complicates conventional understandings of low-income workers engaged in everyday resistance as either dupes, as is often suggested by academic research, or schemers, as is frequently articulated by the self-perceived targets of worker rule-breaking – their managers. Based on 10 months of ethnographic observation and interviews with nurses and nursing assistants in a long-term care facility, I demonstrate that while workers recognize the constraints within which they act, they nonetheless make sense of their acts of everyday resistance as defiant. The realities of precarious labor and family responsibility do not combine to prevent resistance at work for these women; they combine to transform it. Asserting their agency through a series of relatively mundane and covert acts that gain them autonomy and dignity, workers readily acknowledge their policy refusals while at the same time recognizing the factors that shape them. Describing subversions of authority as strategic collaborations, the constrained agency these workers articulate hinges on their own and their coworkers’ identities not just as workers, but in many cases as low-income working mothers.

Within the context of residential care settings in England and Germany little consideration is given to the role of care assistants. Policies that determine the staffing levels in both countries have resulted in care assistants making a considerable contribution towards the ‘hands‐on’ care of dependent, older people. However, the policies overlook the need to encourage and support care assistants in developing the skills required to provide effective, efficient care to dependent, older people. This paper presents the findings of a small‐scale qualitative study conducted in residential care settings situated in the south east of England and north Germany. The study establishes the connection between the nature of ‘emotional labour’ and the need to provide suitable training to care assistants, thus influencing the quality of care provided to dependent, older people. At present training in both countries is focused on qualified staff. Overlooking care assistants and their contribution towards care could be detrimental to the quality of care provided to older people in both England and Germany.

To explain job hours in four health-care occupations – physicians, nurses, emergency medical technicians (EMTs), and nursing assistants, this paper focuses on three sets of factors: class and gender, job conditions and commitment, and family situation. We find that class counts, whether understood in terms of occupation or earnings. Gender shapes hours, but more as a characteristic of occupations than of individuals. Job conditions that explain hours vary, depending on occupational grouping. Families also matter – children, but not spouses, shape the work hours of nurses; spouses, but not children, shape work hours for the other three occupations.

Examines the relationship between empowerment, desire to be empowered and perceived control among professional nursing staff in a small healthcare institution where recent attempts at empowerment have had limited success. A sample of 31 nurses and nursing assistants was used to test hypotheses that there is a positive relationship between perceived control and empowerment and that this relationship is moderated in a positive direction by desire to be empowered. Questionnaires measuring the four dimensions (meaning, competence, self‐determination, impact) of empowerment and desire to be empowered as well as work locus of control were administered to subjects. Results support the hypothesized relationship between perceived control and empowerment. However, that between desire to be empowered and empowerment was not supported. Implications of these findings are discussed including several possible ways of increasing perceived control in specific situations. These include changing some organizational, supervisory style, reward system and job design factors.

Aim: Previous research has documented the widespread use of antipsychotic drugs by nursing staff with older persons, although less is known about the knowledge that nurses actually have about these drugs. The purpose of this exploratory, descriptive study was to survey a sample of UK gerontological nurses from different work settings on their knowledge of antipsychotic drugs.Methods: An exploratory descriptive study design was utilised, whereby a sample of nursing staff was given a questionnaire developed to determine knowledge about antipsychotic drugs and their use with older persons. Questionnaires were distributed to 100 nursing staff, including registered general nurses, registered mental nurses, state enrolled nurses, nursing assistants and care assistants. Of the 100 questionnaires distributed, 62 were returned and 57 were completed substantially enough for data analysis.Results: Descriptive statistics including frequencies and means were calculated for demographic variables and the questionnaire responses. Results indicated that the use of antipsychotic drugs within the psychiatric hospital setting was substantial, with 43.7% of patients receiving antipsychotic drugs, for an average length of time of 1.8 years. Conclusions: Nursing staff participants from all three work settings revealed a number of significant knowledge gaps, particularly with regard to appropriate indications for antipsychotic drugs with older persons and the side‐effects of antipsychotic drugs. Summary: This paper adds new information regarding the use of antipsychotic drugs in the nursing care of older people.

Employing a participatory approach, the purpose of this paper is to identify possible areas for improvement in visiting nurses’ post-hospital medication management and to facilitate suggestions for changes in future practices.

Based on a previous study on visiting nurses’ post-hospital medication management, two workshops were conducted in a visiting nurse department in a Danish municipality.

The visiting nurses emphasised knowledge of patients’ basic needs and prioritised their performance of context-specific nursing assessments, with a preventive focus as a prerequisite for improved patient safety in post-hospital medication management.

The participatory approach can increase the acceptability and feasibility of changes regarding future practices and thereby reduce the gap between official documents and daily practice. Although the local development of suggestions for changes in practices does not provide general knowledge, a subsequent detailed description of the changes in practices can promote transferability to other healthcare settings after local adjustments are made.

Flexible home healthcare, with stable relationships enabling the continuous assessment of the patient’s needs and symptoms, along with subsequent adjustments being made in care and medical treatment, might enhance patient safety in post-hospital medication management.

This paper adds to the knowledge of the need for integrated care in medication management in patients’ homes. It argues for primary healthcare professionals as “experts in complexity” and suggests a reconsideration of the purchaser-provider division of care to patients with unstable health conditions and complex care needs during the first days following hospital discharge.

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.

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.

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.

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.

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.