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      Organizational Factors Associated with Certified Nursing Assistants’ Job Satisfaction during COVID-19

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          Abstract

          Given the instability of the nursing home (NH) certified nursing assistant (CNA) workforce and the challenging demands during COVID-19, it is important to understand the organizational factors that are correlated with job satisfaction which is a major predictor of CNA turnover. The purpose of this study was to determine the associations between quality of supervisor relationships, organizational supports, COVID-19 work-related stressors, and job satisfaction among CNAs in NHs. The results indicate that CNAs who reported a more optimal relationship with their supervisors, felt appreciated for the job they do and worked in NHs with lower COVID-19 resident infection rates tended to report higher rates of job satisfaction. The COVID-19 work-related stressors of increased workload demands and understaffing were associated with lower rates of job satisfaction. The study has practical implications for employers regarding how to support CNAs to improve job satisfaction especially during a crisis.

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          Most cited references32

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          Front-line Nursing Home Staff Experiences During the COVID-19 Pandemic

          Elizabeth White, Terrie Wetle, Ann Reddy … (2020)
          Objective The Coronavirus disease 2019 (COVID-19) pandemic is an unprecedented challenge for nursing homes, where staff have faced rapidly evolving circumstances to care for a vulnerable resident population. Our objective was to document the experiences of these front-line healthcare professionals during the pandemic. Design Electronic survey of long-term care staff. This report summarizes qualitative data from open-ended questions for the subset of respondents working in nursing homes. Setting and Participants 152 nursing home staff from 32 states, including direct-care staff and administrators. Methods From May 11 through June 4, 2020, we used social media and professional networks to disseminate an electronic survey with closed- and open-ended questions to a convenience sample of long-term care staff. Four investigators identified themes from qualitative responses for staff working in nursing homes. Results Respondents described ongoing constraints on testing and continued reliance on crisis standards for extended use and reuse of personal protective equipment. Administrators discussed the burden of tracking and implementing sometimes confusing or contradictory guidance from numerous agencies. Direct-care staff expressed fears of infecting themselves and their families, and expressed sincere empathy and concern for their residents. They described experiencing burnout due to increased workloads, staffing shortages, and the emotional burden of caring for residents facing significant isolation, illness, and death. Respondents cited the presence or lack of organizational communication and teamwork as important factors influencing their ability to work under challenging circumstances. They also described the demoralizing impact of negative media coverage of nursing homes, contrasting this with the heroic public recognition given to hospital staff. Conclusions and Implications Nursing home staff described working under complex and stressful circumstances during the COVID-19 pandemic. These challenges have added significant burden to an already strained and vulnerable workforce and are likely to contribute to increased burnout, turnover, and staff shortages in the long-term.
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            Systematic review of studies of staffing and quality in nursing homes.

            Brian Flesner, M Rantz, C. Riggs … (2006)
            To evaluate a range of staffing measures and data sources for long-term use in public reporting of staffing as a quality measure in nursing homes. Eighty-seven research articles and government documents published from 1975 to 2003 were reviewed and summarized. Relevant content was extracted and organized around 3 themes: staffing measures, quality measures, and risk adjustment variables. Data sources for staffing information were also identified. There is a proven association between higher total staffing levels (especially licensed staff) and improved quality of care. Studies also indicate a significant relationship between high turnover and poor resident outcomes. Functional ability, pressure ulcers, and weight loss are the most sensitive quality indicators linked to staffing. The best national data sources for staffing and quality include the Minimum Data Set (MDS) and On-line Survey and Certification Automated Records (OSCAR). However, the accuracy of this self-reported information requires further reliability and validity testing. A nationwide instrument needs to be developed to accurately measure staff turnover. Large-scale studies using payroll data to measure staff retention and its impact on resident outcomes are recommended. Future research should use the most nurse-sensitive quality indicators such as pressure ulcers, functional status, and weight loss.
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              High Nursing Staff Turnover In Nursing Homes Offers Important Quality Information: Study examines high turnover of nursing staff at US nursing homes.

              Ashvin Gandhi, Huizi Yu, David Grabowski (2021)
              Nursing staff turnover has long been considered an important indicator of nursing home quality. However, turnover has never been reported on the Nursing Home Compare website, likely because of the lack of adequate data. On July 1, 2016, the Centers for Medicare and Medicaid Services began collecting auditable payroll-based daily staffing data for US nursing homes. We used 492 million nurse shifts from these data to calculate a novel turnover metric representing the percentage of hours of nursing staff care that turned over annually at each of 15,645 facilities. Mean and median annual turnover rates for total nursing staff were roughly 128 percent and 94 percent, respectively. Turnover rates were correlated with facility location, for-profit status, chain ownership, Medicaid patient census, and star ratings. Disseminating facilities' nursing staff turnover rates on Nursing Home Compare could provide important quality information for policy makers, payers, and consumers, and it may incentivize efforts to reduce turnover.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Appl Gerontol
                Journal ID (iso-abbrev): J Appl Gerontol
                Journal ID (hwp): spjag
                Journal ID (publisher-id): JAG
                Title: Journal of Applied Gerontology
                Publisher: SAGE Publications (Sage CA: Los Angeles, CA )
                ISSN (Print): 0733-4648
                ISSN (Electronic): 1552-4523
                Publication date (Electronic): 7 February 2023
                Publication date PMC-release: 7 February 2023
                Electronic Location Identifier: 07334648231155017
                Affiliations
                [1 ]Ringgold 50455, universityLeadingAge; , LTSS Center @UMass Boston, Washington, DC, USA
                [2 ]Ringgold 12295, universityWeill Cornell Medicine; , Division of Geriatrics and Palliative Medicine, New York, NY, USA
                Author notes
                [*]Natasha S. Bryant, LeadingAge LTSS Center @UMass Boston, 2519 Connecticut Avenue NW; Washington, DC 20008, USA. Email: nbryant@ 123456leadingage.org
                Author information
                https://orcid.org/0000-0003-2832-6718
                https://orcid.org/0000-0003-4551-3531
                https://orcid.org/0000-0003-1090-3337
                Article
                Publisher ID: 10.1177_07334648231155017
                DOI: 10.1177/07334648231155017
                PMC ID: 9908517
                PubMed ID: 36748259
                SO-VID: f0e482c7-0531-4dab-a26c-689984cbd152
                Copyright © © The Author(s) 2023
                License:

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                History
                Date received : 2 May 2022
                Date revision received : 17 January 2023
                Date accepted : 17 January 2023
                Funding
                Funded by: Patrick and Catherine Weldon Donaghue Medical Research Foundation, FundRef https://doi.org/10.13039/100001080;
                Award ID: N/A
                Categories
                Subject: Original Manuscript
                Custom metadata
                edited-state corrected-proof
                typesetter ts10

                Keywords: covid-19,nursing homes,caregiving,certified nursing assistants,job satisfaction,nurse supervisor
                Data availability:
                Keywords: covid-19, nursing homes, caregiving, certified nursing assistants, job satisfaction, nurse supervisor

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