Frontline Staff Perspectives, Leadership Styles and Turnover Intentions
Scholarship & Development Faculty Grant, 2015
Final Report
Project Director: Dr. Debra Hagerty
Co-Director: Dr. Janet R Buelow
Research Goals & Objects:
1. Examine relationships between nursing home frontline staff perceptions of job satisfaction, leadership relationships, teamwork, affective commitment and turnover intention.
2. Identify the statistical associations between frontline staff perceptions of the work environment and nurse leaders’ perceptions of the work environment.
3. Support the development of nurse leadership skills and abilities and assess the impact of specific leader actions.
Attainment:
Objective 1 was met after data was collected and analyzed. Two statistically significant relationships were identified.
Objective 2 was met after data was collected and analyzed. Two statistically significant relationships were identified.
Objective 3 was met with development of 4 nursing home reports and individualized meetings with nursing directors of these nursing facilities.
The Directors of the Nursing homes were interested in the nurse aide perceptions. They also were impressed by the suggestions that were made based on the research findings. Improving relationships of staff working in nursing homes is critical to providing quality care.
Description of Project:
Certified nursing assistants (CNAs) are the heart and soul of long care facilities. These workers spend the majority of their shift directly involved with residents; performing intimate daily living activities, such as bathing, dressing, feeding and toileting. When performing these tasks CNAs are encouraged to converse and develop a caring relationship with their residents. Hence CNAs can contribute to expert physical services, as well as emotional and personal care critical to ensuring a high quality of life and mental health for residents. It falls on the geriatric nurse to guide, supervise and manage CNAs with this significant work, yet little research has been conducted in this area.
We used a descriptive survey design to address our research aim. The university ethics committee granted IRB approval and the Director of Nursing and Administrator of each participating nursing facility provided participation permission, as required by the institutional review board.
Nursing home directors from 4 facilities were interested, signed the IRB form and set up a meeting with the researchers. They agreed to allow the authors to distribute questionnaires to their CNAs with all completed surveys remaining completely anonymous. Times for the best response from CNAs were determined, with change of shift times, as well as paycheck days, being favored. Convenience samples of interested CNAs were recruited from each participating nursing facility with researchers returning to each facility two to three times to gather the completed surveys. Candy bars were provided as a thank you for completion of the questionnaires.
The instrument was developed from questionnaires used with nurses and staff in Australian hospitals and then modified to be appropriate for CNAs in nursing facilities. Questions for intrinsic satisfaction, turnover intent, administration and nursing supervisor originated from surveys in Brunnetto, Farr-Wharton and Shacklock’s work in Australian hospitals. Each item was reviewed and modified as appropriate and then pilot tested with two current CNAs for content validity.
The data were entered into SPSS for statistical analysis and a p level of .05 was set for significance. After descriptive analysis for CNA demographics, work history and perceptions were examined, an analysis of variance (ANOVA) was conducted to assess if there were differences in any of these variables by nursing facility. No significant differences were found, so the analysis included CNAs from all nursing homes.
For each variable, the assumption of equality of variance was assessed with a Levene's test. Results of this test indicated that the assumption was met for each variable, so the ANOVA was conducted by generations. However, we realize that job tenure may impact the CNAs’ perspectives, so a multivariate analysis of covariance (MANCOVA) was conducted to assess if there were differences in the independent variables by generation after controlling for job tenure. Results of this test showed no significant difference, so the generational scores for CNA perceptions were examined and are presented below.
Results
For nearly every question, baby boomers provided the poorest perceptions of administrators. Their two poorest perceptions were that administrators do not call in additional help when needed and are not concerned for their health and families (mean scores of 2.32 and 2.39, respectively).
Noted is a significant finding that baby boomers felt the supervisor did not understand their problems as well as the Millennials and Gen X. Although not significant, baby boomers reported most negatively in regard to their supervisor knowing how good they are at their job. Gen X CNAs were in the middle with a slight agreement that supervisors understand my work problems, Millennials were the most positive in their opinions about the supervisor in 4 areas. All generations reported their most positive mean scores in the same two areas: their supervisors were satisfied with their work and knew how good they were at their job.
Baby Boomers were significantly less likely to hear staff talking about others behind their back. Millennials on all 3 measures, had the worst perception of workplace climate. Millennials were more likely to hear staff talk behind their back. Millennials also perceived others not being helpful to new staff and heard staff use disrespectful language toward others at a higher rate than both Gen X and Baby Boomers.
A significant finding among generations was in the area of hearing staff talk behind the backs of other staff. The baby boomers heard staff talk about others the least and the millennials heard this the most. The Millennials had the strongest opinions all negative about the climate of the workplace. The baby boomers witnessed staff use disrespectful language towards others (which could be co-workers or residents) less often than both Gen X and the Millennials. This behavior may create a work environment which adds to the already stressed atmosphere of caregiving and meeting human needs. In fact this disrespectful language toward other staff may lead to an environment at work which breeds incivility. This workplace stressor is not unique to long-term care and impacts the health care team as well as resident’s nursing home experience.
Summary
If long-term care organizations are going to retain staff, meeting the needs of employees and accommodating differences is operationally imperative for success. The lowest mean score for relationship with supervisor was the Baby boomers although all generations had an average score of slightly agree with having a positive relationship. Relationships that are empowering and creating a supervisory workplace environment that allows engagement and active participation is beneficial to the success of all generations. The care model which is patient centered engenders a relationship based approach to delivery and requires CNAs to be collaborative, communicative and coalesced in a teamwork supported environment for quality patient care to be delivered efficiently. This is found in the foundation of Culture Change in nursing facilities where relationships among residents and staff are fostered, respect is practiced, empowerment and choice for residents and staff is normalized.
Geriatric nurse supervisors can play a pivotal role in assignments based on acuity and required support intensity and should ensure that staff do not feel overwhelmed. Care procedures for residents may consume more time per activity by virtue of the multiple comorbidities including mental health impairments ranging from mild cognitive impairment to dementia and other psychiatric disorders. The time and finesse of patient-centered approaches requires an astute, clinically competent geriatric nurse. The nurse needs to be able to assess, as well as assign, based on staff expertise and the clinical behavioral presentations of the patients. Nurse managers play a critical role in the work milieu and stress. Supervisor support and decision authority can buffer the adverse effects of job demands on feelings of emotional exhaustion.
Supportive managers also play an instrumental role in CNA education, skill building and the provision of resources which facilitate completion of work. According to research, organizations who wish to retain committed baby boomers need to focus on supportive management, organizational culture and career development or lateral moves. Supportive managers help their subordinates instrumentally and emotionally by giving recognition when deserved, listening to concerns, standing up for the staff and providing challenging opportunities. When health care teams function as a collaborative unit with regular two-way communication, they can achieve great things—positive patient outcomes, safer care, and increased patient and family satisfaction.
Baby Boomers also were in highest disagreement with staff not using disrespectful language towards others. All generations were found to be ambivalent toward the nursing home. The lower job ambivalence experienced, the stronger job satisfaction and organizational citizenship both critical to a civil work atmosphere.The mean score for thinking about leaving the job was highest for the Baby Boomers. Work expectations that are unreasonable, i.e., high workload has been shown to impact turnover intention. Manager support and behavior has been shown to differentiate baby boomers turnover intention and this emphasizes the importance of supportive behaviors such as providing recognition when deserved, listening to concerns about workload and other issues and standing up for the staff as well as providing challenging opportunities to ensure organization commitment and prevent turnover. Supervision is positively related to job satisfaction and negatively related to intent to leave across generations.Talking behind ones back breeds mistrust and conflict and is dysfunctional for the team. Work climates which have negative disruptive conversations occurring do not support collegiality and collaboration so important in long term care.
Timeline Implementation Plan
DecemberDevelop survey instrument and obtain IRB approval
January Pilot test and recruit nursing homes
FebruarySurvey staff in 2 nursing homes
Data entry &analysis
MarchSurvey staff in 2 nursing homes
Data entry &analysis
AprilDevelop individualized Reports for each nursing home
Meetings with nursing home administrators and nurse leaders
– share findings in reports
May-AugustData analysis, targeting writing of findings for journal submission
Outcomes – Community Benefit, Student Benefit and Scholarly Output:
- Community nursing homes benefited from this research. Providing staff with improved understanding of the functioning of their team and relationships is important. Students who assisted in data collections benefited immensely in developing relationships and improving their understanding of the operations of the nursing home.
- Collaborative relationships have developed between faculty within the College of Health Professions in 2 different disciplines in the college. These relationships produced opportunities for students to engage in the community specifically related to their educational endeavors and produced outcomes which benefit the university, the student, faculty and community.
- Progress is being made toward completion of an article for publication. The targeted date for submission to the Journal of Geriatric Nursing is September 29, 2015.
- Because of this project the researchers were able to secure one of the students a position in a nursing home as an administrator in training. This is a fantastic transitional position from Master’s degree to career employment.
- The Armstrong State University and community relationships have been solidified further and doors are open for new research and educational endeavors in our community partner settings.
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