Background
Methods
Study design
Sample and setting
Data collection
Variables and measures
Variable name | Description | Measurement |
---|---|---|
Outcome variables | ||
Job dissatisfaction | 4-point Likert-type scale ranging from 1 ‘very satisfied’ to 4 ‘very unsatisfied’ dichotomized into ‘satisfied (1–2)’ vs. ‘dissatisfied (3–4)’ | |
Emotional exhaustion | Single item from the Maslach Burnout Inventory assessing how often care workers felt emotionally exhausted from their work [24] | 7-point Likert-type scale ranging from ‘never’ to ‘daily’ dichotomized into ‘few times a month or less often (0–4)’ vs. ‘once a week or more often (5–7)’ |
Intention to leave the current job | Sum over the three items each rated on a 5-point Likert-type agreement scale ranging from ‘strongly disagree (0)’ to ‘strongly agree (4)’; summarized over the three items and dichotomized into ‘no intention (0)’ vs. ‘intention to leave the current job (1–12)’; Cronbach’s α (in this study) = 0.89 | |
Intention to leave the profession | 5-point Likert-type agreement scale ranging from ‘strongly disagree’ (0) to ‘strongly agree’ (4) dichotomized into ‘no intention (0–3)’ vs. ‘intention to leave the profession (4–5)’ | |
Explanatory variables | ||
Care workers’ administrative burden | 4-point Likert-type scale ranging from 1 ‘weak’ to 4 ‘strong’; Cronbach’s α (in this study) = 0.83 | |
Control variables | ||
Facility characteristics | ||
Language region | Nursing homes in the German- or French-speaking region | 1 = German-speaking 2 = French-speaking |
Nursing home size | The facility's size, based on the number of long-term beds | 1 = Small (< 50 beds) 2 = Medium (50–100 beds) 3 = Large (> 100 beds) |
Ownership status | The type of nursing home based on financing | 1 = Public 2 = Private subsidized 3 = Private |
Unit characteristics | ||
Full-time equivalent per 100 beds | Full-time equivalent positions divided by number of beds, multiplied by 100 | Number |
Skill mix level | Percentage of all full-time equivalents per unit who are registered nurses | Number |
Work environment | ||
Leadership | 5-item “Nurse manager ability, leadership, and support of care workers” subscale of the Practice Environment Scale–Nursing Work Index, assessing direct supervisors in terms of the support they provided, their competency, back-up in decision-making, praise and recognition given, and the use of mistakes as learning opportunities rather than criticisms [29] | 4-point Likert-type scale from 1 ‘strongly disagree’ to 4 ‘strongly agree’; Scale built with mean over items; Cronbach’s α (in this study) = 0.86 |
Staffing and resources adequacy | 3-item subscale “Staffing and resources adequacy” of the Practice Environment Scale–Nursing Work Index, assessing whether there was enough time and opportunity to discuss resident care problems, enough qualified personnel to provide quality resident care, and enough staff to get the work done [29] | 4-point Likert-type scale ranging from 1 ‘strongly disagree’ to 4 ‘strongly agree’; Scale built with mean over items; Cronbach’s α (in this study) = 0.75 |
Implicit rationing of nursing care | Mean score of the 21-item Basel Extent of Rationing of Nursing Care-Nursing Home version [30] | 5-point Likert-type scale with the following response options: 0 ‘activity was not necessary’, 1 ‘never’, 2 ‘seldom’, 3 ‘sometimes’, or 4 ‘often’; Cronbach’s α (in this study) = 0.93 |
Care workers’ socio-demographic/professional characteristics | ||
Gender | Care worker gender | 1 = Female 2 = Male |
Age | Care worker age in years | Years (in six categories) |
Educational background | Care worker professional education | 1 = Registered nurse 2 = Licensed practical nurse |
Tenure in current facility | Care worker tenure in current facility | Years (in three categories) |
Employment level | Care worker employment level | % of employment (20–100), grouped in three categories for reporting |
Main shift | Shift care worker most often works | 1 = Regular change of shifts 2 = Day or evening shift 3 = Night shift |
Working overtime | Frequency care worker works more than 30 min overtime | 1 = Almost every shift 2 = Once a week 3 = Less frequently |
Data analyses
Results
Sample description
Characteristics | Missing (%) | ||
---|---|---|---|
Facility characteristics (n = 118 facilities), %—n | |||
Nursing home size | 0.0 | ||
Small (20–49 beds) | 22.9 | 27 | |
Medium (50–99 beds) | 47.4 | 56 | |
Large (≥ 100) | 29.7 | 35 | |
Ownership status | 0.0 | ||
Public | 45.8 | 54 | |
Private subsidized or private | 54.2 | 64 | |
Language region | 0.0 | ||
German-speaking | 83.1 | 98 | |
French-speaking | 16.9 | 20 | |
Service area | 0.0 | ||
Urban | 72.0 | 85 | |
Rural | 8.5 | 10 | |
Agglomeration | 19.5 | 23 | |
Unit characteristics (n = 368 units), Median – Interquartile range | |||
Bed capacity, | 24 | 11 | 0.0 |
Full-time equivalent per 100 beds (FTE/100 beds) | 49.3 | 22.3 | 0.0 |
Skill mix level (% registered nurse) | 28.8 | 16.5 | 0.0 |
Care worker characteristics (n = 2′207 care workers), %—n | |||
Gender (female) | 88.9 | 1´947 | 0.8 |
Age (years) | 0.3 | ||
< 21 | 6.2 | 137 | |
21–30 | 22.9 | 505 | |
31–40 | 19.5 | 428 | |
41–50 | 19.9 | 439 | |
51–60 | 25.4 | 557 | |
> 60 | 6.1 | 135 | |
Educational background | 0.0 | ||
Registered nurse (3–4 years of education) | 48.9 | 1´079 | |
Licensed practical nurse (3 years of education) | 51.1 | 1´128 | |
Tenure in current facility | 2.4 | ||
0–4 years | 53.6 | 1´154 | |
5–9 years | 20.9 | 451 | |
≥ 10 years | 25.5 | 549 | |
Employment level | 0.0 | ||
< 51% | 14.5 | 320 | |
51%-90% | 56.5 | 1´247 | |
91%-100% | 29.0 | 640 | |
Main shift | 0.1 | ||
Regular change of shifts | 49.8 | 1´099 | |
Day or evening shift | 41.4 | 912 | |
Night shift | 8.8 | 194 | |
Working overtime | 0.3 | ||
Almost every shift | 7.0 | 153 | |
Once a week | 43.2 | 950 | |
Less frequently | 49.8 | 1´097 |
Variable result description
Care workers’ burden and differences between registered nurses and licensed practical nurses
Administrative burden items | Total (N = 2′207), % (n) | Registered nurses (n = 1′079), % (n) | Licensed practical nurses (n = 1´128), % (n) | P valuec |
---|---|---|---|---|
Filling out the resident’s health record.a | 75.3 (1´621) | 79.4 (842) | 71.2 (779) | < 0.001 |
Coordinating activities, exams or appointments.a | 49.5 (1´045) | 52.8 (550) | 46.4 (495) | 0.003 |
Managing/administrating residents’ admissions and discharges.a | 55.5 (1´159) | 61.3 (637) | 49.8 (522) | < 0.001 |
Exchange of information (orally or written to colleagues, within the interprofessional team).a | 52.3 (1´117) | 54.6 (575) | 50.2 (542) | 0.046 |
Evaluating residents with the assessment instruments (with RAI, BESA or PLAISIR).a | 73.0 (1´510) | 76.7 (798) | 69.2 (712) | < 0.001 |
Ordering supplies and managing stocks.a | 42.6 (884) | 42.5 (438) | 42.7 (446) | 0.93 |
Overall administrative burden.a | 73.9 (1´561) | 80.4 (837) | 67.6 (724) | < 0.001 |
Spending 2 h or more during a "normal" day performing administrative tasks.b | 36.6 (787) | 48.2 (507) | 25.5 (280) | < 0.001 |
Care worker outcomes, work environment and rationing of nursing care
Variables | % (n) | Mean (SD) | Facility level, ICC1 (95%CI) |
---|---|---|---|
Nurse outcomes | |||
Job dissatisfactiona | 17.9 (383) | - | 0.018 (0–0.044) |
Emotional exhaustionb | 18.8 (414) | - | 0.031 (0.001–0.068) |
Intention to leave the current jobc | 70.1 (1′536) | 0.071 (0.025–0.103) | |
Intention to leave the professiond | 25.5 (561) | - | 0.027 (0.005–0.057) |
Administrative burden | - | 2.64 (0.63) | 0.066 (0.037–0.096) |
Work environment | |||
Leadership | - | 3.14 (0.63) | 0.135 (0.092–0.181) |
Staffing and resources adequacy | - | 2.66 (0.67) | 0.201 (0.145–0.257) |
Implicit rationing of nursing care | - | 0.91 (0.59) | 0.151 (0.105–0.199) |
Association between administrative burden and care workers’ outcomes
Care workers’ outcomes | Crude models a | Multiple adjusted model 1 (without staffing and resources adequacy, leadership and rationing of nursing care)a,b | Multiple adjusted model 2 (with staffing and resources adequacy, leadership and rationing of nursing care)a,b | ||||||
---|---|---|---|---|---|---|---|---|---|
OR | 95%CI | SE | OR | 95%CI | SE | OR | 95%CI | SE | |
Job dissatisfaction | |||||||||
Administrative burden | 1.47*** | 1.22–1.76 | 0.09 | 1.32** | 1.09–1.61 | 0.10 | 0.96 | 0.76–1.20 | 0.11 |
Leadership | 0.21* | 0.17–0.26 | 0.10 | 0.30*** | 0.24–0.38 | 0.12 | |||
Staffing and resources adequacy | 0.27* | 0.23–0.33 | 0.10 | 0.60*** | 0.46–0.77 | 0.13 | |||
Implicit rationing of nursing care | 2.99* | 2.47–3.63 | 0.10 | 1.53*** | 1.19–1.96 | 0.13 | |||
Emotional exhaustion | |||||||||
Administrative burden | 1.84*** | 1.53–2.21 | 0.09 | 1.66*** | 1.36–2.03 | 0.10 | 1.22 | 0.98–1.52 | |
Leadership | 0.39*** | 0.32–0.46 | 0.08 | 0.56*** | 0.45–0.69 | ||||
Staffing and resources adequacy | 0.34*** | 0.29–0.41 | 0.09 | 0.71** | 0.56–0.90 | ||||
Implicit rationing of nursing care | 3.76*** | 3.10–4.56 | 0.10 | 2.38*** | 1.87–3.04 | ||||
Intention to leave the current job | |||||||||
Administrative burden | 1.46*** | 1.26–1.68 | 0.07 | 1.42*** | 1.21–1.66 | 0.08 | 1.07 | 0.89–1.28 | 0.09 |
Leadership | 0.21*** | 0.17–0.25 | 0.09 | 0.30*** | 0.24–0.37 | 0.11 | |||
Staffing and resources adequacy | 0.28*** | 0.24–0.33 | 0.08 | 0.59*** | 0.48–0.73 | 0.11 | |||
Implicit rationing of nursing care | 3.34*** | 2.81–3.97 | 0.09 | 1.75*** | 1.40–2.18 | 0.11 | |||
Intention to leave the profession | |||||||||
Administrative burden | 1.49*** | 1.27–1.75 | 0.08 | 1.52*** | 1.28–1.81 | 0.08 | 1.24* | 1.02–1.50 | 0.10 |
Leadership | 0.43*** | 0.37–0.50 | 0.08 | 0.59*** | 0.48–0.71 | 0.10 | |||
Staffing and resources adequacy | 0.42*** | 0.36–0.49 | 0.08 | 0.66*** | 0.53–0.82 | 0.11 | |||
Implicit rationing of nursing care | 2.31*** | 1.94–2.74 | 0.09 | 1.49*** | 1.19–1.85 | 0.11 |