Frontline Worker Satisfaction and the Quality of Supervision in Long-Term Care

New research published in the Journal of Aging and Health stresses that the job satisfaction of frontline long-term care (LTC) staff reflects the quality of supervision and outlines the factors that influence satisfaction with supervisors.

Previous research indicates that nursing home frontline staff demonstrates more positive work outcomes when they are provided personal growth opportunities within a framework of quality supervision. These factors have been shown to increase worker retention, reduce personnel costs, and enhance the quality of care. The present study built upon these findings in an effort to seek the factors that influence satisfaction with supervision (e.g. employee background characteristics, personal and job related stress, workplace social support, and organizational factors).

Data for this analysis came from a larger study designed to assess the training needs of workers in three different LTC settings in the state of Ohio. The research was conducted in 27 nursing homes (NH), 14 assisted-living facilities (ALF), and 8 home-healthcare agencies (HHA). Proportionate random-sampling techniques were utilized to select a pool of potential organizations (and respondents within participating organizations) large-enough to allow them to analyze organizational level data.

The factors they used to explain worker satisfaction with supervision were defined as follows: Four index measures of personal stress (financial stress, family-work conflict, health-related stressors, and CES-Depression scale); Three components of job-related stress (job design features, such as rating the difficulty of making scheduling changes; perceived adequacy of available training, such as quality of orientation, continuing education, and mentorships; perceived problems with staff turnover); job-related support, which included a variety of ratings of the quality of staff interactions; Several variables that helped describe the organizational setting (profit status, type of LTC setting, % of services reimbursed through private pay).

Worries about family while at work and finances were reported very often by respondents in this study; in addition over 1/4th of the sample reported experiencing clinical levels of depression. Scheduling changes did not appear to be overly stressful for workers and they felt that, on the average, they had adequate access to professional development resources. Finally, worker turnover was reportedly a problem more often than not.

Their findings indicate that frontline staff who experience particular forms of personal (financial) and work-related (troubles making scheduling changes) stress, have less support available to them in the workplace, and face high levels of supervisor turnover are significantly more likely to express dissatisfaction with their supervisors. At the level of the organization, NH staff was significantly more likely than ALF and HHA staff to report dissatisfaction with their employer. The same was true of staff working in for-profit organizations that cater to private paying individuals.

These findings suggest that supervisor quality ratings can be improved by stress management programs and further attention to teamwork dynamics in the workplace. More practically, they can also be improved by attempts to manage the scheduling process in a way that minimizes employee stress. In short, they demonstrate the need to maintain quality relationships at all staffing levels and promote a supportive teamwork culture that allows staff to become a natural mechanism through which they can manage the day-to-day stresses of the care environment.

However, they also suggest that organizations will unnecessarily distort the relationship between supervisors and their frontline staff whenever they invest less in personnel costs and staff development and wherever they have high rates of supervisor turnover. Staffing costs make up the bulk of operational expenses and are the easiest to target for short-term solutions. Yet over the long-term the costs of such budgeting decisions need to be weighed against the short-term staffing costs (e.g. lost productivity, increased job related stress, higher rates of turnover) that such cuts necessarily entail.


Source: Noelker, L., Ejaz, F., Menne, H., Bagaka, J. 2009. Factors affecting frontline worker’s satisfaction with supervision. Journal of Aging and Health 24(1): 85-101.

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