Skip to main content
PMC home page
American Journal of Alzheimer's Disease and Other Dementias logoLink to American Journal of Alzheimer's Disease and Other Dementias
. 2007 Aug-Sep;22(4):251–260. doi: 10.1177/1533317507303439

Job Satisfaction and Career Commitment Among Nursing Assistants Providing Alzheimer's Care

Constance L Coogle 1, Iris A Parham 2, Katherine A Young 3
PMCID: PMC10846085  PMID: 17712156

Abstract

As part of a statewide dementia-specific training collaborative, data were collected from nursing assistants and aides who provide paid Alzheimer's care. This study explored the relevance of previous education and practical experiences to specific constructs associated with worker recruitment and retention. Direct-care providers with prior training in gerontology and geriatrics had lower levels of extrinsic job satisfaction and career resilience than those without this kind of continuing education. Program participants who were currently or previously the primary caregiver for a friend or relative with Alzheimer's disease had higher levels of intrinsic job satisfaction but lower levels of career resilience than those with no informal caregiving experience. Current or previous informal caregiving experience may enhance intrinsic job satisfaction by increasing personal commitment to pursue formal care work and providing a kind of inoculation against the demoralization that is too often suffered in these very challenging jobs.

Keywords: professional development, staff education, employee retention, informal caregiving, gerontology training

Full Text

The Full Text of this article is available as a PDF (79.5 KB).

Contributor Information

Constance L. Coogle, Virginia Center on Aging Virginia Commonwealth Univ. Medical Center, Richmond, VI, clcoogle@vcu.edu, Department of Gerontology Virginia Commonwealth University Medical Center, Richmond, Virginia.

Iris A. Parham, Department of Gerontology Virginia Commonwealth University Medical Center, Richmond, Virginia.

Katherine A. Young, Department of Gerontology Virginia Commonwealth University Medical Center, Richmond, Virginia.

References

  1. Wells DL, Dawson P. A framework for developing nurses knowledge about the effects of dementia on older persons' abilities. J Appl Gerontol. 2002;21:90-102. [Google Scholar]
  2. Wells DL, Dawson P., Sidani S., Craig D., Pringle D. Effects of an abilities-focused program of morning care on residents with dementia and on caregivers. J Am Geriatr Soc. 2000;48:442-449. [DOI] [PubMed] [Google Scholar]
  3. McCallion P. , Toseland RW, Lacy D., Banks S. Educating nursing assistants to communicate more effectively with nursing home residents with dementia. Gerontologist. 1999;39:546-558. [DOI] [PubMed] [Google Scholar]
  4. Beck C., Ortigara A., Mercer S., Shue V. Enabling and empowering certified nursing assistants for quality dementia care. Int J Geriatr Psychiatry. 1999;14:197-212. [DOI] [PubMed] [Google Scholar]
  5. Harmuth S., Dyson S. Results of the 2002 National Survey of State Initiatives on the Long-Term Care Direct Care Workforce. Bronx, NY: Paraprofessional Healthcare Institute, National Clearinghouse on the Direct Care Workforce and the North Carolina Department of Health and Human Services, Office of Long Term Care; 2002. [Google Scholar]
  6. Harmuth S., Dyson S. Results of the 2005 National Survey of State Initiatives on the Long-Term Care Direct-Care Workforce. Bronx, NY: Paraprofessional Healthcare Institute, National Clearinghouse on the Direct Care Workforce and the Direct Care Workers Association of North Carolina; 2005. [Google Scholar]
  7. Wagner L. New strategies for enhancing employee growth. Provider. 2005;31:22-33. [PubMed] [Google Scholar]
  8. Waxman HM, Carner EA, Berkenstock G. Job turnover and job satisfaction among nursing home aides. Gerontologist.1984;24:503-509. [DOI] [PubMed] [Google Scholar]
  9. Hollinger-Smith L., Ortigara A. Changing culture: creating a long-term impact for a quality long-term care workforce. Alzheimer Care Q. 2004;5:60-70. [Google Scholar]
  10. Maas M., Buckwalter KC, Swanson E., Mobily PR Training key to job satisfaction. J Long-Term Care Admin. 1994;22: 23-26. [PubMed] [Google Scholar]
  11. Feldt KS, Ryden MB Aggressive behavior: educating nursing assistants. J Gerontol Nurs. 1992;18:3-12. [DOI] [PubMed] [Google Scholar]
  12. Stevens-Roseman ES, Leung P. Enhancing attitudes, knowledge, and skills of paraprofessional service providers in elder care settings. Gerontol Geriatr Educ. 2004;25: 73-88. [DOI] [PubMed] [Google Scholar]
  13. Austrom MG Addressing issues of staff stress and turnover in long term care. In: Vellas BJ, Fitten LJ, eds. Research and Practice in Alzheimer's Disease . Vol. 3. New York, NY: Springer Publishing; 2000:329-332. [Google Scholar]
  14. Braun KL, Suzuki KM, Cusick CE, Howard-Carhart K. Developing and testing training materials on elder abuse and neglect for nurse aides. J Elder Abuse Neglect. 1997;9:1-15. [Google Scholar]
  15. Fitzwater EL , Gates DM Testing an intervention to reduce assaults on nursing assistants in nursing homes: a pilot study. Geriatr Nurs. 2002;23:18-23. [DOI] [PubMed] [Google Scholar]
  16. Phillips R. , Baldwin B. Teaching psychosocial care to long-term care nursing assistants. J Contin Educ Nurs. 1997. ;28:130-134. [DOI] [PubMed] [Google Scholar]
  17. McCallion P. , Toseland RW, Lacy D., Banks S. Educating nursing assistants to communicate more effectively with nursing home residents with dementia. Gerontologist. 1999;39:546-558. [DOI] [PubMed] [Google Scholar]
  18. Schonfeld L. , Cairl R., Cohen D., Neal KK, Watson MA, Westerhof C. The Florida care college: a training program for long-term care staff working with memory-impaired residents. J Mental Health Aging. 1999;5:187-199. [Google Scholar]
  19. Goodridge D. , Johnston P., Thomson M. Impact of a nursing assistant training program on job performance, attitudes, and relationships with residents. Educ Gerontol. 1997;23:37-51. [Google Scholar]
  20. Noel MA, Pearce GL, Metcalf R. Front-line workers in long-term care: the effect of educational interventions and stabilization of staffing ratios on turnover and absenteeism. J Am Med Dir Assoc. 2000;1:241-247. [PubMed] [Google Scholar]
  21. Schrijnemaekers V., van Rossum E., Candel M., et al. Effects of emotion-oriented care on work-related outcomes for professional caregivers in homes for elderly persons . J Gerontol B Psychol Sci Soc Sci. 2003;58:50-57. [DOI] [PubMed] [Google Scholar]
  22. Bowers FL, McCullough CS, Pille BL Synthesis of research findings regarding Alzheimer's disease: part IV, education of family and staff caregivers. Online J Knowl Synth Nurs. 2002;9. [PubMed] [Google Scholar]
  23. Benjamin AE Labor Force Expansion Through Retention of Related Caregivers: Better Jobs Better Care Program. Washington, DC: Institute for the Future of Aging Services, American Association of Homes and Services for the Aging; 2006. [Google Scholar]
  24. Kahn K. Recruiting Quality Health Care Paraprofessionals. Bronx, NY: Paraprofessional Healthcare Institute; 2000. [Google Scholar]
  25. Polivka L. Paying Family Members to Provide Care: Policy Considerations for States: Policy Brief 7: Who Will Provide Care? Emerging Issues for State Policymakers. San Francisco, CA: Family Caregiver Alliance and the Robert Wood Johnson Foundation. [Google Scholar]
  26. Coogle CL, Head CA, Parham, IA The long-term care workforce crisis: dementia care training influences on job satisfaction and career commitment. Educ Gerontol. 2006;32:611-631. [Google Scholar]
  27. Coogle CL, Head CA, Parham IA, Zeman S. Person-centered care and the workforce crisis: a statewide professional development initiative. Educ Gerontol. 2004; 30:1-20. [Google Scholar]
  28. Weiss DL, Dawis RV, England GW, Lofquist LH Manual for the Minnesota Satisfaction Questionnaire (Minnesota Studies in Vocational Rehabilitation: XXII). Minneapolis/St. Paul, MN: University of Minnesota, Industrial Relations Center; ; 1967. [Google Scholar]
  29. Gillet B., Schwab D. Convergent and discriminant validities of corresponding Job Descriptive Index and Minnesota Satisfaction Scales. J Appl Psychol. 1975;60:313-317. [Google Scholar]
  30. Grieshaber L., Parker P., Deering J. Job satisfaction of nursing assistants in long-term care. Health Care Supervisor. 1995. ;13:18-28. [PubMed] [Google Scholar]
  31. Waxman HM, Carner EA, Berkenstock G. Job turnover and job satisfaction among nursing home aides. Gerontologist. 1984;24:503-509. [DOI] [PubMed] [Google Scholar]
  32. Carson K., Bedeian A. Career commitment: construction of a measure and examination of its psychometric properties. J Vocat Behav. 1994;44:237-262. [Google Scholar]
  33. Monahan RS, McCarthy S. Nursing home employment: the nurse's aide's perspective. J Gerontol Nurs. 1991;18: 13-16. [DOI] [PubMed] [Google Scholar]
  34. Beville PK Virtual Dementia Tour© helps sensitize health care providers. Am J Alzheimers Dis Other Demen. 2002; 17:183-190. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Morgan DG, Semchuk KM, Stewart NJ, D'Arcy C. Job strain among staff of rural nursing homes: a comparison of nurses, aides, and activity workers. J Nurs Admin. 2002;32:152-161. [DOI] [PubMed] [Google Scholar]
  36. Karasek R., Brisson C., Kawakami N., Houtman I., Bongers P., Amick B. The job content questionnaire (JCQ): an instrument for internationally comparative assessments of psychosocial job characteristics. J Occup Health Psychol. 1998; 3:322-355. [DOI] [PubMed] [Google Scholar]
  37. Novak M., Chappell N. Nursing assistant burnout and the cognitively impaired elderly. Int J Aging Hum Dev. 1994;39:105-120. [PubMed] [Google Scholar]
  38. Heiselman T., Noelker LS Enhancing mutual respect among nursing assistants, residents, and residents' families. Gerontologist. 1991;31:552-555. [DOI] [PubMed] [Google Scholar]
  39. Karner TX Professional caring: homecare workers as fictive kin. J Aging Stud. 1998;12:69-82. [Google Scholar]
  40. Meagher G. What can we expect from paid carers? Politics Soc. 2006;34:33-53. [Google Scholar]
  41. Ryan T., Nolan M., Enderby P., Reid D. “ Part of the family”: sources of job satisfaction amongst a group of community-based dementia care workers. Health Soc Care Commun . 2004;12:111-118. [DOI] [PubMed] [Google Scholar]
  42. Stone D. Caring by the book. In Meyer MH, ed. Care Work: Gender, Class, and the Welfare State. New York, NY: Routledge; 2000:61-87. [Google Scholar]
  43. Sumaya-Smith I. Caregiver/resident relationships: surrogate family bonds and surrogate grieving in a skilled nursing facility. J Adv Nurs. 1995;21:447-451. [DOI] [PubMed] [Google Scholar]
  44. Piercy KW, Woolley DN Negotiating worker-client relationships: a necessary step to providing quality home health care. Home Health Care Serv Q. 1999;18:1-24. [DOI] [PubMed] [Google Scholar]
  45. Hullett CR, McMillan JJ, Rogan RG Caregivers' predispositions and perceived organizational expectations for the provision of social support to nursing home residents. Health Commun. 2000;12:277-300. [DOI] [PubMed] [Google Scholar]
  46. Pilette PC, Berck CB, Achber LC Therapeutic management of helping boundaries. J Psychosoc Nurs Ment Health Serv. 1995;3:40-47. [DOI] [PubMed] [Google Scholar]
  47. Hicks B., Miller BK Correlates of knowledge of Alzheimer's disease among caregivers. Am J Alzheimers Dis Other Demen. 1994;9:31-39. [Google Scholar]
  48. Peterson D. , Berg-Weger M., McGillick, J., Schwartz L. Basic care I: the effect of dementia-specific training on certified nursing assistants and other staff. Am J Alzheimers Dis Other Demen. 2002;17:154-164. [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Ramirez M., Teresi J., Holmes D., Fairchild S. Ethnic and racial conflict in relation to staff burnout, demoralization and job satisfaction in SCUs and non-SCUs. J Ment Health Aging. 1998;4:459-479. [Google Scholar]
  50. Peacock JR, Shenk D. A training program on implementing person-centered care: Introducing a new culture of care to people with dementia. Paper presented at the 23rd Annual Meeting of the Southern Gerontological Society; 2002; Orlando, FL. [Google Scholar]
  51. Gilster SD Leadership: key to creating a caring culture. Am J Alzheimers Dis Other Demen. 2002;17:232-236. [DOI] [PMC free article] [PubMed] [Google Scholar]
  52. Harahan MF, Kiefer KM, Johnson AB, Guiliano J., Bowers B., Stone RI Addressing the Shortages in the Direct Care Workforce: The Recruitment and Retention Practices of California's Not-For-Profit Nursing Homes, Continuing Care Retirement Communities, and Assisted Living Facilities. Washington, DC: Institute for the Future; of Aging Services/American Association of Homes and Services for the Aging; 2003. [Google Scholar]
  53. Jinnett K., Alexander JA The influence of organizational context on quitting intention: An examination of treatment staff in long-term mental health care settings. Res Aging. 1999;21:176-204. [Google Scholar]
  54. Schaefer JA , Moos RH Effects of work stressors and work climate on long-term care staff's job morale and functioning. Res Nurs Health. 1996;9:63-73. [DOI] [PubMed] [Google Scholar]
  55. Hare J., Pratt CC, Andrews D. Predictors of burnout in professional and paraprofessional nurses working in hospitals and nursing homes. Int J Nurs Stud. 1988;25: 105-115. [DOI] [PubMed] [Google Scholar]
  56. Reinhard SC, Reinhard T. Scanning the Field: Nursing Leadership in Long-Term Care. Washington, DC: Institute for the Future; of Aging Services, American Association of Homes and Services for the Aging; 2006. [Google Scholar]
  57. Chappell NL , Novak M. The role of support in alleviating stress among nursing assistants. Gerontologist. 1992. ; 32:351-359. [DOI] [PubMed] [Google Scholar]
  58. Monahan D. Staff perception of behavioral problems in nursing home residents with dementia: the role of training. Educ Gerontol. 1993;19:683-694. [Google Scholar]
  59. Bowers B., Becker M. Nurse's aides in nursing homes: the relationship between organization and quality. Gerontologist. 1992;32:360-366. [DOI] [PubMed] [Google Scholar]
  60. Richter JM, Bottenberg D., Roberto K. Communication between formal caregivers and individuals with Alzheimer's disease . Am J Alzheimers Dis Other Demen. 1993;8:20-26. [Google Scholar]
  61. Tellis-Nayak V., Tellis-Nayak M. Quality of care and the burden of two cultures: when the world of the nurse's aide enters the world of nursing home. Gerontologist. 1989;29:307-313. [DOI] [PubMed] [Google Scholar]
  62. Noelker LS, Ejaz FK, Menne HL, Jones JA The impact of stress and support on nursing assistant satisfaction with supervision . J Appl Gerontol. 2006;25:307-323. [Google Scholar]
  63. Cohen-Mansfield J. Stress in nursing home staff: A review and a theoretical model. J Appl Gerontol. 1995. ; 14:444-466. [Google Scholar]
  64. Cohen-Mansfield J., Noelker LS Nursing staff satisfaction in long-term care: an overview. In: Cohen-Mansfield J, Ejaz FK, Werner P, eds. Satisfaction Surveys in Long-Term Care. New York, NY: Springer; 2000:52-75. [Google Scholar]
  65. Binstock RH , Spector WD Five priority areas for research on long-term care. Health Serv Res. 1997;3:715-730. [PMC free article] [PubMed] [Google Scholar]
  66. Cohen-Mansfield J. Turnover among nursing home staff: a review . Nurs Manage. 1997;28:59-64. [PubMed] [Google Scholar]
  67. Halbur B. Managing nursing personnel turnover rates: strategies for nursing home professionals . J Appl Gerontol. 1986;5:64-75. [Google Scholar]
  68. Noelker L., Parker V. Strategies for empowering direct care workers in nursing homes. Gerontologist. 2004;44:103. [Google Scholar]
  69. Barry T., Brannon D., Mor V. Nurse aide empowerment strategies and staff stability: effects on nursing home resident outcomes. Gerontologist. 2005. ;45:309-317. [DOI] [PubMed] [Google Scholar]
  70. Burgio LD, Allen-Burge R., Roth D., et al. Come talk with me: improving communication between nursing assistants and nursing home residents during care routines. Gerontologist. 2001;41:449-460. [DOI] [PubMed] [Google Scholar]
  71. Burgio LD, Stevens A., Burgio KL, Roth D., Paul P., Gerstle J. Teaching and maintaining behavior management skills in the nursing home. Gerontologist. 2002; 42:487-496. [DOI] [PubMed] [Google Scholar]
  72. Stevens AB, Burgio LD, Bailey E., Burgio KL, Paul P., Capilouto E. Teaching and maintaining behavior management skills with nursing assistants in a nursing home. Gerontologist. 1998;38:379-384. [DOI] [PubMed] [Google Scholar]
  73. Broad ML Overview of transfer of training: from learning to performance. Perform Improve Q. 1997;10:7-21. [Google Scholar]
  74. Mace NL Teaching the care of people with dementia: can the newly-trained implement what they have learned? Am J Alzheimers Dis Other Demen. 1996;11:44-45. [Google Scholar]
  75. Lekan-Rutledge D., Palmer MH, Belyea M. In their own words: Nursing assistants' perceptions of barriers to implementation of prompted voiding in long-term care. Gerontologist. 1998;38:370-378. [DOI] [PubMed] [Google Scholar]
  76. Castle NJ Innovation in nursing homes: which facilities are the early adopters? Gerontologist. 2001;41:161-172. [DOI] [PubMed] [Google Scholar]
  77. Potter SJ, Churilla A., Smith K. An examination of full-time employment in the direct-care workforce. J Appl Gerontol. 2006;25:356-374. [Google Scholar]

Articles from American Journal of Alzheimer's Disease and Other Dementias are provided here courtesy of SAGE Publications

RESOURCES