views of job satisfaction and dissatisfaction in australian long-term care

Views of job satisfaction and dissatisfaction in Australian

long-term care

WENDY MOYLEWENDY MOYLE MHSc, BN, PhD

Senior Lecturer, Centre for Practice Innovation in Nursing and Midwifery, Griffith University,

Nathan, Australia

JAN SKINNERJAN SKINNER Dip App Sc, BN, MN, RN

Director of Nursing, Blue Care Brisbane South Region, Brisbane, Australia

GILLIAN ROWEGILLIAN ROWE RN

Care Manager, Blue Care Brisbane Central Region, Brisbane, Australia

CHRIS GORKCHRIS GORK RN

Registered Nurse, Blue Care Brisbane Central Region, Brisbane, Australia

Accepted for publication 21 August 2002

Summary

• The existing job satisfaction literature has tended towards an overemphasis on

job satisfaction instruments.

• In the study reported here the views of 27 nurses and assistants-in-nursing,

collected through focus group interviews, were examined to determine the

factors that contribute to workplace satisfaction and dissatisfaction in long-term

care of older people.

• Content analysis of focus group interview data revealed that job satisfaction

was related to workplace flexibility, residents, working within a team environ-

ment and dedication to the service of optimal resident care. Dissatisfaction was

linked to working with unskilled or inappropriately trained staff, laborious tasks

such as documentation, staffing levels, tensions within role expectations and the

increasing need to be available for overtime.

• In spite of different role expectations, long-term nursing home care is

reported to be a very satisfying area in which to work. However, care managers

need to put in place strategies for building improved job satisfaction and

workplace incentives to encourage graduates to consider long-term care

opportunities.

• Limitations of the study include the small number of participants, bias

towards one organization and lack of generalizability of the results.

Correspondence to: Dr Wendy Moyle, Senior Lecturer, Centre forPractice Innovation in Nursing and Midwifery, Griffith University,Kessels Road, Nathan, QLD 4111, Australia (tel.: +61 7 3875 5526;e-mail: [email protected]).

Journal of Clinical Nursing 2003; 12: 168–176

168 � 2003 Blackwell Publishing Ltd

• However, the findings confirm many earlier job satisfaction studies and further

support the need to consider these issues in relation to recruitment and retention

in long-term care.

Keywords: focus groups, job dissatisfaction, job satisfaction, long-term care.

Background

The worldwide shortage of nurses has created an emerging

crisis for long-term care, as finding staff becomes more

demanding. An adjunct to this is the issue of potential

staff being enticed back into acute care, where flexible

hours and other incentives such as continuing education

and child care services are being offered. To work within

this crisis it is essential that health care administrators seek

new ways to promote and develop strategies for building

commitment to working in long-term care, thereby

increasing job satisfaction through improved recruitment

and retention.

Job satisfaction can be broadly defined as ‘the favour-

ableness or unfavourableness with which employees view

their work’ (Grieshaber et al., 1995, p. 19). This definition

may in fact be too simplistic, as a number of researchers

(e.g. Wagnild, 1988; Jenkins, 1993; Stamps, 1997) argue

that personality factors play a part in determining whether

people will stay in their job. Furthermore, jobs are

considered to have a variety of components. Thus,

workers may find satisfaction with one aspect while at

the same time they may dislike another. Such factors help

to explain why people remain in areas of employment

about which they continually complain.

A number of theories have been developed to try to

understand job satisfaction. One of the earliest was

Herzberg’s (1957) motivation-hygiene theory, which

investigated the concept of job satisfaction/job dissatisfac-

tion. Herzberg’s theory delineated motivating and hygiene

factors, which aided in determining job satisfaction. He

defined motivating variables as achievement, recognition,

the work itself and responsibility, while hygiene factors

were company policy and administration, supervision,

working conditions, salary and status. He theorized that

work satisfaction resulted from the presence of motivating

factors and absence of hygiene factors. As employers

become aware of motivating and hygiene factors these

could be addressed in the workplace. A number of other

job satisfaction theories have continued the theory of

motivational job characteristics (e.g. Hackman & Oldham,

1976; Stone, 1976). In more recent times job satisfaction

research has explored the notion of person–environment

fit, for example the work of Holland (1985), who

successfully showed the importance of person–environ-

ment fit in vocational choice and job satisfaction.

Job satisfaction is of interest to employers and is

considered to be a desirable outcome of employment. It

has been linked positively to productivity and negatively

to absenteeism (Arnold & Feldman, 1982; Anderson et al.,

1991; de Jonge et al., 1999), poor performance and staff

turnover (Dahlke, 1996; Gifford et al., 2002). de Jonge

et al. (1999) found that job characteristics such as job

demands and autonomy at the individual level have a

significant negative and positive association with job

satisfaction. Furthermore, although motivating the long-

term employee is difficult, it is significant, as motivation

effects attitude and behaviour, and consequently job

satisfaction (Vance & Davidhizar, 1997). The job satisfac-

tion literature (Grieshaber et al., 1995; Acorn et al., 1997;

McNeese-Smith, 2001) also highlights the influence of the

work environment and workers’ organizational commit-

ment. Indeed, these investigators determined that man-

agers can influence workers’ organizational commitment,

and when workers are happy and satisfied with organiza-

tional management, there is a decrease in staff absenteeism

and turnover.

In nursing, documentation of care is also considered to

cause job dissatisfaction (Buelow & Cruijssen, 2002). In

Australia funding for the care of older people is varied and

based on their relative care needs. Through an instrument

termed the Resident Classification Scale (RCS), long-term

care residents are allocated a care category. The

Commonwealth Government subsidy for each resident is

determined by the RCS and the resident’s financial status

(Commonwealth Department of Health and Family

Services, 1998). The appraisal used for the RCS considers

only those factors that have been identified as contributing

the most to differences in the total cost of care. As the care

classification appraisal must be based on written evidence

about the care needs and care interventions provided for

the resident over a period of at least 21 days, this often

requires a high degree of staff attention to documentation.

This attention takes staff away from direct care. Buelow &

Cruijssen (2002) suggested that the demands of docu-

mentation and low levels of staffing affect communication

opportunities with residents and thus impact negatively on

job satisfaction.

Clinical nursing: roles, individual differences and decision-making Views of job satisfaction 169

� 2003 Blackwell Publishing Ltd, Journal of Clinical Nursing, 12, 168–176

Staff who are dissatisfied in their role may avoid work

responsibilities, through absenteeism, deliberately avoid-

ing activities, taking shortcuts or making themselves

unavailable when actions are required (Grieshaber et al.,

1995). Furthermore, they may find it difficult to

construct a friendly and personable atmosphere within

the care setting. Overarching themes of all job satis-

faction research has been the need to understand why

some workers may feel disempowered in their work

environment and whether absence of satisfaction means

dissatisfaction.

JOB SATISFACTION INSTRUMENTS

The majority of research has measured job satisfaction

through survey instruments. These include the Nursing

Work Index (Kramer & Hafner, 1989), Job Description

Index (Smith et al., 1969) and the revised Index of Work

Satisfaction (Stamps, 1997). Such instruments focus on

the relationship between job satisfaction and the personal

characteristics of workers, job satisfaction as arising from

the job itself, or as a response to the organization. Whilst

this diversity assists towards an understanding of job

satisfaction, it tends to narrow the focus to particular

components of the job or characteristics of the worker,

whereas in effect job satisfaction or dissatisfaction may be

a result of both.

A search of the literature found very few qualitative

investigations of job satisfaction (e.g. Wagnild, 1988;

McNeese-Smith, 1999, 2001). We suggest that this may be

because of the ready availability of instruments that

measure job satisfaction and overemphasis by psycholo-

gists and management on deductive methods, as well as

the time required to collect and analyse qualitative data.

We therefore decided to conduct a descriptive study

because this would offer the possibility of adding to the

existing job satisfaction literature.

The study

AIM

The aim of the study was to identify the level of

satisfaction among Registered Nurses (RNs), Enrolled

Nurses [ENs – second level nurses with either a Level

IV Certificate (12 months education) or Diploma

(18 months education) who are authorized to practice

under the supervision, either directly or indirectly, of an

RN] and assistants-in-nursing (AINs, unregulated Level

III Certificate care workers assisting with direct care

under the direct supervision of an RN) in two long-term

care facilities for older people operated by the same

organization. It was considered that these three groups

required separate investigation as they have different

roles within the care facilities. For example, AINs

provide the majority of direct resident care, while RNs

and ENs frequently undertake specialized activities such

as medication administration, documentation and wound

management.

SETTINGS

Both facilities are located in Brisbane, Australia. One

facility is a 185-bed nursing home, and the other is a

73-bed nursing home. The two facilities were selected

because the senior nursing staff had an interest in

understanding job satisfaction, particularly in the light of

recruitment difficulties created by a nursing shortage in

long-term care. These senior staff also saw this as a way of

improving both practice and research activity within the

organization, providing a foundation for future projects in

care of older people. Prior to the project there was no

indication that there was any concern about job satisfac-

tion in these two homes.

SAMPLE

Following ethics approval, a purposive sample of nursing

and AIN staff were recruited through advertisements in

internal newsletters and an information letter sent out

with salary notifications. As a result, nine RNs, five ENs,

and 13 AINs consented to participate in the study.

Approximately half of the sample were from each

organization.

DATA COLLECTION

The principal investigator (W. Moyle), who was not an

employee of the organization, conducted 10 focus group

interviews to gather participants’ views of job satisfaction

and factors that affect both job satisfaction and dissatis-

faction. Focus groups, often called group interviews, were

used to explore the amount of variation, diversity or

consensus on the topic (St John, 1999). The advantage of

focus group interviews is that participants work together

to gather interactive verbal data on the given topic

(Taylor, 2002). These audiotaped interviews lasted from 1

to 1.5 hours and were conducted in a quiet place within

the work environment and away from residents. All group

participants were asked the same questions and questions

were extended and refocused on job satisfaction according

to their responses. Examples of questions were: ‘What is it

170 W. Moyle et al.


that keeps you working in long-term care?’ and ‘Tell me

about the things that have added satisfaction to your

working life over the last week’. This direct approach to

questioning resulted in structured data and enabled wide

coverage of the topic (Frey & Fontana, 1991). As each

category of staff was interviewed within their specific

group, this resulted in focus groups ranging from two to

five participants. Although these groups were small, this

research supported the premise that focus groups of this

size are effective when participants have a lot to discuss

(Krueger, 1994). Data were gathered between February

and March 2002 and until the interviewer felt that no new

data were being gathered (St John, 1999).

DATA ANALYSIS

Tesch (1990, p. 114) defined qualitative data analysis as ‘a

process, which entails an effort to formally identify themes

and to construct hypotheses (ideas) as they are suggested

by the data and an attempt to demonstrate support for

those themes and hypotheses’. In this study Tesch’s

approach to data analysis was followed. The audiotaped

interviews were transcribed verbatim and identification of

themes took place while asking the following questions of

the data: Why? How? What if? Initially data from all

interviews were analysed into seven themes using an

inductive process. Once the researcher felt convinced

about the emerging themes, a comparison of the themes

took place between the RNs, ENs and AINs data. In

the majority of cases, groups had similar perceptions

and, where there were different perceptions, these are

highlighted separately in the presentation of findings.

Findings

DEMOGRAPHIC DATA

The 27 participants ranged in age from 19 to 55, with an

average age of 46 years, and only one was male. The RN

participants had the highest qualifications, some having a

single registration certificate and others having double

certification such as General and Midwifery, or General

and Mental Health. All but one of the ENs had undergone

additional education and training in medication adminis-

tration and management that would allow them to manage

medications up to and including Schedule 4 Medications

[‘poisons that should, in the public interest, be restricted

to medical, dental or veterinary prescription or supply,

together with substances or preparations intended for

therapeutic use, the safety of efficacy of which requires

further evaluation’ (Australian Health Ministers’ Advisory

Council, 1998)]. Schedule 4 does not include drugs of

dependence. Mean length of time employed in long-term

care was 16 years for RNs, 23 years for ENs and 11 years

for AINs. No participants held specialist gerontological

qualifications.

Participants presented seven themes that contributed to

their job satisfaction and dissatisfaction. These were:

1 Long-term care is a workplace of convenience.

2 Contact with residents promotes enjoyment and

encourages admiration of residents and job satisfaction.

3 Job satisfaction comes from resident gratification.

4 Satisfaction is raised when working with people who

work well within a team, whereas dissatisfaction occurs

when staff are considered inappropriate to work in long-

term care.

5 Job dissatisfaction increases when tasks and time

constraints prevent the opportunity to relate to resi-

dents and offer the opportunity for error.

6 Job dissatisfaction occurs when tensions are not recog-

nized within the workplace.

7 Staying over time at work creates both job dissatisfac-

tion and job satisfaction. These themes are presented

below. A variety of quotations covering all 27 parti-

cipants are used to support the presentation.

THEMES

Long-term care is a workplace of convenience

The RNs and ENs revealed that they had come to work in

long-term care because they had been out of nursing for

some time and felt that their knowledge levels made them

unsafe to go back to acute care. There was a perception that

they would not need many skills and that their knowledge

would not be tested in this setting. In addition they sought

employment in long-term care because of flexible work

times that would fit around their personal and family

needs. However, they very readily became disillusioned

and anxious once they recognized that long-term care was

quite complex and that it required specialized skills and

knowledge. Working efficiently within this environment

improved their self-esteem, as they perceived they were

valued by the long-term care community and experienced

job satisfaction. However, they expressed disappointment

that, in their view, the public continued to perceive the care

of older people as non-prestigious and an area where skills

and knowledge were not a priority. This made them feel

undervalued in spite of the fact that they had also come to

this environment with similar beliefs. Furthermore, all

groups of participants mentioned practical reasons for

working in long-term care, such as needing to finance a



mortgage. Two examples from participants are provided to

support this theme:

RN: I had been out of nursing too long to go back

to acute care and I could get a job part-time that

fitted around my family…it used to be simple but it’s

not anymore.

RN: It’s not prestigious as people perceive it as not

real nursing…

Contact with residents promotes enjoyment and encourages

admiration of residents and job satisfaction

Despite community perceptions that suggest that long-

term care is not a pleasant working environment, parti-

cipants tended to find the work very rewarding and one

that readily created job satisfaction. All three groups

reported on the enjoyment they gained from working in

this environment:

RN: It’s the most all-round nursing that I have ever

done. It encompasses everything and is so rewarding

when you sense that you have made a difference in

the day of a resident.

EN: I enjoy the work and now that I have done a lot

of training in dementia I really like working here.

I feel I can relate to people with dementia.

AIN: I get enjoyment out of listening to the

residents…their history and knowledge.

All groups of participants remarked on the satisfaction

that they received from feeling as though they were

constantly learning on the job. They acknowledged the

satisfaction they felt from being an advocate for older

people, and several reported that working with older

people was important in their development, as they had

few other opportunities to mix with this group.

Job satisfaction comes from resident gratification

Job satisfaction was also perceived to come from interac-

tion with residents. All groups recognized that, no matter

how difficult their shift had been, the appreciation they

received from residents made up for any difficulties

experienced. They felt that the job was worth doing, in

particular when they received compliments from resi-

dents, and they talked of individual residents or situations

where they had received gratification and satisfaction over

the last week:

RN: They are always very appreciative and they

always say, ‘Thank you’. It makes you feel that what

you are doing is not taken for granted.

EN: At night when I am feeling stressed I get quite a

few hugs and kisses from them.

Satisfaction is raised when working with people who work well

within a team, whereas dissatisfaction occurs when staff

are considered inappropriate to work in long-term care

In spite of a number of employment difficulties, all groups

referred to work problems as not being insurmountable ‘if

you are working with a good team’. While many employers

concentrate on getting the work environment right, these

participants suggested that it is work colleagues who make

the most difference to job satisfaction:

RN: Collegiality with other workers gets you support

and gets you through the difficult days.

EN: Dissatisfaction is more related to who you work

with than the residents. You could be working with

someone who you don’t think should be here or who

is doing the wrong thing and you don’t necessarily

have a good day.

A trustworthy person was described as someone you

want to work with:

EN: Whether they’ve done what they have to do and

whether their temperament is suited to yours. Just

people who are getting on with their work.

At times participants felt that some staff were not

tolerant and upset staff and residents. This created

dissatisfaction and often caused participants anxiety, as

they worried before their shift if they were working with

staff whom they viewed as being inappropriate:

AIN: I was on my second day here and got told,

‘You’re useless. Get out!’

RN: I’ve had a few days where the staff really are

unsuitable…One girl talks really loudly and con-

stantly with an accent and that bothers the residents.

They get stressed because they won’t do what she

wants them to do.

Some participants spoke of feeling bullied and felt that

this sort of interaction created dissatisfaction and made

them think about leaving their employment:

AIN: You can say something nice in a courteous

manner that makes it seem a whole lot better, but the

way some people speak to you it’s so easy to make

you feel worthless. I was fine the first couple of

months, thinking, ‘It’s OK, I’m new’, but now

I can’t handle this any more and that would be the

reason why I’d leave.

Job dissatisfaction increases when tasks and time constraints

prevent the opportunity to relate to residents and offer

the opportunity for error

All groups referred to being dissatisfied with anything that

took them away from direct resident care. They stated that

172 W. Moyle et al.


job dissatisfaction was related to demands from documen-

tation of care and reduced levels of staffing. Documenta-

tion in this theme was seen as a problem rather than as

something that improved quality of service. It was also

seen as something that took one away from the enjoyable

part of work, that being communication and social

interaction with colleagues and residents.

Documentation. RN: The level of satisfaction is

determined by the number of RCSs (Resident

Classification Scales) that have to be undertaken.

When you have to do two a week you just don’t

have the time to talk to anyone.

EN: Sad part about documentation is that we

don’t have the time to sit and talk with residents.

Staffing levels. Staffing levels were also included in this

theme. Although staff recognized that staffing levels were

a result of government funding, they felt frustrated and

impotent because they perceived that these did not

provide adequate resources for the frail ageing population:

RN: It’s the interruptions, the phone calls, the

buzzers that create stress. Often when you are in the

office writing, the girls (staff) are out working so you

have to go and answer buzzers.

AIN: The problem is that everyone is trying to

budget and having just one RN and EN at night…when it comes to pills time you may have a problem

and need an RN’s advice…they can’t just drop

everything to help.

The RNs in particular were concerned that the reduced

staffing levels created situations where there was the

potential for mistakes to occur:

RN: When you are busy and you can’t think and you

can’t address problems there’s scope there for error. I

find that very frustrating.

Reduced staffing also created conflict where staff

questioned whether categories of staffing were appropriate

for the care situation:

RN: There should be more than one qualified

nurse on. The AINs try and do their best but often

they’re just running back and forth asking the RNs

questions and we spend a lot of time dealing with that.

Job dissatisfaction occurs when tensions are not recognized

within the workplace

Tensions occurred when there was a perception that

managerial staff were not listening to concerns and when

staff perceived conflict between documentation and care-

giving.

Dissatisfaction occurs when there is a perception of not being

listened to. All levels of staff felt that they had suggestions

about how things could be done or improved within the

current system. However, they felt that no one was

interested in their opinions, and this was borne out

through lack of contact with senior management and

perceived communication difficulties within units and

within the organization. For example, some participants

felt that policies and procedures had encroached on

their initiative in planning care and that policies were

rigid, outdated or not functional within the current

system. However, they felt unable to make or suggest

changes:

EN: You couldn’t change the policy (having residents

dressed for breakfast). You know residents have to

look good…self-esteem and all that. No, you

wouldn’t be allowed to bring them to breakfast

in their nightie. There are policies, procedures,

people…AIN: There’s so much you can do to build morale

and teamwork and have a really good team but when

you get continually knocked down…it makes you feel

down, you can’t be bothered, you want to go home or

walk out and leave it.

There was a perception among AIN participants that

communication was either avoided or forgotten, and they

saw this as destructive to team-building:

AIN: I think communication gets lost. As much as

we have these handover sheets, which are good.

Every shift there’s a verbal handover, but even

then you don’t get everything. The RN will be

told by the boss about changes, but that’s as far as

it goes.

Tensions between documentation and caring. Although all

staff recognized the constant need for documentation, it

raised tensions that they felt got in the way of both their

job and the way that work was carried out:

RN: It becomes a battle between documentation and

your actual hands on caring. The constant battle to

maintain those levels so that the funding will come

in. But then if we are spending the amount of time

doing the documentation correctly, we are not doing

the stuff that you are supposed to be doing…that you

are writing down that you do.

EN: What do you do? You have to document, even

though we would rather be doing things for

residents rather than writing about it. However,

you can’t do both – write about it and do it. So a

lot of the time I do it and I don’t bother to write

about it.



Staying over time at work creates both job dissatisfaction

and job satisfaction

Although not all participants regularly worked overtime, a

number habitually stayed beyond the end of their shift.

They saw this as an essential part of the job, created

through not having enough time to complete all that was

required of them. Staying over time created conflict but

was also valued, as participants saw it as an opportunity to

show their dedication to older people. They considered

that they were helping residents and they gained satisfac-

tion from feeling that they are doing more than necessary

in their employment:

EN: There isn’t a choice if you want to get your work

done – you have to stay and finish it. You can’t leave,

as you feel like you are letting the residents down.

You couldn’t leave the residents, as this is the reason

you are working.

EN: My family does not like it when I stay late. And

no, it makes me angry…It makes me feel good

knowing that I am helping the residents but it makes

me cross that there aren’t enough staff, and I get

angry when people don’t acknowledge that I am

staying late and doing things for the residents.

Discussion and recommendations

The findings from this study suggest that, in spite of

different role expectations, the overall satisfaction level

appears to be similar among the three groups and

demonstrate that the nurses and AINs found long-term

care a very satisfying area in which to work. They

particularly enjoyed the satisfaction and challenge of

working with residents who had much to offer in terms

of history, knowledge and gratitude for the care

received. These findings are supported by other research

(Patrick, 1986) which suggests that some people who

have worked in long-term care for a period of time

become more motivated to work in this setting because

they value their role in improving quality of life for

older people.

At present it is difficult to attract staff into long-term

care, partly because of the belief that this type of work is

not prestigious. Thus, it is recommended that testimonials

such as those given by these participants should be used to

promote long-term care in recruitment drives. Such

statements may also help to reduce community myths

that long-term care is an area that only attracts and

employs unskilled workers. It is imperative that people

who enjoy working with older people and have problem-

solving and care-giving skills are encouraged to work in

long-term care, not only to improve its quality but also to

assist other employees’ job satisfaction.

Where it is difficult to attract staff, managers may be

tempted to employ either unskilled or unsuitable people to

deal with the staffing crisis. However, participants in this

study demonstrated that this has a negative effect and only

encourages dedicated staff to move on when confronted

with people they deem to be unsuitable or untrustworthy

employees. This is supported by other research (Waxman

et al., 1984; Grieshaber et al., 1995; McNeese-Smith,

1999) confirming the importance of satisfied employees,

and suggests that a dissatisfied employee is more likely to

take shortcuts than a satisfied employee. Where staff

believe that residents are not being treated appropriately,

they may move on rather than face conflict.

Participants also recognized that long-term care offered

them learning opportunities. It is clear that developing an

understanding of older people and their behaviours assists

staff to be empathic and provide a more holistic approach

to this field of care. Managers should be encouraged to

extend staff learning opportunities in a supportive envi-

ronment that facilitates a more positive approach to

resident care, thereby increasing staff retention through

job satisfaction. Although staff education is deemed to be

expensive, this cost should be recouped through staff

retention and fewer workplace difficulties (Vance &

Davidhizar, 1997; McNeese-Smith, 2001).

Participants raised a number of concerns in relation to

staffing levels. Although they recognized funding prob-

lems, they felt disempowered by a situation that placed

them at risk of error. Gifford et al. (2002) also suggest that

staffing levels require attention, and argue that strategies

to save labour costs may end up costing an organization

more in the end, as they may increase staff turnover and

burnout, and be associated with poorer outcomes for

residents.

Participants’ emphasis on choice of employment to

meet family needs, citing proximity to home and flexibility

to meet personal needs are important. Clearly, these issues

need to be considered when developing a recruitment

programme to attract staff to long-term care environ-

ments. McNeese-Smith (1999, 2001) argues that measures

designed to capture commitment to the organization, such

as being flexible to employees’ needs, will assist in both

recruitment and retention of staff.

Participants demonstrated that they valued the time

they spent with residents. They felt frustrated when they

were taken away from this by tasks such as documentation,

which they saw as not contributing to residents’ well-

being. Ensuring that staff are provided with adequate

support and education in the area of documentation, as

174 W. Moyle et al.


well as an understanding of how this contributes to overall

resident care, is a significant prerequisite for working in

this field of care. Whilst long-term care funding continues

to be determined by the level of documentation, it is

paramount that staff are given the time needed to fulfil

this role adequately. Clearly outlining requirements for

documentation, providing a framework for completing the

RCS and providing appropriate feedback and support to

staff may allay some of the feelings that documentation

engenders.

The importance of dedication to the job can never be

underestimated. This study has revealed that, in spite of

dissatisfaction with a number of aspects, participants found

comfort in the thought that they were giving of themselves

to others. Similar findings were reported by Corser (1998),

who identified that employees who committed themselves

to their work because of congruity with the mission and

values of the organization were an asset. We suggest that a

value clarification exercise might be useful in determining

staff suitability for long-term care employment.

Dissatisfaction often appears to be related to a lack of

understanding and feelings of impotence or disempower-

ment. Many participants reported that as they worked

closely with residents they were in a position to see solutions

to problems. They made a number of recommendations

that they believed would assist management and resident

care. If staff perceive that they are team members and feel

that their views are respected, this can have a motivating

effect which will ultimately improve workforce morale

(Vance & Davidhizar, 1997). Staff then feel that what they

do makes a difference. Strategies that build trust and

commitment could be implemented, such as regular

meetings where staff can have their needs and suggestions

listened to, reports can be made on ideas that have been

implemented and management views can be heard.

Finally, it is of concern that this investigation confirmed

the ageing of the nursing workforce. As stated earlier, the

mean age of the participants was 46 years. Nurses tend to

cut back their work time or retire after the age of 50, often

because they have other demands on their time, for

example responsibility for ageing parents (Russell & Goile,

2001). Thus, there is potential for a further staffing crisis

in long-term care as staff age and it is imperative that

managers concentrate on employing younger replacement

staff to replace retiring staff. Incentives such as promo-

tional opportunities and education incentives, although

initially expensive may assist in increasing organizational

commitment that will work towards improving this

situation (McNeese-Smith, 2001). New graduates in

particular need to be encouraged to see the benefits of

working in long-term care.

FURTHER RESEARCH

While the findings suggest that staff gain satisfaction from

gratification for care given by residents, if residents are

unable to give this, such as following a stroke or in the later

stages of dementia, what are the consequences of this for

job satisfaction and for resident care? For example, is there

an increased likelihood that residents who do not give

positive feedback will be avoided? Do male staff receive the

same satisfaction from hugs and kisses given by residents as

do female staff? Do residents use opportunities for

thanking staff as opportunities for the comfort of touch

that they may be missing out on? These are questions that

require further investigation. It could be argued that

employers may have to provide higher levels of gratification

in areas where residents are known to be difficult to work

with and are incapable of giving positive feedback.

LIMITATIONS

The small number of participants, bias towards one

organization and lack of generalizability of the results limit

the findings of this study. However, they confirm many

earlier job satisfaction studies and provide further strength

for the support needed for recruitment and retention.

Further study will be undertaken at a later stage to see

whether the findings of this research have assisted in

changing the workplaces studied.

A larger number of staff wanted to join in the focus

groups but reported reluctance due to their already

demanding time schedule. As participation was voluntary,

no staff were pressured into attending the interviews. In

spite of these concerns, those who participated commen-

ted on the benefit of such an exercise, as it gave them an

opportunity to talk about their concerns and they felt

empowered as they recalled that others also enjoyed

working in long-term care:

EN: Thank you for letting us undertake this exercise.

I have enjoyed this. You know, we don’t get the

opportunity to sit down together and to discuss work

issues. I don’t think we have ever done it. We are

always so busy. Thank you for this opportunity.

A small group of participants who had difficulties with

what they saw as staff bullying reported that the exercise

made them realize that it was time they sought support

through their area manager.

It is important to remember that these findings do not

suggest that this sample is any different from staff in other

long-term care facilities and the concerns raised are not

considered to be any greater than those raised by other

samples. Merely asking staff whether they are satisfied or



dissatisfied will always encourage issues to be raised that may

not be discussed openly or frequently in other situations.

Conclusion

This qualitative study has reported on a number of factors

that both strengthen job satisfaction and dissatisfaction in

the long-term care workplace. Although AINs carry out

most of the day-to-day care of residents, the personal and

organizational factors are similar for RNs and ENs. It is

imperative that long-term care managers consider the

factors that impact on job satisfaction and attempt to

resolve these issues where possible, as negativism and

complex resident needs can slow down both productivity

and quality of care (Ryan, 1994; Vance & Davidhizar,

1997).

Acknowledgements

We acknowledge the participants who took time away

from their busy schedules to contribute their views and to

the organizational support.

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