RESEARCH TO PRACTICE
The Effects of Empowerment of Certified Nurse Aides
and Staff Stability on Nursing Home Resident OutcomesBarry T., Brannon D., & Mor V. (2005). Nurse Aide Empowerment Strategies and Staff Stability: Effects on Nursing Home Resident Outcomes. The Gerontologist, 45.3, 309-317.
The nurse aide turnover in nursing homes is an ongoing difficulty across the country that affects the quality of treatment for residents. Nurse aides provide most of the care to residents, and the stability of this workforce is crucial to the provision and quality of care. It is widely acknowledged that these workers experience stressful working conditions and limited career mobility, and their pay is among the lowest in the health field. It seems that poor wages are not the only reasons contributing to nurse aides’ dissatisfaction. These staff members identify the need for more respect, opportunities for advancement, and autonomy. The nursing home industry is genuinely interested in finding practical solutions to these problems to reduce the turnover rate and consequently increase the quality of life for residents.
Dr. Theresa Barry and her research team examined the relationship between management styles related to staff empowerment and resident outcomes. They defined empowerment “at the organizational level, assuming that empowerment tools provided by the organization become internalized by staff members at the individual level.” The team used Kanter’s theory of structural power and concentrated on two of its three parts, the opportunity structure and power structure. The opportunity structure is seen as a chance for advancement or growth in the organization. The power structure is defined as access to resources, information, and support that promotes the empowerment of employees. When it is effective, staff empowerment is illustrated by workers’ sense of control over their working conditions. This sense of control should result in increased productivity. In culture change terms, both of these elements constitute staff’s empowerment.
The study showed that some management practices for nurse aides’ empowerment are related to a facility’s pressure ulcer incidence rate and psycho-social well-being scores. A chance for advancement in the facility showed a reduction in the pressure ulcer incidence rate. The researchers suggest that this may be a result of empowering aides in homes where care quality had been poor in an effort to improve their skills. The staff empowerment derived from the increase of their skills and knowledge enhanced nurse aides’ involvement in residents’ care and consequently contributed to their higher quality of care.
Nurse aides’ access to resources, information, and support influenced the residents’ psycho-social outcome of social engagement. This finding demonstrates that nurse aide involvement in the care planning is related to the psychological well-being of residents. In resident-centered homes the same staff are assigned to the same residents every day. This permanent assignment results in knowledge of the residents’ needs, preferences and routines and its outcome is the residents’ increased social engagement. This knowledge of residents can be easily passed to other staff who can develop appropriate activities and interventions for the resident.
When the research team looked into the effect of the stability of direct care staff on the pressure ulcer incidence rate, they identified that the rates are lower in facilities with lower staff turnover and higher retention rates. Barry suggests that the time it takes to train new nurse aides in these homes may compromise resident care.Implications: This study demonstrated the critical role that nurse aides play in residents’ quality of care and well-being. More and more research shows the positive effects of staff empowerment, both for their retention rate and resident’s better quality of care and well-being. The Wellspring model, the Eden Alternative, and many nursing homes in Kansas have shifted from a hierarchical structure to a more lateral decision-making structure. Nurse aides have an opportunity for advancement through career ladders, mentoring, and reward systems. This study demonstrates the importance of the stability of the nursing staff. The best empowerment mechanisms in place will not be effective when the nursing staff turnover rate is high.