Modeling the Determinants to Regulated Nurses' and Allied Health Staff Members' Job Satisfaction ...

190 Pages·2017·2.01 MB·English

Modeling the Determinants to Regulated Nurses' and Allied Health Staff Members’ Job
Satisfaction in Residential Long-Term Care Facilities

Laura Denise Aloisio, RN, BScN

School of Nursing
Faculty of Health Sciences
University of Ottawa

A Thesis Submitted in Partial Fulfillment of the Requirements
for the Master’s Degree of Science in Nursing

© Laura Denise Aloisio, Ottawa, Canada, 2018
Abstract
Factors affecting job satisfaction among regulated nurses and allied health
workers in long-term care (LTC) facilities remain poorly understood. A secondary
analysis using data from the Translating Research in Elder Care program was done to
model determinants of job satisfaction. Demographic, individual-level, and context-level
variables were assessed. Separate GEE models were constructed for regulated workers (n
= 756) and allied health workers (n = 334). Emotional exhaustion and cynicism predicted
lower job satisfaction in regulated nurses and allied health workers, respectively.
Psychological empowerment and adequate orientation predicted higher job satisfaction in
both groups. Work engagement, culture, and organizational slack-space predicted higher
job satisfaction in regulated nurses. Social capital, organizational slack-time, and formal
interactions predicted higher job satisfaction in allied health workers. These findings
provide empirical support for individual-level and context-level variables and identify the
importance of adequate orientation in job satisfaction in this population.

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Dedication
This thesis is dedicated to my parents, John and Denise Aloisio, who taught me
how, with hard work and tenacity, even the largest goals can be accomplished. Their
belief in me gave me the courage to try and their love and support provided me with the
strength to complete this goal.

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Acknowledgements
I would like start by thanking my master’s supervisor, Dr. Janet Squires, for your
ongoing support. Your commitment to student successes has made this journey
enjoyable, productive, and irreproachable. With patience and understanding, you taught
me everything I needed to know and provided me with opportunities I could have never
dreamed of. I am forever grateful for the council of and opportunity to work with you,
Dr. Squires, throughout this journey. In addition, I would like to thank my co-supervisor
and mentor, Dr. Wendy Gifford, for the simple act of agreeing to work with me. Without
your support and our mutual passion for long-term care, this valuable research would not
have been possible. I would be remiss if I did not give my most genuine thanks to my
supervisory committee, Dr. Kathy McGilton and Dr. Michelle Lalonde. You both
patiently read drafts, provided guidance, and inspired me with insight. Your knowledge,
passion, and ideas helped fill this experience with joy, meaning, and motivation.
To my father and mother, John and Denise Aloisio. Thank you for ensuring I had
the tools needed to accomplish my dreams, for taking care of me all these years, and for
your inexorable love and support. Mary Aloisio, thank you for being my biggest fan and
for believing this was possible. Antoinette Gerardi, your love has been with me every
step of the way. Jackson, thank you so very much for your resolute and adamantine
support. Tetyana, thank you for all of your help and encouragement. Most of all, a very
special thank you to Gracie, Charlie, and Tigs, for always taking the time out of your
busy schedules to listen to me.
This project would not have been possible without the Translating Research in
Elder Care project and its director, the esteemed Dr. Carole Estabrooks. Thank you for
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allowing me to be a part of your significant work and for the opportunities you have
thusly given me to grow, to learn, and to engage with other wonderful researchers. A
final thank you to the University of Ottawa for their munificent scholarships and their
entire faculty for providing me with the skills and resources I needed. To the countless
others who supported me throughout this journey, I give my warmest love and deepest
appreciation.

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Table of Contents
Abstract ............................................................................................................................................ ii
Dedication ....................................................................................................................................... iii
Acknowledgements ......................................................................................................................... iv
Table of Contents ............................................................................................................................ vi
List of Figures ................................................................................................................................. xi
List of Tables ................................................................................................................................. xii
List of Abbreviations .................................................................................................................... xiii
Chapter 1 ........................................................................................................................................... 1
Introduction and Relevance ......................................................................................................... 1
Personal Impetus .......................................................................................................................... 2
Study Purpose and Objectives ..................................................................................................... 3
Significance of Study ................................................................................................................... 4
Theoretical Framework ................................................................................................................ 5
Kanter’s Theory of Structural Empowerment in Organizations. ............................................. 5
Spreitzer’s Theory of Psychological Empowerment. .............................................................. 6
Relationship between psychological & structural empowerment. ........................................... 7
Thesis Outline .............................................................................................................................. 9
References .................................................................................................................................. 11
Chapter 2 ......................................................................................................................................... 14
Search Strategy and Results ....................................................................................................... 14
Factors Related to Job Satisfaction ............................................................................................ 14
Demographic variables. ......................................................................................................... 14
Individual-level variables. ...................................................................................................... 15
Employment characteristics. .............................................................................................. 15
Burnout. ............................................................................................................................. 16
Work engagement. ............................................................................................................. 16
Psychological empowerment. ............................................................................................ 17
Problem solving. ................................................................................................................ 18
Physical and mental health status. ..................................................................................... 18
Context-level variables. ......................................................................................................... 19
Leadership. ......................................................................................................................... 19
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Culture. ............................................................................................................................... 20
Evaluation. ......................................................................................................................... 20
Social capital. ..................................................................................................................... 21
Organizational slack. .......................................................................................................... 21
Formal interactions. ........................................................................................................... 22
Informal interactions. ......................................................................................................... 23
Structural and electronic resources. ................................................................................... 23
Adequate orientation. ......................................................................................................... 24
Working with challenging residents. ................................................................................. 24
Summary of the Literature ......................................................................................................... 24
Regulated nurses. ................................................................................................................... 24
Demographic-level variables. ............................................................................................ 25
Individual-level variables. .................................................................................................. 25
Context-level variables. ..................................................................................................... 25
Allied health professionals. .................................................................................................... 26
Demographic-level variables. ............................................................................................ 26
Individual-level variables. .................................................................................................. 26
Context-level variables. ..................................................................................................... 26
References .................................................................................................................................. 63
Chapter 3 ......................................................................................................................................... 66
Study Design and Rationale ....................................................................................................... 66
Study Sample ............................................................................................................................. 66
Data Collection .......................................................................................................................... 66
Data Measures ............................................................................................................................ 67
Dependent variable. ............................................................................................................... 67
Independent variables. ........................................................................................................... 68
Demographic variables. ..................................................................................................... 68
Individual-level variables. .................................................................................................. 68
Context-level variables. ..................................................................................................... 69
Data Analysis & Modeling Approach ........................................................................................ 69
Ethics Statement ......................................................................................................................... 70
References .................................................................................................................................. 82
Chapter 4 ......................................................................................................................................... 83
Abstract ...................................................................................................................................... 84
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Introduction ................................................................................................................................ 86
Theoretical Framework .............................................................................................................. 87
Methods...................................................................................................................................... 87
Design. ................................................................................................................................... 87
Sampling. ............................................................................................................................... 87
Data collection. ...................................................................................................................... 88
Measures. ............................................................................................................................... 88
Dependent variable. ........................................................................................................... 88
Independent variables. ....................................................................................................... 89
Statistical analysis. ................................................................................................................. 90
Ethics approval. ...................................................................................................................... 90
Results ........................................................................................................................................ 90
Demographic characteristics. ................................................................................................. 90
Bivariate and multivariate analysis. ....................................................................................... 91
Discussion .................................................................................................................................. 92
Individual-level variables. ...................................................................................................... 92
Burnout. ............................................................................................................................. 92
Work engagement. ............................................................................................................. 93
Psychological empowerment. ............................................................................................ 93
Context-level variables. ......................................................................................................... 94
Organizational slack-space. ............................................................................................... 94
Adequate orientation. ......................................................................................................... 94
Leadership. ......................................................................................................................... 96
Strengths and Limitations .......................................................................................................... 97
Conclusion ................................................................................................................................. 98
References ................................................................................................................................ 107
Chapter 5 ....................................................................................................................................... 111
Abstract .................................................................................................................................... 112
Introduction .............................................................................................................................. 114
Theoretical Framework ............................................................................................................ 115
Methods.................................................................................................................................... 115
Design. ................................................................................................................................. 115
Sampling. ............................................................................................................................. 115
Data sources and collection. ................................................................................................ 116
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Measures. ............................................................................................................................. 116
Dependent variable. ......................................................................................................... 116
Independent variables. ..................................................................................................... 117
Statistical analysis. ............................................................................................................... 118
Ethics approval. .................................................................................................................... 118
Results ...................................................................................................................................... 119
Demographic characteristics. ............................................................................................... 119
Bivariate and multivariate analysis. ..................................................................................... 119
Discussion ................................................................................................................................ 120
Individual-level factors. ....................................................................................................... 120
Psychological empowerment. .......................................................................................... 120
Burnout-cynicism. ............................................................................................................ 122
Context-level factors. ........................................................................................................... 123
Formal interactions and social capital. ............................................................................. 123
Adequate orientation. ....................................................................................................... 125
Organizational slack-time. ............................................................................................... 126
Strengths and Limitations ........................................................................................................ 126
Conclusion ............................................................................................................................... 127
References ................................................................................................................................ 138
Chapter 6 ....................................................................................................................................... 142
Thesis Summary ....................................................................................................................... 142
Summary of Thesis Findings ................................................................................................... 142
Manuscript one: Regulated nurses. ...................................................................................... 142
Manuscript two: Allied health professionals. ...................................................................... 143
Integrated Discussion ............................................................................................................... 143
Level of job satisfaction in the present thesis. ..................................................................... 143
Demographic variables. ....................................................................................................... 144
Culture, social capital, formal interactions, and leadership. ................................................ 144
Emotional exhaustion and cynicism. ................................................................................... 146
Psychological empowerment. .............................................................................................. 148
Work engagement. ............................................................................................................... 149
Adequate orientation. ........................................................................................................... 150
Organizational slack time and space. ................................................................................... 152
Organizational slack-time. ............................................................................................... 152
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Organizational slack-space. ............................................................................................. 152
Implications for Practice .......................................................................................................... 153
Implications for nursing practice. ........................................................................................ 153
Implications for education. .................................................................................................. 154
Increase gerontological and leadership training in entry-to-practice programs. .............. 154
Design and implement preceptorship, internship, and residency programs. ................... 158
Improve job orientation. ................................................................................................... 160
Provide and support continuing education and in-services. ............................................. 161
Implications for policy. ........................................................................................................ 162
Implement policies known to promote factors involved in job satisfaction. ................... 162
Improve policies to promote flexible scheduling. ............................................................ 164
Improve organizational slack space in LTC facilities. ..................................................... 165
Implications for research. ..................................................................................................... 166
Study Strengths and Limitations .............................................................................................. 166
Secondary analysis. .............................................................................................................. 166
Present study. ....................................................................................................................... 167
Conclusion ............................................................................................................................... 168
References ................................................................................................................................ 169
Chapter 7 Contributions of Collaborators Co-Authorship ............................................................ 176

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