Schwendimann et al.

BMC Nursing (2016) 15:37

DOI 10.1186/s12912-016-0160-8

RESEARCH ARTICLE Open Access

Factors associated with high job

satisfaction among care workers in Swiss
nursing homes – a cross sectional survey
study
René Schwendimann1*, Suzanne Dhaini1, Dietmar Ausserhofer1,2, Sandra Engberg1,3 and Franziska Zúñiga1

Abstract
Background: While the relationship between nurses’ job satisfaction and their work in hospital environments is
well known, it remains unclear, which factors are most influential in the nursing home setting. The purpose of this
study was to describe job satisfaction among care workers in Swiss nursing homes and to examine its associations
with work environment factors, work stressors, and health issues.
Methods: This cross-sectional study used data from a representative national sample of 162 Swiss nursing homes
including 4,145 care workers from all educational levels (registered nurses, licensed practical nurses, nursing
assistants and aides). Care worker-reported job satisfaction was measured with a single item. Explanatory variables
were assessed with established scales, as e.g. the Practice Environment Scale – Nursing Work Index. Generalized
Estimating Equation (GEE) models were used to examine factors related to job satisfaction.
Results: Overall, 36.2 % of respondents reported high satisfaction with their workplace, while another 50.4 %
were rather satisfied. Factors significantly associated with high job satisfaction were supportive leadership (OR = 3.
76), better teamwork and resident safety climate (OR = 2.60), a resonant nursing home administrator (OR = 2.30),
adequate staffing resources (OR = 1.40), fewer workplace conflicts (OR = .61), less sense of depletion after work
(OR = .88), and fewer physical health problems (OR = .91).
Conclusions: The quality of nursing home leadership–at both the unit supervisor and the executive administrator
level–was strongly associated with care workers’ job satisfaction. Therefore, recruitment strategies addressing
specific profiles for nursing home leaders are needed, followed by ongoing leadership training. Future studies
should examine the effects of interventions designed to improve nursing home leadership and work
environments on outcomes both for care staff and for residents.
Keywords: Nursing homes, Care workers, Job satisfaction, Work environment, Leadership

Background needs [3]. However, nursing homes’ attempts to meet

In long-term care facilities, ongoing societal and demo- the rising demand are impeded by considerable annual
graphic changes are increasing both the number of care- turnover rates among care workers [4]. Since higher job
dependent older people and the demand for professional satisfaction is closely linked to less intention to leave
nursing care [1, 2]. For example, in Switzerland it is esti- and lower turnover [5–11], the identification of modifi-
mated that the population of nursing staff will need to able factors associated with job satisfaction might sup-
grow by 30% by 2020 to cover stationary long-term care port nursing home managers in reducing turnover and
maintaining high care quality. In both hospital- and
* Correspondence: [email protected]
long-term care-based empirical studies, several such
1
Institute of Nursing Science, University of Basel, Bernoullistr. 28, Basel 4056, factors have already been found. These link health
Switzerland personnel job satisfaction with working conditions and
Full list of author information is available at the end of the article

© 2016 The Author(s). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
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Schwendimann et al. BMC Nursing (2016) 15:37 Page 2 of 10

work environment, job stress, role conflict and ambigu- greater job autonomy, job control, and involvement in
ity, role perception and content, and organizational and decision-making are all associated with higher satisfac-
role commitment [12–14]. To date, however, few nurs- tion [32–36].
ing home studies have examined a wider combination Care workers with lower job satisfaction not only
of organizational factors related to job satisfaction [14]. have a high probability of leaving their job [5, 6], but
Overall, nursing home care workers with diverse edu- also show higher rates of absenteeism and emotional
cational backgrounds report moderate to high job satis- exhaustion or burnout [12]. Therefore, in addition to
faction [15–18]. In the U.S., data from the 2004 supporting staff stability, improvement of factors re-
National Nursing Home Survey indicated that 82 % of lated to higher job satisfaction in nursing homes might
nursing assistants were satisfied or extremely satisfied also advance the well-being of care workers, and by ex-
with their jobs [19]; in Sweden, 76 % of nursing assis- tension, of the residents who depend on them.
tants reported moderate or high general job satisfaction In Switzerland, the nursing home sector employs over
[20]. In a recent concept analysis, job satisfaction was de- 120,000 persons in 1,558 facilities with over 92,000
fined as “an affective reaction to a job that results from the beds (median size: 59 beds) [37]. Nursing homes have
incumbent’s comparison of actual outcomes with those that public, private or mixed ownership and offer services
are desired, expected and deserved” (p 130) [21]. Accord- ranging from adult daycare and post-acute care (includ-
ingly, the complex phenomenon of nurses’ job satisfaction ing rehabilitation) to dementia care and long-term care
depends upon their sense of personal accomplishment, in home-like environments [38]. Roughly 30 % of these
their personal expectations, and the nature of their jobs facilities’ care workers are registered nurses, comple-
[12]. Along with broad differences in these variables mented by licensed nurses (21 %, 3 years’ education)
among care workers, methodological differences in meas- and nurse aides (21 %: 1–2 year’ education; 28 %: train-
uring them can lead to broad variations in care workers’ ing on the job). In view of the growing number of older
job satisfaction and its antecedents, not only between people in Switzerland, the pressing need for more care
countries but also between settings and professional services, and the difficulties replacing staff members–
groups. A recent review compared results concerning per- especially registered nurses–in nursing homes [38],
sonal and organizational antecedents of job satisfaction nursing home administrators face increasing challenges
between nurses in hospitals and care aides in residential to uphold the quality of care and service. The identifi-
long-term care [14]. In the latter group, observed varia- cation of factors that contribute to nursing home care
tions included a higher valuation of workload and lower workers’ job satisfaction is highly relevant to staff reten-
valuation of coworker support regarding job satisfaction. tion and ultimately to safe care.
Although the question remains open whether this reflects
differences in educational backgrounds or in settings, it Literature gap
shows that desired, expected or deserved outcomes vary Although multiple nursing home studies have examined
considerably among healthcare professionals, and that a job satisfaction and its antecedents, it remains unclear
context-specific approach is needed to identify relevant which factors are most influential regarding high job sat-
antecedents. isfaction in this setting. While previous studies focused
Both personal and organizational factors have been on isolated influencing factors, they lacked a compre-
examined as possible antecedents of job satisfaction. In hensive exploration of multiple organizational factors,
nursing home studies, results concerning individual particularly including aspects and combinations of work
(e.g., age) or facility characteristics (e.g., bed count) environment and care workers’ health simultaneously.
show either no relationships or equivocal ones, while For the current study, then, we approached job satis-
organizational factors are often positively associated faction as an outcome determined by a combination of
with job satisfaction [14, 22]. Higher job satisfaction organizational and personal factors–to which we added
among nursing home care staff is related to the oppor- care workers’ health complaints. Controlling for facility
tunity to provide high-quality, person-centered care and care worker characteristics, we focused on modifi-
[13, 20, 23], to effective leadership [24] and teamwork able factors including the work environment (e.g., lead-
[25], and to resident satisfaction [26]. Lower job satis- ership), work stressors and the teamwork and safety
faction correlates with shortages of qualified personnel climate (see Fig. 1).
[27], inadequate supervision [28], lack of cooperation
[28, 29], health complaints, and absence due to illness Methods
[20, 30, 31]. At the organizational level, along with a Study aims
lack of opportunities for advancement and professional The goals of this study are 1) to measure job satisfaction
growth, insufficient compensation appears to contrib- among Swiss nursing home healthcare workers, and 2)
ute strongly to job dissatisfaction [23–25, 27], while to examine how work environment, work stressors, and
Schwendimann et al. BMC Nursing (2016) 15:37 Page 3 of 10

Facility characteristics
Work environment
– Language region*
– Nurse manager ability, leadership,
– Nursing home size*
and support of nurses (leadership)
– Profit status* – Staffing and resources adequacy
(staffing)
– Job autonomy
– Shared decision making
– Advancement opportunities Job satisfaction
Care worker characteristics – Collaboration w. higher management
– Gender* Teamwork and safety climate
– Age* Work stressors
– Educational background* – Conflict and lack of recognition
– Physical health – Workload
– Emotional exhaustion – Lack of preparation

*control variables

Fig. 1 Nursing home and care worker characteristics and workplace factors related to job satisfaction

care workers’ health complaints are associated with job validity index (I-CVI) or scale content validity index
satisfaction in nursing homes. (S-CVI)) was confirmed, and all items were pre-tested
for comprehensibility in end-user focus groups. Further
Design and sample information related to the development and validity test-
This study utilizes data from the Swiss Nursing Homes ing of the questionnaire are described elsewhere [39].
Human Resources Project (SHURP), a cross-sectional
multi-center study using a random sample of 163 officially
listed nursing homes across Switzerland, stratified accord- Outcome variable
ing to language region (German, French, or Italian) and Care worker job satisfaction was measured using a single
facility size (small: 20–49 beds; medium: 40–99 beds; item: “How satisfied are you overall with your current
large: 100 or more beds). Residential homes and hos- job in this nursing home?“Respondents rated their satis-
pices were excluded. In the participating nursing faction on a 4-point Likert-type scale, ranging from 1
homes, only care workers who engaged in direct care (strongly dissatisfied) to 4 (strongly satisfied). To focus
and were employed a minimum of 8 h per week were our analysis on the most satisfied respondents, we di-
surveyed, resulting in a final sample of 5,323 individ- chotomized the outcome variable as follows: 1 = strongly
uals. The SHURP study’s sampling and survey methods satisfied vs. 2 = rather satisfied, rather dissatisfied, or
are described elsewhere in greater detail [39]. To ad- strongly dissatisfied. The single item approach reflects
dress the objectives of this sub-study, we excluded per- job satisfaction as a whole with high reliability and valid-
sons in leadership positions (e.g., unit and department ity [40], and has been used successfully in previous hos-
managers), leaving a sub-sample of 4,145 care workers pital and nursing home studies [19, 26, 41, 42].
from 162 nursing homes.

Variables and measurements Explanatory variables

Socio-demographic and professional data on care workers, The independent variables of interest are presented in
including their perceptions of their work environment, Table 1. They include assessments of work environment
work stressors, and health complaints, were collected factors (via the Practice Environment Scale–Nursing
using a structured survey questionnaire [39]. Facility Work Index (PES–NWI)), of teamwork and safety cli-
characteristics were assessed via a questionnaire com- mate (via the Safety Attitude Questionnaire (SAQ)), and
pleted by the nursing home administrators. Both ques- of workplace stressors (via the Health Professions Stress
tionnaires were translated into German, French, and Inventory (HPSI)). Care workers’ health complaints were
Italian. Items were verified against their original lan- assessed using five items from the Swiss Health Survey;
guage versions by comparison with back translations. ratings of “feeling depleted from work” were gathered
The care worker questionnaire’s items and scales were via a single item from the Maslach Burnout Inventory.
tested for their relevance in consultation with geronto- Further details on items and measurement levels are de-
logical experts. Their content validity (item content scribed in Table 1.
Schwendimann et al. BMC Nursing (2016) 15:37 Page 4 of 10

Table 1 Description of independent variables assessing the work environment, work stressors and care workers’ health complaints
Variable Name Description Measurement
Work environment
Leadership 5-item subscale “Nurse manager ability, leadership, and support of care workers” 4-point Likert-type scale from
of the Practice Environment Scale-Nursing Work Index (PES-NWI) [60], assessing 1 = strongly disagree to 4 = strongly agree
support by direct supervisors, their competency, back-up in decision making, Cronbach’s α = .84
praise and recognition given, and the use of mistakes as learning opportunities
and not criticism
Staffing and 3-item subscale “Staffing and resources adequacy” of the PES-NWI [60], assessing 4-point Likert-type scale from
resource adequacy whether there was enough time and opportunity to discuss resident care 1 = strongly disagree to 4 = strongly agree
problems, enough qualified personnel to provide quality resident care, Cronbach’s α = .74
and enough staff to perform all necessary tasks
Job autonomy Single item (Investigator developed), assessing whether care workers decide 4-point Likert-type scale from
autonomously how to perform their work 1 = strongly disagree to 4 = strongly agree
Shared decision Single item of the PES-NWI [60], assessing opportunities for care workers to Idem
making participate in nursing home policy decisions (e.g., about resident care or work
organization)
Advancement Single item of the PES-NWI [60], assessing opportunities for professional advancement Idem
opportunities (e.g., continuing education opportunities, special tasks within the team/in the
nursing home)
Teamwork and Combination of two subscales of the Safety Attitude Questionnaire (SAQ) [61]. 5-point Likert-type scale from
safety climate Based on confirmatory factor analysis, the original two subscales for Teamwork 1 = strongly disagree to 5 = strongly agree
and Safety Climate could not be confirmed. Three items with low item with the option “don’t know”
discrimination (corrected item-scale correlation < 0.4) were removed. This resulted Cronbach’s α = .89
in one 10-item single factor for Teamwork and Safety Climate, assessing, e.g., the
opportunity to speak up or to ask questions when something is not understood,
the extent to which other team members provide assistance when needed, the
opportunity to discuss errors and to learn from each other, and the reception of
feedback about one’s performance.
Available director Single item of the PES-NWI [60], assessing whether the director of nursing is 4-point Likert-type scale from 1 = strongly
of nursing available for the care staff disagree to 4 = strongly agree
Resonant nursing Single item of the PES-NWI [60], assessing whether the nursing home administrator Idem
home has an “open ear” and responds to issues raised by the care staff
administrator
Work stressors
Of the original 30-item Health Professions Stress Inventory (HPSI) [62], 2 items 5-point Likert-type scale ranging from
were selected based on expert ratings concerning their relevance in the nursing 0 = never to 4 = very often
home context. Exploratory factor analysis identified 3 factors.
Conflict and lack of 6-item subscale, assessing, e.g., disagreement with other health professionals Idem
recognition concerning residents’ treatment, conflicts with supervisors, not being asked about Cronbach’s α = .76
one’s opinion concerning decisions about one’s job, and not being paid enough
Workload 3-item subscale, assessing, e.g., having so much work to do that not everything can Idem
be done well and not having enough people working to perform the work well Cronbach’s α = .74
Lack of preparation 3-item subscale, assessing, e.g., lacking the training to meet residents’ needs, Idem
being afraid of making a mistake in the residents’ treatment and being Cronbach’s α = .63
overwhelmed by caring for terminally ill residents
Health complaints
Physical health From the original Swiss Health Survey [63], 5 items on health complaints, 3-point Likert-type scale from “1 = not
including back pain, joint pain, tiredness, problems with sleeping, and headache at all to 3 = strongly”
were extracted to assess care workers’ self-reported physical health. We combined Cronbach’s α = .70
the 5 items to form a sum index ranging from 0 to 10 to express care workers
general health condition.
Depleted from Single item according to the Maslach Burnout Inventory [64], assessing care 7-point Likert-type scale from "0 = never
work workers’ feelings of being depleted at the end of a working day to 6 = daily"

Control variables or higher degrees, licensed practical nurses with associate

Care worker and nursing home characteristics were used degrees, and nursing assistants/nursing aides with certified
as control variables. Care worker characteristics included education or informal in-service training). Nursing home
age and educational level (registered nurses with diploma characteristics included facility size, ownership status
Schwendimann et al. BMC Nursing (2016) 15:37 Page 5 of 10

(public, private-public subsidized, and private nursing workers’ job satisfaction was high, with 36.2 % being
homes), and language region. strongly satisfied and 50.4 % rather satisfied, while
13.4 % were either rather or strongly dissatisfied. Re-
Data collection garding work environment factors, we observed high
The SHURP survey was administered from May 2012 values for teamwork and safety climate (3.97 on a
until April 2013. All nursing home administrators gave scale from 1–5) and for leadership (3.13 on a scale
informed consent for their facilities’ participation and from 1–4), alongside low values for work stress due ei-
forwarded the questionnaires and return envelope pack- ther to conflict and lack of recognition (.91 on a scale
ages to their care workers. Care workers individually from 0–4) or to lack of job preparation (.68 on a scale
completed and returned the questionnaires to the study from 0–4). In addition, relatively high proportions of
cnter. respondents agreed or strongly agreed with shared de-
cision making options (86.1 %), and with directors of
Data analyses nursing being available for care staff (89.6 %). All re-
Descriptive statistics (frequencies, percentages, means sults related to facility and care worker characteristics
and standard deviations) were used to determine the and the examined independent variables are summa-
prevalence of strong job satisfaction, and to summarize rized in Table 2.
data on nursing home and care worker characteristics,
as well as on work environment, work stressors and care Job satisfaction and workplace characteristics
workers’ health complaints. To examine the independent Higher job satisfaction (i.e., strong satisfaction with the
variables’ relationships with care workers’ job satisfaction workplace) was significantly associated with half of the
(dichotomized as 1 = strongly satisfied vs. 2 = rather sat- examined work environment factors. The strongest asso-
isfied, rather dissatisfied, or strongly dissatisfied), we ciation was with leadership: the odds of high job satisfac-
used logistic regression with generalized estimating tion increased almost four-fold with each 1-point
equation (GEE) modeling, controlling for care workers increase in leadership rating odds ratio (OR) (OR = 3.76;
being nested within facilities and units (Intra Class Coef- 95 % CI, 2.83-4.99). Similarly, the odds increased more
ficient (ICC 1) for job satisfaction: facility level: 0.07; than two-fold with each 1-point increase either in team-
unit level: 0.10). The model was set to control for care work & resident safety climate (OR = 2.59; 95 % CI,
worker characteristics (age, educational level) and facility 2.02-3.32), or for nursing home administrators being res-
characteristics (size, ownership status, language region). onant (as opposed to not listening to care workers) (OR
Our analyses tested both unadjusted and adjusted = 2.23; 95 % CI, 1.67-2.97). The odds of strong job satis-
models. As several variables (job autonomy, shared de- faction also increased significantly with staffing and
cision making, advancement opportunities, and collab- resource adequacy (OR = 1.42; 95 % CI, 1.17-1.72), and
oration with higher management) yielded left-skewed decreased significantly with increases in workplace con-
distributions, they were dichotomized accordingly for flict (OR = .61; 95 % CI, .48-.76), being “depleted from
the analysis (1 = strongly agree/agree vs. 2 = disagree or work” (emotional exhaustion) (OR = .88; 95 % CI, .83-.93),
strongly disagree). Multicollinearity among the inde- and physical health issues (OR = .91; 95 % CI, .87-.96). For
pendent variables was determined with the Variance more details see Table 3.
Inflation Factor (VIF). All variables produced VIF out-
comes below the threshold of 5 [43] and were retained Discussion
for the analyses. The GEE was run with listwise dele- This is Switzerland’s most comprehensive study to date
tion of missing cases. The analysis was repeated using a of associations between organizational factors, health-
GEE model employing multiple imputation: all variables related issues and job satisfaction in the nursing home
showed similar significance levels to the first model. A p- setting. Conducted in a representative national sample
level of < .05 was considered significant. All analyses were of Swiss nursing homes, it revealed that slightly over a
performed using IBM© SPSS© Statistics for Windows©, third of care workers were strongly satisfied with their
Version 21.0 software (Armonk, NY: IBM Corp.). current workplace. Strong job satisfaction was signifi-
cantly associated with higher ratings for supportive lead-
Results ership, teamwork and safety climate, resonant nursing
Sample characteristics and care workers’ job satisfaction home administrators, and adequate staffing resources,
The final study sample consisted of 4,145 care workers and with lower ratings for workplace conflict and health
from 162 nursing home facilities across Switzerland, complaints. Other work environment factors, e.g., job
with an overall response rate of 76.4 %. Respondents autonomy, the director of nursing being available to the
came mainly from medium sized facilities in the care workers, and stress due to workload, showed no
German-speaking region of Switzerland. Overall, care significant associations with job satisfaction.
Schwendimann et al. BMC Nursing (2016) 15:37 Page 6 of 10

Table 2 Sample characteristics The high overall job satisfaction ratings of care
% Mean SD workers in Swiss nursing homes concur not only with
Facility characteristics (n =162) previous findings in nursing home [9] and acute-care
Facility size (number of beds)
settings [41], but also with those derived from research
in other sectors [44, 45]. While previous researchers di-
Small (< 50) 38.9
chotomized their data to distinguish positive job satis-
Medium (50–99) 46.3 faction ratings from negative [9, 19, 26], we focused
Large (≥ 100) 14.8 exclusively on highly satisfied care workers. By examin-
Ownership status ing this group’s data, we aimed to identify factors separ-
Public 37.0 ating the average or good nursing home workplaces
Private, public subsidized 26.5
from the excellent. Using an approach employed by
Forbes-Thompson and colleagues, we highlighted dif-
Private 36.4
ferences in nursing home performance by focusing on
Language region rather extreme cases (i.e., strong job satisfaction ratings
German speaking 75.9 only) [46].
French speaking 18.5 In our adjusted regression model, three factors most
Italian speaking 5.6 significantly explained variations in the proportions of
Care worker characteristics (n = 4,145)
care workers reporting strong job satisfaction–nursing
home leadership, teamwork and safety climate and the
Females (n = 4,105) 92.5
resonance of the nursing home administrator. In this
Age in years (n = 3,750) 42.9 12.3 context, links between perceptions of supportive leader-
Educational level (n = 4,109) ship–particularly of individual leaders’ types and levels
Registered nurse (3–4 year education) 25.8 of interaction with their staff–strongly suggest that
Licensed practical nurse (3 year education) 22.1 workers strongly satisfied with their jobs perceive that
Certified nurse assistant (1–2 year education) 19.2
their leaders both support them and recognize their in-
put. In addition, as observed elsewhere, leadership
Nurse aide (short course, training on the job) 29.6
styles that treat care errors as learning opportunities ra-
Other 3.2 ther than opportunities for criticism are more likely to
Work environment develop trust and commitment among care workers
Leadership (PES-NWI) (1–4), (n = 4,145) 3.13 .60 [47, 48]. In former studies, a variety of leadership styles
Staffing & resources adequacy (PES-NWI) (1–4), 2.82 .66 were examined concerning their relationship with job
(n = 4,138) satisfaction. A high score on the PES-NWI “Nurse man-
Job autonomy (a), (n = 4,117) 80.6 ager ability, leadership, and support of care workers” sub-
Shared decision making(a), (n = 4,123) 86.1 scale requires a relationship-oriented leadership style that
a focuses on supporting care workers, developing their skills
Advancement opportunities ( ), (n = 4,130) 84.4
and recognizing their work with praise and appreciation
Teamwork & safety climate (SAQ) (1–5), 3.97 .66
(n = 4,133)
[42]. Previous studies indicated that supportive managers
or a relationship-oriented leadership style contribute to
Conflict and lack of recognition (HPSI) (0–4), .91 .67
(n = 4,138) nurses` job satisfaction [18, 42, 49].
Interestingly, however, in nursing homes, depending
Workload (HPSI) (0–4), (n = 4,138) 1.53 .82
on the stability of the staff, Havig et al. found a stronger
Lack of preparation (HPSI) (0–4), (n = 4,132) .68 .59
effect for task-oriented leadership (focusing on plan-
Resonant nursing home administrator (a), 75.7 ning work activities, clarifying roles and objectives, and
(n = 4,093)
monitoring performance) than for relationship-oriented
Available director of nursing(a), (n = 4,114) 89.6 leadership [42]. They suggest that different teams or sit-
Care worker reported health uations might call for different leadership styles, and
Physical health (0–10), (n = 4,035) 3.48 2.27 that teams whose work involves a high level of inter-
Depleted from work (0–6), (n = 4,097) 2.88 1.82 dependence might need a more task-oriented style to
Note: Underlined scores are preferable scores; adichotomized variables allow more role clarity and less work stress. While we
indicate proportion of respondents who agreed strongly/agreed vs. those who can confirm the value of supportive leadership in nurs-
disagreed strongly/disagreed with item, or who rated quality of care as rather
high/very high vs. rather low/very low
ing homes, we cannot exclude the possible advantage of
adapting one’s leadership style to the situation at hand.
Furthermore, the high resonance ratings of very satis-
fied workers toward their nursing home administrators
Schwendimann et al. BMC Nursing (2016) 15:37 Page 7 of 10

Table 3 Job satisfaction and nursing home work environment colleagues regarding residents’ care. This, in turn,
characteristics* strengthens care workers’ sense of belonging to a strong
Job satisfactiona (n = 3,750) team, fostering the personal attitude that “I would feel
OR 95% CI p-value safe being a resident on this unit.” As observed in the
Work environment current study, confidence in colleagues and stimulation
Leadership (PES-NWI) 3.761 2.833 − 4.993 < 0.001
from co-workers [23] are both related to positive percep-
tions of teamwork, fostering high job satisfaction.
Staffing & resource adequacy (PES-NWI) 1.418 1.166 − 1.724 < 0.001
Staffing adequacy ratings reflected workers’ personal
Job autonomy .788 .619 − 1.004 0.054 senses of whether their units’ staff counts and skill mixes
Shared decision making 1.351 .884 − 2.065 0.164 were sufficient to perform all necessary work while
Advancement opportunities 1.130 .772 − 1.654 0.530 maintaining high care quality. Significantly linked to job
Teamwork & safety climate 2.592 2.021 − 3.323 < 0.001 satisfaction, staffing adequacy included care workers’
Available director of nursing 1.474 .908 − 2.393 0.117
perceptions of whether they had the time and the oppor-
tunity to discuss resident care problems. However, Van
Resonant nursing home administrator 2.231 1.676 − 2.970 < 0.001
Beek and colleagues [16] initially observed that appar-
Work stressors ently significant relationships between nurse manager
Conflict and lack of recognition (HPSI) .605 .483 − .759 < 0.001 reported staffing levels and staff job satisfaction disap-
Workload (HPSI) .863 .737 − 1.011 0.068 peared when communication density was controlled for,
Job preparation (HPSI) .995 .829 − 1.193 0.953 i.e., that higher staffing alone did not increase care
Health complaints
workers’ job satisfaction. Instead, where workplace satis-
faction is concerned, the current study findings suggest
Physical health .910 .866 − .955 < 0.001
that the effect of allocating a specific number of workers
Depleted from work .877 .825− .933 < 0.001 to a unit is secondary to those workers’ perceptions of
Note: *Binary logistic regression with GEE. The model was controlled for care staffing adequacy (including skill mix), and to their op-
worker characteristics (age, educational level) and facility characteristics (size,
ownership status, and language region), OR = Odds ratio, portunities to communicate with one another.
CI = Confidence interval
a
The topic of workplace conflict and lack of recognition
Two groups: 1 = strongly satisfied vs. 2 = rather satisfied, dissatisfied, or
strongly dissatisfied. Group 1 is reported
encompasses a range of stressors with the potential to
impact care workers’ job satisfaction. Our findings con-
imply that top nursing home leaders foster and maintain firm previous findings [55] that workplace conflict nega-
direct communication with front-line care workers, tively correlates with job satisfaction. Typical stressors
monitor their needs, and support the achievement of include disagreements between care workers and other
organizational goals in their daily operations [46, 50]. health professionals concerning residents’ care, not being
Donoghue & Castle [51] found that nursing home ad- asked for input on decisions related to one’s job (e.g.,
ministrators who solicit and act upon their staff ’s input assignment of residents, task scheduling), clashes with
have lower facility-level staff turnover–a key goal of supervisors, not being permitted to use all one’s skills,
promoting job satisfaction. Similarly, in a review of and being underpaid. Our analyses linked conflict and
relationship-oriented management practices, Toles and lack of recognition significantly to job satisfaction. The
Anderson [52] found that reciprocal staff and manager subscale used included the item “not being paid
communication added to staff satisfaction as well as to enough,” a factor examined in studies associating nurs-
effective resident care. On the other hand, where staff ing assistants’ job satisfaction strongly with wages and
members perceive no connection to their managers, benefits [9, 26]. Additional stressful situations, e.g.,
open communication about medical errors is impeded, work interruptions or input from non-health profes-
as care workers feel ignored or blamed [52, 53]. I.e., sionals on how to do one’s work [56], are not explicitly
lack of a connection with managers hinders both staff identified in the current study. Nevertheless, care
satisfaction and quality of care. workers in environments where workplace conflict is
As interconnected work environment aspects, en- poorly managed tend not only to exhibit reduced prod-
hanced teamwork and safety climate are both associated uctivity [57], but also to identify poorly with their team
with strong job satisfaction. Teamwork is vital for staff and to report low job satisfaction [58].
satisfaction–a key mechanism for staff retention and Health issues, including emotional strain (reflected in
nursing stability at the facility level [54]. In theory, sta- feelings of emotional exhaustion or depletion at the end
bility within an organization’s nursing system will en- of a working day) and physical symptoms of stress (such
hance that organization’s equilibrium, and will positively as back pain, headache, tiredness or problems with
influence nurses’ satisfaction [54]. Furthermore, both sleeping) were also inversely associated with strong job
teamwork and safety climate involve support from satisfaction. Our findings corroborated those of earlier
Schwendimann et al. BMC Nursing (2016) 15:37 Page 8 of 10

studies linking low job satisfaction with emotional ex- For future studies, we recommend developing and
haustion [31] and physical health complaints [20] in testing complex interventions necessary to develop and
nursing home care staff as well as with the burden of measure the effects of enhanced nursing home leader-
emotional stress and depression in critical care nurses ship competencies on care staff outcomes as well as on
[59]. These findings suggest that physical discomfort and residents’ health and quality of care.
emotional exhaustion deplete one’s energy, impairing per-
formance, inducing low mood, depression and unpleasant Abbreviations
feelings, and ultimately reducing job satisfaction. CI, confidence interval; GEE, generalized estimating equation; HPSI, health
professions stress inventory; ICC, intra class coefficient; I-CVI, item content
validity index; OR, odds ratio; PES–NWI, practice environment scale–nursing
Strengths and limitations work index; SAQ, safety attitude questionnaire; S-CVI, scale content validity
The greatest strength of this job satisfaction study index; SHURP, swiss nursing homes human resources project; VIF, variance
inflation factor
among care workers in Swiss nursing homes was its
extensive dataset–the product of a large representative Acknowledgements
nursing home sample and high response rates. Add- We deeply appreciate the many contributions of the SHURP research team
members and express our thanks to the participating care workers of the
itionally, the strict focus on strong job satisfaction re- nursing homes for their support.
sponses allowed identification of the associations most
relevant to the nursing home care workforce. However, Funding
The SHURP study received funds from the Swiss Health Observatory, Nursing
the findings should be interpreted with caution in view
Science Foundation Switzerland, the University of Basel’s Research fund 2012,
of its limitations. First, as its cross-sectional design cap- the Swiss Alzheimer Association, and an anonymous sponsor. The funding
tures care workers’ job satisfaction and associated fac- sources were in no way involved in the collection, analysis, or interpretation
of data, or in the writing of this paper.
tors only at a single instant, no causal relationships can
be inferred. Second, considering the complexity of a so- Availability of data and materials
cially determined construct such as job satisfaction, the All the data supporting the presented findings is contained within the
use of a single item to measure it might be disputable. manuscript.

Nevertheless, previous studies have successfully applied Authors’ contributions

similar measures to job satisfaction, as well as to related RS drafted the manuscript. RS, FZ and DA were involved in the conception
workplace factors and perceptions [19, 26, 42]. Third, and methodological construct of the study including data analysis and
interpretation of data. SE and SR critically reviewed the manuscript. All
the selection of items examined in relation to job satis- authors read and approved the final version of the manuscript.
faction was limited to those used in the SHURP study.
Other potentially relevant factors, such as work-family Competing interests
The authors declare that they have no competing interests.
conflict or the opportunity to provide person-centered
care, were left unexamined. Finally, social desirability Consent to publish
bias might have skewed the results towards the positive Not applicable.
end, reflecting the workers’ desire to be members of a
Ethics approval
good workplace. The SHURP study was approved by all Swiss cantonal ethics committees
(leading ethics committee: Beider Basel, Ref.Nr. EK 02/12). As per prior
Conclusions instruction, care workers’ completion and return of the questionnaire was
considered informed consent.
This study revealed significant associations between
strong job satisfaction in Swiss nursing home care Author details
1
workers and six work environment factors: nursing Institute of Nursing Science, University of Basel, Bernoullistr. 28, Basel 4056,
Switzerland. 2College of Health-Care Professions Claudiana, Lorenz-Böhlerstr.
home leadership, teamwork and safety climate, the res- 13, Bozen 39100, Italy. 3Pittsburgh University, School of Nursing, 350 Victoria
onance of the nursing home administrator, workers’ Building, 3500 Victoria St, Pittsburgh, PA 15261, USA.
perceptions of staffing adequacy, workplace conflict,
Received: 26 January 2016 Accepted: 31 May 2016
and health complaints. Of these, the effectiveness of
the nursing home leadership at both levels–unit super-
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