Employee Retention in the Long-Term Care Setting Nursing Homes Term Paper

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baby boomers grow older, America is faced with a growing need to provide for them in long-term care situations, such as Nursing Homes. However, at the same time, we are faced with a growing difficulty finding and retaining a workforce to care for them. People are attracted to the health care industry that have a genuine heart-felt desire to care for people. They receive their education and enter the industry with enthusiasm. However, for many, it does not take long until the realities of the working conditions set in and the employee finds themselves burnt-out and they leave.

The causes of employee burnout are many. Caring for disabled and frail patients is physically and mentally demanding. Employees involved directly in the care of patients often have few advancement opportunities. In addition, direct care employees are often the lowest paid employees in the field of long-term health care (Turner, 2002). With these factors against them it is no surprise that employees often do not stay in the profession for a long period of time.

Employees that do not feel satisfied with their working conditions are costly to the health care facility as they can suffer illness due to the negative effects of stress. Stressed employees are more likely to make mistakes that could endanger a patient's health. This research will explore the connection between employee satisfaction among health care workers and its relationship to the rate of mistakes and quality of care for the patients that they serve. It is expected, based on past research, that facilities where workers are unhappy will have a higher incidence rate of mistakes and a lower quality of care than those where employees are more satisfied with their work environments.

Problem Statement

In 2000, 12.5% of the population was 65 or older. This percentage is predicted to reach 17% by 2020. In addition to the growing number of seniors, improvements in medicine have led to an increasing number of people living to reach 90 years old. Many of these people will need a long-term care facility at some point in their life. Currently, it is difficult to say who will care for these elderly citizens in the future.

The typical direct care provider is a middle aged, female, living at or below the federal poverty level (Crown, et. al., 1995). Many of them do not feel that the job was the same as the one that they were taught in school. The classroom cannot begin to prepare them for the reality of the stresses of the workplace. Many of them become disenchanted after a short time and seek other work. The problem of how to attract and maintain an experienced workforce is the greatest dilemma faced in health care today.

Employee burnout is not only problematic for the employees themselves, but it also places the patient at considerable risk of receiving improper medication, or perhaps having a lack of care. This can create a dangerous situation, to say the least, and is perhaps the most serious effect of the nursing shortage. No one will deny the value of an experienced employee that knows their job well. However, the high turnover rate in the health care field makes this employee a rare, but highly desirable asset.

This means that the majority of our elderly are being cared for by those with less experience. For many reasons, the shortage of long-term care workers places the patient at much greater risk. This problem appears that it will only become exponentially greater in the near future. This research will focus on the relationship between employee satisfaction and its affect on the quality of care that a patient receives.

Research Question

The primary question to be explored in this research will place further emphasis on the importance of solving the employee retention issue in the health care industry. This research will answer the question "Does employee satisfaction among direct care health care workers effect the quality of care for the patients?" The question will be solution oriented with an emphasis on pinpointing the sources of employee satisfaction in hopes of finding ways to increase employee satisfaction and reduce patient risk. The research will produce actionable results and will lead to the development of a set of guidelines that will help increase employee satisfaction and therefore improve the quality of patient care.

In order to properly address the research question and produce a set of actionable guidelines several Sub-set questions will have to be answered. The first sub-set question will focus on the degree of employee satisfaction within a facility. Then this will be compared with the number and type of incidences as reported by management. The employee satisfaction level will be measured for each individual employee and the results will then be combined in order to obtain an overall rating for the facility. This sub-set question will be quantitative in nature.

The second sub-set question will focus on locating the source and types of stress factors in each work place. This will help in the development of a set of guidelines for reducing stress among health care workers. It is expected that reducing employee stress will have positive influences on the number of mistakes made and that it will greatly improve the quality of care that patients receive. This sub-set question will focus on the identification of the specific stress factors and will be qualitative in nature. In order to produce results that will be useful in producing a solution to the dilemma, this is an essential step in the research process. This sub-set question will rely on subjective response both from the health care provider and researcher.


The rationale behind this research is solution oriented and stems from the growing deficiencies in the number of direct care health care workers. It is imperative that the health care industry finds solutions to this growing problem. As a growing percentage of the population grows older the current workplace stresses will only increase on individual workers. This will ultimately lead to even heavier workloads and will lead to an increase in employee dissatisfaction and an increase in employee stress. This is very difficult on the workers, however, in the end it is the patients that will ultimately lose.

The first step in solving the health care crisis is to identify the problem. Preliminary research into the problem finds that many do know that a problem exists and some go as far as to offer solutions. However, the solutions offered are not based on actual employee needs and only guess at appropriate actions that need to be taken. This research will delve deeper into the employee satisfaction issue from an employee's standpoint. Demographic information will play an important part in this research, as we seek to form a profile of both satisfied and dissatisfied workers.

There are many that recognize the problem and understand the urgent need to find solutions. Proactive measures need to be taken in order to curb the problem before the crisis grows more severe. This issue needs concrete answers, ones that rooted on solid research directed at identifying the needs and then implementing a plan to decrease the number of negative patient incidents in that facility. This research will have a direct impact on the facilities in the study as well as give a set of guidelines that will help other facilities in a similar process.

This far the solutions to the health care crisis have failed to produce positive results, or results that will solve both the immediate and future needs of the industry. After the development and implementation of the guidelines that will result from this research future research will need to be conducted to determine if these guidelines have been effective. The nature of this study will be short-term. However, long-term studies will have to be conducted to determine I these guidelines do indeed offer a solution to resolving the employee retention problems that exist in the industry today.


Direct care health care worker - a worker that works as a care provider directly with the patient.

Sometimes these workers are referred to as "floor nurses." For purposes of this study management will not be included.

Long-Term Care Facility - This will, in general, refer to traditional nursing homes where patients are expected to stay for a long duration of time. It will only include traditional nursing homes and will not include assisted living or out-patient service facilities.

Employee satisfaction - This will be defined through the use of a survey using a Likert scale.

The Likert scale will rate employee satisfaction on a scale of 1-5 with one being the most satisfied with their job and five being the least satisfied. Individual results will be statistically combined to result in an overall rating for the entire facility.

Incident - An incident, for the purposes of this study will be obtained from those reported to management via an incident report. An incident will include a medication mix-up including a missed dosage, patient…[continue]

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