Factors Associated with Perceived Work Effectiveness in Nursing Homes

We present a tool designed to measure attributes of work environment and examine their relationship to work effectiveness among frontline staff in nursing homes. The objectives are to: 1) test reliability and validity of an instrument measuring work environment of frontline staff, and 2) examine factors associated with perceived work effectiveness.

The survey instrument, designed to measure work environment and effectiveness, includes 46 Likert scale items measuring the attributes of: leadership; communication and coordination; conflict resolution; staff cohesion; and perceived work effectiveness. Other questions address: teamwork, workplace conditions, resources, staffing, and facility management style. The analytical sample included 7,418 surveys from professionals and paraprofessionals

Cronbach's alphas, analysis of variance, and regression models were used to assess the reliability and the validity of the instrument. Multivariate regression analysis, with random effects, was used to examine predictors of work effectiveness.

Cronbach's alphas (from 0.70 to 0.89) demonstrate good-to-high reliability for all domains. Perceived work effectiveness is significantly (p<0.001) higher: with longer tenure in the facility; better workplace conditions; greater resources and staffing; presence of teams; for minority respondents and for paraprofessionals. Staff in facilities with autocratic management style are significantly (p=0.001) less likely to perceive their work as effective.

We identified several aspects of work environment, representing modifiable management practices, associated with increased perceived work effectiveness. The survey tool can be used in future studies assessing nursing home practice and its relationship to quality of care. Our findings contribute to the understanding and identification of facilities with superior work organization and practices.