The importance of supervision in retention of CNAs

Research in Nursing and Health

Volumn 35, Issue 2, 2012, Pages 187-199

  Choi, Jisun ^a   Johantgen, Meg ^b  

^a UNIVERSITY OF KANSAS MEDICAL CENTER   (United States)

^b UNIVERSITY OF MARYLAND SCHOOL OF NURSING   (United States)

Author keywords

Certified nursing assistants (CNAs); Intent to leave; Job satisfaction; Multilevel modeling; Nursing homes

Indexed keywords

ADULT; ARTICLE; CROSS-SECTIONAL STUDY; HUMAN; JOB SATISFACTION; MANPOWER; NURSING; NURSING ASSISTANT; NURSING HOME; PERSONNEL MANAGEMENT; PSYCHOLOGICAL ASPECT; STATISTICAL MODEL; STATISTICS; UNITED STATES;

ADULT; CROSS-SECTIONAL STUDIES; HUMANS; JOB SATISFACTION; LOGISTIC MODELS; NURSES' AIDES; NURSING HOMES; NURSING, SUPERVISORY; PERSONNEL TURNOVER; UNITED STATES;

EID: 84862795800     PISSN: 01606891     EISSN: 1098240X     Source Type: Journal    
DOI: 10.1002/nur.21461     Document Type: Article

References (41)

1. Barry, T. T., Brannon, D., & Mor, V. (2005). Nurse aide empowerment strategies and staff stability: Effects on nursing home resident outcomes. The Gerontologist, 45, 309-317. DOI: 10.1093/geront/45.3.309
2. Bickel, R. (2007). Multilevel analysis for applied research: It's just regression! New York, NY: The Guilford Press.
3. Bishop, C. E., Squillace, M. R., Meagher, J., Anderson, W. L., & Wiener, J. M. (2009). Nursing home work practices and nursing assistants' job satisfaction. The Gerontologist, 49, 611-622. DOI: 10.1093/geront/gnp040
4. Bostick, J. E., Rantz, M. J., Flesner, M. K., & Riggs, C. J. (2006). Systematic review of studies of staffing and quality in nursing homes. Journal of the American Medical Directors Association, 7, 366-376. DOI: 10.1016/j.jamda.2006.01.024
5. Bowers, B. J., Esmond, S., & Jacobson, N. (2003). Turnover reinterpreted: CNAs talk about why they leave. Journal of Gerontological Nursing, 29(3), 36-43.
6. Brannon, D., Barry, T., Kemper, P., Schreiner, A., & Vasey, J. (2007). Job perceptions and intent to leave among direct care workers: Evidence from the Better Jobs Better Care demonstrations. The Gerontologist, 47, 820-829. DOI: 10.1093/geront/47.6.820
7. Carle, A. (2009). Fitting multilevel models in complex survey data with design weights: Recommendations. BMC Medical Research Methodology, 9(49), Retrieved from
8. Castle, N. G. (2007). Assessing job satisfaction of nurse aides in nursing homes: The nursing home nurse aide job satisfaction questionnaire. Journal of Gerontological Nursing, 33(5), 41-47.
9. Castle, N. G. (2008). State differences and facility differences in nursing home staff turnover. Journal of Applied Gerontology, 27, 609-630. DOI: 10.1177/0733464808319711
10. Castle, N. G., & Engberg, J. (2005). Staff turnover and quality of care in nursing homes. Medical Care, 43, 616-626.
11. Castle, N. G., Engberg, J., Anderson, R., & Men, A. (2007). Job satisfaction of nurse aides in nursing homes: Intent to leave and turnover. The Gerontologist, 47, 193-204. DOI: 10.1093/geront/47.2.193
12. Cohen-Mansfield, J. (1997). Turnover among nursing home staff: A review. Nursing Management, 28(5), 59-64.
13. Collier, E., & Harrington, C. (2008). Staffing characteristics, turnover rates, and quality of resident care in nursing facilities. Research in Gerontological Nursing, 1, 157-170. DOI: 10.3928/00220124-20091301-03
14. Decker, F. H., Harris-Kojetin, L. D., & Bercovitz, A. (2009). Intrinsic job satisfaction, overall satisfaction, and intention to leave the job among nursing assistants in nursing homes. The Gerontologist, 49, 596-610. DOI: 10.1093/geront/gnp051
15. Donoghue, C. (2010). Nursing home staff turnover and retention. Journal of Applied Gerontology, 29, 89-106. DOI: 10.1177/0733464809334899
16. Harrington, C., & Swan, J. H. (2003). Nursing home staffing, turnover, and case mix. Medical Care Research and Review, 60, 366-392. DOI: 10.1177/1077558703254692
17. Hayes, L. J., O'Brien-Pallas, L., Duffield, C., Shamian, J., Buchan, J., Hughes, F., ... Stone, P. W. (2006). Nurse turnover: A literature review. International Journal of Nursing Studies, 43, 237-263. DOI: 10.1016/j.ijnurstu.2005.02.007
18. Institute of Medicine. (2008). Retooling for an aging America: Building the health care workforce. Washington, DC: The National Academies Press.
19. Maas, C., & Hox, J. J. (2005). Sufficient sample sizes for multilevel modeling. Methodology: European Journal of Research Methods for the Behavioral and Social Sciences, 1, 86-92.
20. McGuire, M., Houser, J., Jarrar, T., Moy, W., & Wall, M. (2003). Retention: It's all about respect. Health Care Manager, 22, 38-44.
21. Mukamel, D. B., Spector, W. D., Limcangco, R., Wang, Y., Feng, Z., & Mor, V. (2009). The costs of turnover in nursing homes. Medical Care, 47, 1039-1045. DOI: 10.1097/MLR.0b013e3181a3cc62
22. National Center for Health Statistics. (2007). 2004 National Nursing Home Survey data dictionary: Facility public-use file. Retrieved from
23. Paraprofessional Healthcare Institute. (2010, February). Who are direct-care workers? (Issue brief no. 3). Bronx, New York: Paraprofessional Healthcare Institute.
24. Parsons, S. K., Simmons, W. P., Penn, K., & Furlough, M. (2003). Determinants of satisfaction and turnover among nursing assistants. The results of a statewide survey. Journal of Gerontological Nursing, 29(3), 51-58.
25. Price, J. L. (2001). Reflections on the determinants of voluntary turnover. International Journal of Manpower, 22, 600-624. DOI: 10.1108/EUM06233
26. Probst, J. C., Baek, J. D., & Laditka, S. B. (2010). The relationship between workplace environment and job satisfaction among nursing assistants: Findings from a national survey. Journal of the American Medical Directors Association, 11, 246-252. DOI: 10.1016/j.jamda.2009.08.008
27. Rabe-Hesketh, S., & Skrondal, A. (2006). Multilevel modelling of complex survey data. Journal of the Royal Statistical Society: Series A (Statistics in Society), 169, 805-827. DOI: 10.1111/j.1467-985x.2006.00426.x
28. Raudenbush, S. W., & Bryk, A. S. (2002). Hierarchical linear models: Applications and data analysis methods. Thousand Oaks, CA: Sage.
29. Seavey, D., & Salter, V. (2006). Paying for quality care: State and local strategies for improving wages and benefits for personal care assistants. Washington, DC: AARP Public Policy Institute.
30. Siegel, E. O., Young, H. M., Mitchell, P. H., & Shannon, S. E. (2008). Nurse preparation and organizational support for supervision of unlicensed assistive personnel in nursing homes: A qualitative exploration. The Gerontologist, 48, 453-463. DOI: 10.1093/geront/48.4.453
31. Sloane, P. D., Williams, C. S., & Zimmerman, S. (2010). Immigrant status and intention to leave of nursing assistants in US nursing homes. Journal of the American Geriatrics Society, 58, 731-737. DOI: 10.1111/j.1532-5415.2010.02781.x
32. Snijders, T. (2005). Power and sample size in multilevel linear models. In B. S. Everitt & D. C. howell (Eds.), Encyclopedia of statistics in behavioral science (Vol. 3, pp. 1570-1573). Chicester, UK: Wiley.
33. Spybrook, J., Raundenbush, S. W., Congdon, R., & Martínez, A. (2009). Optimal design software (version 2.0). Retrieved from
34. Squillace, M. R., Remsburg, R. E., Bercovitz, A., Rosenoff, E., & Branden, L. (2007). An introduction to the National Nursing Assistant Survey. Vital and Health Statistics, 1(44), Retrieved from
35. Squillace, M. R., Remsburg, R. E., Harris-Kojetin, L. D., Bercovitz, A., Rosenoff, E., & Han, B. (2009). The National Nursing Assistant Survey: Improving the evidence base for policy initiatives to strengthen the certified nursing assistant workforce. The Gerontologist, 49, 185-197. DOI: 10.1093/geront/gnp024
36. Stearns, S. C., & D'Arcy, L. P. (2008). Staying the course: Facility and profession retention among nursing assistants in nursing homes. Journal of Gerontololy Series B: Psychological Sciences and Social Sciences, 63, 113-121.
37. Tak, S., Sweeney, M. H., Alterman, T., Baron, S., & Calvert, G. M. (2010). Workplace assaults on nursing assistants in US nursing homes: A multilevel analysis. American Journal of Public Health, 100, 1938-1945. DOI: 10.2105/AJPH.2009.185421
38. Tyler, D. A., Parker, V. A., Engle, R. L., Brandeis, G. H., Hickey, E. C., Rosen, A. K., ... Berlowitz, D. R. (2006). An exploration of job design in long-term care facilities and its effect on nursing employee satisfaction. Health Care Management Review, 31, 137-144.
39. Wanous, J. P., Reichers, A. E., & Hudy, M. J. (1997). Overall job satisfaction: How good are single-item measures? Journal of Applied Psychology, 82, 247-252. DOI: 10.1037/0021-9010.82.2.247
40. White-Chu, E. F., Graves, W. J., Godfrey, S. M., Bonner, A., & Sloane, P. (2009). Beyond the medical model: The culture change revolution in long-term care. Journal of the American Medical Directors Association, 10, 370-378. DOI: 10.1016/j.jamda.2009.04.004
41. Yallowitz, W., & Hofland, B. F. (2008). Better Jobs Better Care: A foundation initiative focusing on direct care workers. The Gerontologist, 48( suppl 1), 14-16. DOI: 10.1093/geront/48.Supplement_1.14