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Considering the Employee Point of View: Perceptions of Job Satisfaction and Stress Among Nursing Staff in Nursing Homes


Insufficient nursing staff is a major source of stress for workers in long-term care facilities, according to a survey of more than 1,200 nurses and nursing assistants. Despite this finding and other job stressors identified by the survey, overall job satisfaction among nurses is high.

The Issue

Recruiting and retaining nursing staff remains a significant obstacle for long-term care facilities. Nursing shortages, coupled with the rising cost of long-term care, have led to an increase in reliance on nursing assistants and a reduction in the use of registered nurses—a trend that has been shown to compromise the continuity and quality of care in nursing homes. Little is known about the impact of job satisfaction and stress among nurses in nursing homes.

Key Findings

  • The most stressful situations for nurses are: not having enough staff; having too much work; dealing with interruptions; having non-health professionals determine how nurses should do their job; poor pay; and responsibility for patient outcomes.
  •  Nursing assistants identified poor pay, understaffing, and having too much work as the most stressful situations for them.
  • Nurses were more likely than nursing assistants to report stress that is related to their responsibility for patient outcomes, expectations placed on them for providing high-quality care, and the need to keep up with new developments to perform their job well. Nurses were also more likely to identify as a source of stress situations related to their supervisory roles.
  • Nursing assistants were more likely than nurses to report stress linked to not being accepted as 'true health professionals." Receiving inadequate information to deliver patient care was also a stress factor cited more frequently by nursing assistants.


Addressing the Problem IMPORTED: __media_98A33960DC684CE3B51FB2E602E750D4_w_220_h_314_as_1.gif

Increased staffing has been shown to improve patient outcomes in nursing homes, but research has not yet considered the additional benefits of job satisfaction and employee stress. Such factors could reduce the currently high levels of staff turnover in nursing homes, which could in turn help lower costs, the authors say. Another strategy for reducing stress and improving job satisfaction is to provide higher wages or improved training for specific duties.


About the Study

The survey respondents included 1,283 nurses and nursing assistants from 25 nursing facilities participating in a long-term care pharmacy demonstration project in North Carolina. The survey was mailed to participants in 2002.

The Bottom Line

Understaffing is a major source of stress for nurses and nursing assistants in the long-term care setting, raising concerns about the quality of care delivered to an estimated 1.6 million nursing home residents. Better support of nursing staff is needed to ensure a level of care that is acceptable to government, the public, residents, and their families.


Publication Details



K. L. Lapane and C. M. Hughes, "Considering the Employee Point of View: Perceptions of Job Satisfaction and Stress Among Nursing Staff in Nursing Homes," Journal of the American Medical Directors Association, Jan. 2007 8(1):8–13.