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Journal Article


Nurse Aide Decision Making in Nursing Homes: Factors Affecting Empowerment

The Issue

As the number of nursing homes and other assisted-living facilities has grown, nurse aides have increasingly been relied upon to provide much of residents’ direct care. While these typically entry-level positions require little formal training or education, they often carry highly varied responsibilities. This study aimed to determine which factors affect decision-making by nurse aides—the caregivers with the most firsthand knowledge of residents.

What the Study Found

Commonwealth Fund–supported researchers analyzed data from a survey of nurse aides at 11 nursing homes, focusing on personal characteristics like gender, race, and education as well as “structural” characteristics such as supervisory support. Contrary to their hypothesis, gender did not appear to have an impact on nurse aides’ decision-making. Race, however, did, with black nurse aides in particular less likely than their white counterparts to make work decisions on their own.

The study also found, somewhat counterintuitively, that “emotional exhaustion”—burnout—had a positive association with decision-making. The authors theorize that nurse aides who make more resident care decisions on their own feel greater responsibility and, in turn, incur higher levels of stress. Having support from supervisors was also associated with increased decision-making.


The authors recommend that future research explore race as a determinant of decision-making among nurse aides, particularly in light of high minority participation in the profession. The nature of emotional exhaustion among nurse aides also needs to be better understood.

Publication Details



T. Chaudhuri, D. E. Yeatts, and C. M. Cready, "Nurse Aide Decision Making in Nursing Homes: Factors Affecting Empowerment," Journal of Clinical Nursing, Sept. 2013 22(17–18):2572–85.