Abstract
Background
The population aging trend and the shortage of elderly care workers require the long-term care profession to become more attractive. However, the professional attractiveness among long-term care workers has yet to be extensively studied. This study aims to identify the factors that influence the attractiveness of the long-term care profession for nursing home (NH) care workers..
Methods
A cross-sectional study was conducted in more than 50 NHs. Perception of professional attractiveness among long-term care workers and potential associated factors were measured using the Attractive Work Questionnaire (AWQ) and structural instruments including the Fraboni Scale of Ageism (FSA) and the Maslach Burnout Inventory (MBI). A multiple linear regression method was employed to explore the influence of potential independent variables on professional attractiveness.
Results
The overall response rate was 99%. The results showed the score of professional attractiveness (185.37 ± 20.034), as well as the scores of each component (99.26 ± 11.258 for work condition, 30.13 ± 3.583 for work content, and 55.99 ± 7.074 for job satisfaction). Findings of multiple linear regression analysis indicated that age(β = 0.129, p<.05), years of work(β = 0.156, p<.05), 12-hour shifts(β = 0.185, p<.05), and training times per year(β = 0.148, p<.05) positively associated with long-term care workers perceived professional attractiveness. Whereas only ageism(β=-0.267, p<.05) significantly and negatively influenced professional attractiveness.
Conclusions
The perceived professional attractiveness of long-term care workers in NHs was acceptable. Age, years of work, shifts, training opportunities, and ageism contributed to the professional attractiveness of nursing home care workers in China. Target intervention measures should be taken to enhance the attractiveness of long-term care careers so as to avoid the shortage of long-term care workers.
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Background
Population aging has become an inevitable trend that could pose serious health challenges worldwide. The proportion of older persons in the world is anticipated to increase from the current level of 9% to nearly 16% by 2050, with 1.6 billion older people [1]. According to the National Bureau of Statistics of China data [2], the number of elderly adults aged 60 years and over reached 264 million in 2020, accounting for 18.7% of the total Chinese population. Elderly people experience a decline in cognition and function as they age, threatening independence. An estimated 47 million disabled or semi-disabled older adults live in China in 2020 [3]. Hence, there is an urgent need to develop long-term care (LTC) to address the challenges of aging and rising disabled populations.
LTC refers to care provided by carers or care workers for individuals with declines in intrinsic capacity or functional ability, which can last for an extended period [4]. LTC services generally occur in non-institutional settings such as homes and communities or institutional settings such as LTC facilities (i.e., nursing homes (NHs)). China’s long-term care service system consists of three main types of services: home-based, community-based, and institution-based, and shows a pattern of “9073”, namely, 90% of the elderly ageing at home, 7% receiving community-based services and 3% receiving institutionalized services [5]. Home care, with family members as the primary caregivers, has long been the traditional mode of care in China [6]. However, decreased fertility rates, shrinking family sizes, and frequent internal immigration from rural to urban have shifted China’s traditional family-based care model for the elderly to the current trend toward greater reliance on NHs [52]. However, to maximize the attractiveness and retention of talent in the elderly care industry while improving the quality of care of LTC facilities, these measures are far from sufficient. By exploring the potential influences on the perceived professional attractiveness of long-term care workers, the current study provides a direction for policymakers and managers of long-term care institutions to consider improvements. Training programs, not only on nursing skills but also on knowledge of aging, should be prioritized to improve the ability of care workers to provide quality care and to mitigate ageism, potentially reversing unattractive career prospects. This will require greater government investment in education and training, as well as monitoring of the effective implementation of policies in LTC facilities. Additionally, managers of LTC institutions should consider a series of effective co** and managing mechanisms to attract talent. Career promotion systems and incentive mechanisms that go beyond the traditional ones should be put in place, with pay scales set according to the level of vocational skills qualification, years of experience, and working performance, to enhance the enthusiasm of elderly care workers. We have highlighted the importance of suitable working hours for ensuring care workers that are more likely to behave in high efficiency. Hence, administrators should optimize shift settings and try to avoid employees working too long hours in a row, maximizing job satisfaction of care workers while ensuring the quality of care, which in turn increases their perceived professional attractiveness.
Future research should include larger cross-regional samples and longitudinal studies to further verify relevant predictors and examine relationships across time. Besides, other LTC settings beyond nursing homes need to be considered, such as LTC hospitals. Additionally, future studies should explore professional attractiveness of long-term care workers from a qualitative perspective.
Conclusions
This study examines the current state of professional attractiveness among LTC care workers in nursing homes. It also assessed the factors associated with professional attractiveness. This study provides insight into the plight faced by China’s LTC industry and strategies to improve the attractiveness of LTC industry to retain and appeal to healthcare professionals.
Data availability
The datasets analysed during the current study are available from the corresponding author on reasonable request.
Abbreviations
- NH:
-
Nursing Home
- LCT:
-
Long-term Care
- FSA:
-
Fraboni Scale of Ageism
- AWQ:
-
The Attractive Work Questionnaire
- MBI:
-
The Maslach Burnout Inventory
References
United Nations, Department of Economic and Social Affairs, Population Division. (2019): World Population Prospects 2019: Highlights (ST/ESA/SER.A/423).; 2019.
National Bureau of Statistics of China. Communiqué of the Seventh National Population Census (No. 5). http://www.stats.gov.cn/sj/tjgb/rkpcgb/qgrkpcgb/202302/t20230206_1902005.html. Accessed 6 May 2023.
Ge Y, Wang L, Feng W, Zhang B, Liu S, Ke Y. The challenge and strategy selection of healthy aging in China. J Manage World. 2020;36(04):86–96.
Perracini MR, Arias-Casais N, Thiyagarajan JA, Rapson C, Isaac V, Ullah S, Hyobum J, Sadana R, Han ZA. A recommended Package of Long-Term Care services to promote healthy ageing based on a WHO Global Expert Consensus Study. J AM MED DIR ASSOC. 2022;23(2):297–303.
Wan H, Wang Y, Fang L, Tao L, Li S, Yang Y, Yang C. Study on integrated health care under institution-community-home endowment mode. Chin Health Resour. 2018;21(01):61–6.
Chen L, Zhang X, Xu X. Health Insurance and Long-Term Care Services for the disabled Elderly in China: based on CHARLS Data. RISK MANAG HEALTHC P. 2020;13:155–62.
Fang EF, **e C, Schenkel JA, Wu C, Long Q, Cui H, Aman Y, Frank J, Liao J, Zou H et al. A research agenda for ageing in China in the 21st century (2nd edition): Focusing on basic and translational research, long-term care, policy and social networks. AGEING RES REV 2020, 64:101174.
Wang L. A study on the Development of China’s Nursing Home Services in Urban Area. Popul J. 2014;36(04):83–92.
Two Departments Promulgate and Implement the National Occupational Skills Standard for Elderly Caregivers. (2019 Edition). https://www.gov.cn/xinwen/2019-10/17/content_5440977.htm. Accessed 8 April 2024.
Hauser C, Stahl J, Simon M, Valenta S, Favez L, Zuniga F. Identifying work-related factors associated with work-family conflict of care workers in nursing homes: a cross-sectional study. J ADV NURS 2023.
Pardo-Garcia I, Martinez-Lacoba R, Escribano-Sotos F. Socioeconomic factors related to job satisfaction among Formal Care Workers in nursing homes for older dependent adults. INT J ENV RES PUB HE 2021, 18(4).
Zeng Y, Hu X, Li Y, Zhen X, Gu Y, Sun X, Dong H. The quality of caregivers for the Elderly in Long-Term Care Institutions in Zhejiang Province, China. INT J ENV RES PUB HE 2019, 16(12).
Dai F, Zhang X, Wan Q. Willingness and influencing factors for senior nurses involving in long-term care for the elderly. Chin Gen Pract. 2014;17(24):2880–4.
Darling R, Sendir M, Atav S, Buyukyilmaz F. Undergraduate nursing students and the elderly: an assessment of attitudes in a Turkish university. GERONTOL GERIATR EDU. 2018;39(3):283–94.
Rust TB, Wagner LM, Hoffman C, Rowe M, Neumann I. Broadening the patient safety agenda to include safety in long-term care. Healthc Q. 2008;11(3 Spec No):31–4.
Ateg M, Andersson I, Rosen G. Change processes for attractive work in Small Manufacturing companies. Hum FACTORS Ergon Manuf. 2009;19(1):35–63.
Qi X, Wang Q, Zhao H, Kong L, Fan J, Li J. A conceptual analysis of long-term caregivers’ occupational attractiveness. Chin J Mod Nurs. 2022;28(25):3502–7.
Kash BA, Naufal GS, Dagher RK, Johnson CE. Individual factors associated with intentions to leave among directors of nursing in nursing homes. HEALTH CARE MANAGE R. 2010;35(3):246–55.
Aloisio LD, Coughlin M, Squires JE. Individual and organizational factors of nurses’ job satisfaction in long-term care: a systematic review. INT J NURS STUD. 2021;123:104073.
Choi J, Flynn L, Aiken LH. Nursing practice environment and registered nurses’ job satisfaction in nursing homes. GERONTOLOGIST. 2012;52(4):484–92.
Foa C, Guarnieri MC, Bastoni G, Benini B, Giunti OM, Mazzotti M, Rossi C, Savoia A, Sarli L, Artioli G. Job satisfaction, work engagement and stress/burnout of elderly care staff: a qualitative research. Acta Biomed. 2020;91(12–S):e2020014.
Lee S, Oh G, Fabius CD, Reckrey JM. Working conditions Affecting Home Care workers’ stress and turnover intention. J APPL GERONTOL. 2023;42(4):717–27.
Butler RN. Age-ism: another form of bigotry. GERONTOLOGIST. 1969;9(4):243–6.
Liu CC, Liu LF, Chuang SS. The Effect of Ageist behaviors on Home Care workers’ job satisfaction and Retention in Long-Term Care. J APPL GERONTOL. 2022;41(2):322–31.
Campbell SL. The attractiveness of a career in geriatric nursing. J GERONTOL NURS. 2010;36(6):3.
White EM, Aiken LH, McHugh MD. Registered nurse burnout, Job Dissatisfaction, and missed care in nursing homes. J AM GERIATR SOC. 2019;67(10):2065–71.
Ohara Y, Nomura Y, Yamamoto Y, Okada A, Hosoya N, Hanada N, Hirano H, Takei N. Job Attractiveness and Job Satisfaction of Dental Hygienists: From Japanese Dental Hygienists’ Survey 2019. INT J ENV RES PUB HE 2021, 18(2).
Bjorn C, Josephson M, Wadensten B, Rissen D. Prominent attractive qualities of nurses’ work in operating room departments: a questionnaire study. WORK. 2015;52(4):877–89.
Tabachnick BG, Fidell LS. Using multivariate statistics |.*6*6. 7th edition. Boston: MA: pearson; 2013.
Fraboni M, Saltstone R, Hughes S. The Fraboni Scale of Ageism (FSA): an attempt at a more precise measure of Ageism. Can J Aging / La Revue Canadienne Du Vieillissement. 1990;9(1):56–66.
Fan J, Zhao H, Liu Y, Kong L, Mao J, Li J. Psychometric properties of a Chinese version of the Fraboni scale of ageism: evidence from medical students sample. BMC MED EDUC. 2020;20(1):8.
Maslach C, Schaufeli WB, Leiter MP. Job burnout. ANNU REV PSYCHOL. 2001;52:397–422.
Li C, Shi K. The impact of Distributive and Procedural Equity on Job Burnout. ACTA PSYCHOL SIN 2003(05):677–84.
ÅTEG M, HEDLUND A. Researching attractive work. Analyzing a model of attractive work using theories on applicant attraction, retention and commitment. 1th edition: Linnéuniversitet: Repro Copycenter; 2010.
Liu Z, Zhang Y. A Preliminary Investigation and Analysis on the attractiveness of the Pension Service Industry to talents in China. Sci Res Aging. 2016;5(03):25–32.
Hwalek M, Straub V, Kosniewski K. Older workers: an opportunity to expand the long-term care/direct care labor force. GERONTOLOGIST. 2008;48(Spec 1):90–103.
Kim B, Liu L, Ishikawa H, Park S. Relationships between social support, job autonomy, job satisfaction, and burnout among care workers in long-term care facilities in Hawaii. EDUC GERONTOL. 2019;45(1):57–68.
Yan Z. An ethical glimpse into nursing Home Care Work in China: Mei Banfa. ETHICS SOC WELF. 2020;14(4):417–24.
Yan Z. I tried to control my emotions : Nursing Home Care Workers ' experiences of Emotional Labor in China. J CROSS-CULT GERONTO. 2022;37(1):1–22.
Chenoweth L, Jeon YH, Merlyn T, Brodaty H. A systematic review of what factors attract and retain nurses in aged and dementia care. J CLIN NURS. 2010;19(1–2):156–67.
Li CC, Yamamoto-Mitani N. Ward-level nurse turnover and related workplace factors in long-term care hospitals: a cross-sectional survey. J NURS MANAGE. 2021;29(6):1587–95.
Halter M, Boiko O, Pelone F, Beighton C, Harris R, Gale J, Gourlay S, Drennan V. The determinants and consequences of adult nursing staff turnover: a systematic review of systematic reviews. BMC HEALTH SERV RES. 2017;17(1):824.
Yang L, Tang C, Zhang W, Feng M, Wei P, Guo F, Gao Z. Research on the correlation between clinicians’ working hours and medical errors. Chin Health Service Manage. 2020;37(05):349–52.
Lim J. Characteristics of Elderly Care Work That Influence Care Workers’ Turnover Intentions. HEALTHCARE-BASEL 2021, 9(3).
Colindres CV, Bryce E, Coral-Rosero P, Ramos-Soto RM, Bonilla F, Yassi A. Effect of effort-reward imbalance and burnout on infection control among Ecuadorian nurses. INT NURS REV. 2018;65(2):190–9.
Kubicek B, Korunka C, Ulferts H. Acceleration in the care of older adults: new demands as predictors of employee burnout and engagement. J ADV NURS. 2013;69(7):1525–38.
North MS, Fiske ST. An inconvenienced youth? Ageism and its potential intergenerational roots. PSYCHOL BULL. 2012;138(5):982–97.
Reyna C, Goodwin EJ, Ferrari JR. Older adult stereotypes among care providers in residential care facilities: examining the relationship between contact, eduaction, and ageism. J GERONTOL NURS. 2007;33(2):50–5.
Sao JJ, Amado CA. On studying ageism in long-term care: a systematic review of the literature. INT PSYCHOGERIATR. 2017;29(3):373–87.
Xu D, Wang Y, Li M, Zhao M, Yang Z, Wang K. Depressive symptoms and ageism among nursing home residents: the role of Social Support. INT J ENV RES PUB HE 2022, 19(19).
Lai VS, Yau SY, Lee LY, Li BS, Law SS, Huang S. Caring for Older People during and beyond the COVID-19 Pandemic: Experiences of Residential Health Care Workers. INT J ENV RES PUB HE 2022, 19(22).
Feng Z, Glinskaya E, Chen H, Gong S, Qiu Y, Xu J, Yip W. Long-term care system for older adults in China: policy landscape, challenges, and future prospects. Lancet. 2020;396(10259):1362–72.
Acknowledgements
Thanks to Huazhong University of Science and Technology for providing the referral letter. Thanks to all the nursing home directors in Wuhan and Kaifeng for their support during the survey.
Funding
This work was supported by Humanities and social science foundation of Ministry of Education of China (grant number 20YJZAH054) and National Key Research and Development Program of China [grant number 2023YFC3806503].
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Qi X.J, Dong Z.Y conceived the study. Qi X.J conducted literature retrieval, screening and data collection, data analysis, and data interpretation. Dong Z.Y drafted and revised the manuscript. Dong Z.Y, **e W, and Yang L.Q helped data collection. Li J helped revise the manuscript. All authors have read and approved the manuscript.
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The study used human data and was approved by the ethics committee of Huazhong University of Science and Technology (approval number S028). All participants were informed about the content and purpose of the study in detail and signed an informed consent form.
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Qi, X., Dong, Z., **e, W. et al. Professional attractiveness among long-term care workers in nursing homes in China: a cross-sectional study. BMC Health Serv Res 24, 548 (2024). https://doi.org/10.1186/s12913-024-11023-x
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DOI: https://doi.org/10.1186/s12913-024-11023-x