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Using the Self-Determination Theory to Understand Factors Influencing STNAs’ Intent to Stay in Their Positions at For –Profit Skilled Nursing Facilities

Benner Senecal, Megan E
http://rave.ohiolink.edu/etdc/view?acc_num=toledo1513195577429557

Abstract Details

2017, Doctor of Philosophy, University of Toledo, Health Education.
Background. Over one million Americans utilize skilled nursing facilities (SNFs) annually. State Tested Nursing Assistants (STNAs) are the direct care workers within these facilities. Low retention and high turnover among STNAs threatens care provision and facility functioning. Factors influencing retention and turnover are distinct, however, a model representing STNAs’ intent to stay in their positions does not exist. Purpose. The purpose of the research was to develop and preliminarily test a new conceptual framework that represents intrinsic factors thought to affect STNAs’ intent to stay in their positions at for-profit skilled nursing facilities. Design. This research was conducted in two phases. Phase I was qualitative and included interviewing State Tested Nursing Assistants (STNAs) to explore their workplace experiences in order to identify salient factors affecting their intent to stay in their position. Phase II was quantitative and consisted of model refinement and testing in order to identify a model that best predicted STNAs intent to stay their positions at for-profit SNFs. Methods. Phase I. Ten STNAs employed at for-profit SNFs in the midwestern United States participated in individual face-to-face interviews. A semi-structured interview guide covered three domains: basic psychological needs; physical and psychosocial well being; and organizational factors. Interview transcripts were analyzed and coded by the research team to identify broad concepts, recurrent themes, and illustrative quotes within themes. In the final stage, the coding framework was applied to all data. In Phase II of the research, a random sample of (n=7150) STNAs were recruited from the Ohio Nurse Aide Registry via a postcard. Participants completed an 88 item online questionnaire. Measures included: Basic Psychological Needs at Work Scale (Baard, Deci, & Ryan, 2001), Rosenberg Self-Esteem Scale (Rosenberg et al., 1965), Affective Commitment Scale (Allen & Meyer, 1990), Organizational Citizenship Behavior Checklist (Robinson & Morrison, 1995), and a measure of Intent to Stay (Price & Kim, 1995). Data were analyzed using SPSS. Results. Qualitative findings revealed four themes supporting STNAs intent to stay and four themes threating intent to stay. Data analysis revealed psychosocial stressors, basic psychological needs, health and well-being, and organizational factors to be salient contributors to STNA intent to stay and were incorporated into the finalized conceptual model and survey for Phase II. In Phase II analyses of the total scores from each measure indicate moderate levels of basic psychological need fulfillment and low levels of organizational citizenship behavior, affective commitment, self-esteem, and intent to stay. Simple Linear Regression and Multiple Linear Regression revealed that autonomy was the single statistically significant predictor of intent to stay among STNAs in this study (ß=.200 p-value =.028). Independently, autonomy (ß=.234, p-value =.001) and the number of anxious days (ß=-.165, p-value=.039) were statistically significant predictors of intent to stay among the respondents, with competence indicating a borderline statistically significant relationship (ß=.174, p-value=.054) with intent to stay. There was also a statistically significant relationship between STNAs’ reported Affective Commitment to their place of work and their engagement in Organizational Citizenship Behavior (ß=.579, p-value=.001). Conclusion. The findings from both phases indicate a need for responsive strategies at the facility level to address and reduce contributors to psychosocial stress among STNAs. Further, results indicate that facilities should provide opportunities for relationship development among STNAs and other staff. The results of Phase II also suggest a continued need for STNAs to feel empowered at work. The cultivation of an increased sense of autonomy may increase overall basic psychological need fulfillment and intent to stay. Impact Statement. This research provides insight into the factors that influence STNA intention to stay. The results can be applied to the development of responsive and effective strategies to increase retention behavior among this integral direct care staff. The results also contribute to the body of literature on the workplace experiences of STNAs and provide a unique perspective by examining STNAs at specifically for-profit facilities.
Kimberly McBride, PhD. (Committee Chair)
Victoria Steiner, PhD. (Committee Co-Chair)
Barbara Saltzman, PhD., MPH (Committee Member)
Linda Pierce, PhD RN, CNS, CRRN, FAHA, FAAN, (Committee Member)
157 p.
Gerontology; Health Education; Occupational Psychology; Public Health Education
nursing assistants; for-profit skilled nursing facilities; STNA retention; intent to stay

Recommended Citations

Citations

  • Benner Senecal, M. E. (2017). Using the Self-Determination Theory to Understand Factors Influencing STNAs’ Intent to Stay in Their Positions at For –Profit Skilled Nursing Facilities [Doctoral dissertation, University of Toledo]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1513195577429557

    APA Style (7th edition)

  • Benner Senecal, Megan. Using the Self-Determination Theory to Understand Factors Influencing STNAs’ Intent to Stay in Their Positions at For –Profit Skilled Nursing Facilities. 2017. University of Toledo, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=toledo1513195577429557.

    MLA Style (8th edition)

  • Benner Senecal, Megan. "Using the Self-Determination Theory to Understand Factors Influencing STNAs’ Intent to Stay in Their Positions at For –Profit Skilled Nursing Facilities." Doctoral dissertation, University of Toledo, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1513195577429557

    Chicago Manual of Style (17th edition)

toledo1513195577429557
342
© 2017, all rights reserved.
This open access ETD is published by University of Toledo and OhioLINK.