Nurses' work, work psychology, and the evolution & devolution of care provision in nursing homes: A scoping review

Abstract

Background: Societal aging is exerting profound impacts on providers of long-term care. Nurses provide much of the direct care in the long-term care sector, and they increasingly provide unit- and facility-level leadership and fill top administrative and clinical roles.The work health and quality of work life of long-term care nurses are emergent concerns and the foci of research across multiple disciplines.

Objectives: To enhance our understanding of factors influencing long-term care nurses' work health and quality of work life, we summarize the findings of disparate studies across diverse disciplines, time, and jurisdictions.

Eligibility criteria: No restrictions were placed on study date, design, or country. Searches were restricted to English language only or translated studies. Included studies reported associations and relationships between/amongst nurses' work (role and work design), work environments, work attitudes, and work outcomes. Published peer-reviewed studies and reviews were included, as were reports. Editorials and opinion pieces were excluded. The search included publications up to March 2022.

Sources of evidence: Medline, CINAHL, PsychINFO, EMBASE, Scopus, PSNet.

Charting methods: Data abstraction from full-text articles.

Results: The evolution of long-term care nurses' work to include both medical and administrative responsibilities has generally not been managed well, resulting in persistent role ambiguity, job dissatisfaction, and burnout. Nurses are concerned about their capacity to provide resident care and the adequacy of their preparation. Their work environments are under-resourced, and they are at high risk for workplace injury or violence. Supervisory and organizational support can be protective of negative aspects of nurses' work environments. Supervisory support can improve the immediate work environment, assist nurses in fulfilling their roles, and afford greater role clarity, and supervisors can influence their nursing staff's perceptions of the work safety and the value that their organization places on them. Organizational support can reduce work stress, enhance feelings of self-worth, and mitigate some of the self-stigmatization that influences long-term care nurses' attitudes toward themselves and their work, which influences work outcomes, including job performance and quality of resident care.

Conclusions: Work stress, burnout, increased turnover, decreased morale and work motivation, increased health and safety concerns, and decreases in job satisfaction accompanied by self-stigmatization are all indicators of a system that has failed nurses, other long-term care staff, and nursing home residents. We consider the implications of our findings for enhancing the work health and quality of life of nurses working in long-term care and identify gaps in knowledge about their psychological health that merit future study.

Tweetable abstract: The long-term care sector is failing nurses globally. This review is a step toward understanding how we can improve the work psychology, including work-related psychological health, of nurses in long-term care.

Keywords: Aging; Job performance; Job satisfaction; Long-term care; Nurses; Nursing staff; Psychological health; Scoping review; Work psychology.

Fig. 1

PRISMA flow diagram.

Fig. 2

Number of articles by study setting.