Four Dimensions of Structural Empowerment, Job Satisfaction, and Their Associations with Turnover Intentions Among Certified Nursing Assistants Employed in U.S. Nursing Homes in 2004

Background: With the increasing demands for long-term care, it is critical for attention to be given to the recruitment and retention of direct care workers who are at the frontline of healthcare. Retention issues and increased turnover rates pose a significant economic and decrease the quality of patient care.

Purpose: This quantitative, correlational study aimed to examine (1) participants’ level of structural empowerment; (2) the relationships between variables: structural empowerment, job satisfaction, and turnover intention; (3) the significance of variables predicting turnover intention, and (4) significant differences in structural empowerment and job satisfaction predicting turnover intention when grouped by age and citizenship.

Design: Kanter’s structural empowerment theory provided the framework for this observational study, using archival data from the 2004 National Nursing Assistant Survey (NNAS) data. The sample population for this study included 2,064 participants. Binary logistic regressions were performed to examine the perceptions of structural empowerment between two turnover intention groups.

Results: Moderate levels of structural empowerment were perceived as overall structural empowerment (M = 12.57). Using binary logistic regression models based on an α level of .05, significant relationships were found between opportunity (B = - 0.86, OR = 0.42, p < .001), support (B = - 0.71, OR = 0.49, p < .001), and information (B = - 0.57, OR = 0.57, p < .001). While the resources subscale of structural empowerment was the only subdimension that was not a significant predictor of turnover intention, it had no bearing on the significant predictive outcomes between structural empowerment (B = - 0.12, OR = 0.89, p < .001), and job satisfaction (B = -.97, OR = 0.38, p < .001) on the yes category of turnover intention.

Conclusion: Structural empowerment and job satisfaction were predictors of the CNAs’ turnover intention. These findings support Kanter’s structural empowerment theory, the framework used to guide this study.