Work Autonomy of Certified Nursing Assistants in Long-Term Care Facilities: Discrepant Perceptions Between Nursing Supervisors and Certified Nursing Assistants

Objectives: Despite increasing demand of certified nursing assistants (CNAs) in long-term care (LTC) facilities, their work autonomy delegated by nursing supervisors remains ambiguous and varied. This study investigates the CNAs' role in LTC facilities by examining the degrees of work autonomy of CNAs from the perspectives of nursing supervisors and CNAs. Whether the characteristics of institutions including ownership of facilities, bed size; staffing levels, and the occupancy rate affected the CNAs' work autonomy and delegations was also examined. Design: A stratified random sampling method was used to sample LTC facilities in Taiwan. Methods: A self-administered structured questionnaire was answered by a senior nursing supervisor and CNA in each sampled institution for their perception of work autonomy in the 5 main aspects of CNAs' job contents: personal care, affiliated nursing care, auxiliary medical service, social care, and administration services. Student t test and general linear models (GLM) were used to test the mean differences of CNAs' work autonomy and their relationship with the institutions' characteristics. Results: Nursing supervisors and CNAs both rated the highest scores of work autonomy in the aspect of personal care, and the lowest scores in the aspect of affiliated nursing care. However, the nursing supervisors expected higher work autonomy of CNAs on the work items particularly in affiliated nursing care and auxiliary medical services than did the CNAs (P < .05). The institutional-level factors were significantly associated with perceptions of nursing supervisors toward CNAs' work autonomy. The ownership (hospital-based or freestanding homes), sizes (capacity), occupancy rates, CNA staff numbers of the long-term care facilities, and resident numbers were related to the CNAs' work autonomy as perceived by their nursing supervisors. No difference between the aspects of administration activities and social care was seen. Conclusions: There are discordance views towards CNAs' work autonomy both in nursing supervisors and CNAs across different settings in LTC institutions. The characteristics of institutions influence perceptions of CNAs' work autonomy as perceived by nursing supervisors. Clear and mandated regulation of CNA job contents is needed for their work identity and autonomy to improve the quality of care in LTC facilities. (J Am Med Dir Assoc 2011; 12: 524-534)