Buffering Effects of Job and Personal Resources on the Health and Well-Being of Care Workers

Abstract

The care industry is encountering a critical demand for care workers in the formal and informal sectors. As a result, the healthcare industry is strained from the increasing shortage of workers and capacity in facilities. Moreover, there is a desire among the aged to age in place, thus, care provided in the home and community is also on the rise. The requisite for care workers in the U.S. suggests that this population is vulnerable to job and personal demands in the workplace that are associated with negative health outcomes such as poor sleep and burnout. The purpose of this three-paper dissertation is to evaluate the moderating effects of job and personal resources on the health and well-being of nurses and patient care associates (PCAs) in the formal sector and Filipina care workers in the informal sector. The first two papers used the Boston Hospital Health Workers Study, a longitudinal study that was established in 2006 to examine the working organization and condition, behaviors, and health outcomes among healthcare workers from two large hospitals in the same health system in Boston. The first paper (N=845) used a mixed methods approach and used logistic regression analysis to examine the association of discrimination and short sleep and interaction terms to assess the buffering effect of people-oriented culture between discrimination and short sleep. The qualitative section used a combination of grounded theory and thematic analysis of interviews of unit nurse directors (N=16) to gain an in-depth understanding of how discrimination transpires in the workplace and the resources available to address discrimination and poor sleep among care workers. The second paper (N=874) evaluated the association of job and personal demands and burnout using logistic regression. Interaction terms were implemented to assess the buffering effect of workplace flexibility between job and personal demands and burnout. The third paper used semi-structured interviews of Filipina care workers in New England (N=14). A combination of grounded theory and thematic analysis were used to analyze the qualitative data. In Paper 1, findings showed that people-oriented culture did not buffer the relationship of discrimination and short sleep. However, people-oriented culture slightly attenuated the association of discrimination and odds of short sleep. Qualitative findings illuminated that discrimination transpired among co-workers in relation to their job titles and while numerous job resources are available, these resources do not necessarily address discrimination and promotion of inclusivity. In the second paper, workplace flexibility moderated the relationship between married healthcare workers without children and odds of burnout. Moreover, there are significant associations between active (high demand, high control) and high strained (high demand, low control) workers with perceived low workplace flexibility and odds of burnout. In the third paper, qualitative findings highlighted that Filipina care workers are tasked with multiple job responsibilities that are associated with abuse and injuries and personal demands of providing financial care to their family and saving face from divulging difficult experiences. While job resources like job contracts are helpful in lowering the likelihood of abuse, lack of government oversight facilitated violence in the workplace. Filipina care workers found support through community organizations and advocating for themselves and other fellow care workers. Findings from this study suggest that organizational policies and practices play a role in attenuating poor health outcomes among care workers but not all experience these policies and practices equally. Barriers such as not acknowledging discrimination directly and providing specific resources to discrimination, differing control in the workplace because of job title and racial and gender identities, and reporting abuse and violence in the workplace outweighing the cost of the demand to provide the needs for family members prevent care workers from being able to fully benefit from these policies and practices. Nevertheless, while structural changes take time, unit managers in formal settings and employers in informal settings can address these inequities in their specific settings to improve the health and well-being of care workers. This dissertation will assist the field of social work to advocate for federal, state-level, local, and organizational policies to be implemented in the workplace that will adjust to the needs of healthcare and domestic workers. Furthermore, the study can also inform future interventions to integrate effective organizational policies that reduce poor sleep quality and burnout among care workers.