Title : The role of organizational factors in certified nursing assistant wellbeing in post-acute and long-term care facilities
Abstract:
Certified Nursing Assistants (CNAs) provide the majority of direct resident care in Post-Acute And Long-Term Care (PALTC) settings, yet the sector faces a persistent workforce shortage driven by burnout and high turnover. While compensation and recruitment challenges are well documented, the influence of organizational conditions on CAN wellbeing is less clearly defined. Understanding these workplace factors is important for developing strategies that strengthen resilience, improve job satisfaction, and support workforce retention. This study examines how organizational conditions, including perceived workplace respect and supervisor support, are associated with CNA job satisfaction and burnout in PALTC facilities. An anonymous cross-sectional survey was administered to Certified Nursing Assistants working in post-acute and long-term care facilities in Illinois (n = 243). Participants were recruited through snowball sampling, direct outreach, and facility-based distribution. The survey included Likert-scale and categorical questions measuring individual strain, financial stress, workplace respect, organizational support, job satisfaction, and burnout. Composite wellbeing domain scores were calculated by averaging standardized Likert-scale items, with negatively worded items reverse coded so that higher scores indicated more favorable conditions. Data were analyzed using descriptive statistics, correlation analyses, nonparametric tests, and multivariable linear regression in R. CNAs reported relatively high job satisfaction despite experiencing notable levels of burnout and individual strain, suggesting that meaningful work and emotional exhaustion may coexist in this workforce. Perceived respect from nursing staff and supervisors was positively associated with job satisfaction, while greater organizational support was strongly associated with higher job satisfaction and lower burnout. Financial worry was significantly associated with increased burnout but not with job satisfaction, indicating that economic stress primarily contributes to emotional exhaustion rather than diminished job meaning. In multivariable regression models adjusting for individual strain, hours worked, and shift type, organizational support remained independently associated with lower burnout, while workload variables were not significant predictors. The model explained 36% of the variance in burnout. These findings highlight the central role of organizational culture in shaping CNA wellbeing. Workplace respect and supportive organizational environments appear to act as protective factors that enhance job satisfaction and mitigate burnout. Interventions that strengthen supervisory support, improve workplace culture, and foster respectful interdisciplinary relationships may represent practical and modifiable strategies for improving CNA resilience and workforce stability in PALTC settings.
