Minimizing Staff Turnover from Burn-Out - Thesis Example

Effective Supervision Can Minimize Staff Turnover from Burn-Out in Direct Care Staff in Adolescent Residential Settings Turnover Issues Hecker (2004)predicted that direct care worker occupations are among one of the fastest growing jobs and they also have the largest growth among health occupations between 2002 and 2012. According to the estimates made, an additional 888, 000 direct care worker jobs in California, USA alone, which is an increase of about 34 percent than the previous. This number includes both new jobs and job replacements for those who are retiring. Again, it was predicted that the demand for direct care worker in residential and community based settings will continually grow even higher for institutionalized settings. Factors which Affects the Supply and Turnover of Direct Care Workers Contemporary studies are now offering new insights regarding turnover problem with regards to direct care workers. Most of the studies which can be found can give data taken from interviews with employees and employers, in a study that I have found, the author looked at the problem from a bigger perspective. In the study conducted by Brannon (2002), he examined factors that looked at health facilities with very high and very low direct care worker turnover rates from a middle referent group. From there, he explored the possibility that high turnover and low turnover are distinct occurrences having different originators. The findings in the study suggest that researchers must avoid using a linear function of a single set of predictor model when looking at facility turnover. The study revealed that a relationship between supervisory staff and the home health aide is a significant contributor to worker satisfaction and turnover. In another study which focused on direct care worker-supervisory relationships in the context of hierarchy, it was found out that supervisory staff often blame the cause of recruitment and retention problems to the worker’s personal problems, dysfunctional family structure, and lack of respect for the job (Bowers 2003). It is rarely recognized by supervisors that organizational structure, or mistreatment or poor management by higher employees as a reason for turnover. Most of these top level staff often complain about the long hours of work they spend on paperwork which according to them causes less communication and contact with residents and direct care workers (Bowers 2003). Another study conducted by the California Association of Homes and Services for the Adolescents found unswerving complaints from direct care staff that they feel that they themselves and the work that they do are not given due importance. Using in-depth interviews, it was known that many of the reasons previously shown for turnover such as dissatisfaction with staffing and absenteeism policies, training practices and low compensation are confirmed. For the past few years, a variety of initiatives to improve recruitment and retention of the direct care workforce have been implemented by states and providers. At present, there are few implemented approaches which have evaluation as part of the process. Theories of Burnout Job burnout has been increasingly experienced by many people since the world where we live today has become more and more technological, in which everything moves in a fast pace. As jobs become an all encompassing part of people’s lives, the time spent in the workplace is more than the time spent anywhere else (Bywater, 2008). As such becoming the case, work often becomes stressful and that the result is that many individuals felt that they were unable to cope with their jobs’ circumstances. Maslach, Shaufeli, & Leiter (2001) argue that one of the important phenomenon of the modern age is the relationship that people have with their work, and the challenges that can arise when that relationship goes wrong. Job Satisfaction Employee satisfaction has been an important issue but ironically it has always been neglected. High levels of absenteeism and staff turnover can affect an organization’s bottom line, as temps, recruitment and retraining take their toll. In any case, there are few organizations that have made job satisfaction a top priority since they have seen the opportunity that lies in this dimension (Syptak 2002). Contemporary studies have shown that there is a direct correlation between staff satisfaction and client satisfaction. Satisfied employees have the tendency to be more dynamic, creative, and committed to their employers (Syptak, 2002). Job satisfaction was defined by Berry (1997) as an individual’s reaction to the job experience. An organization must ensure the satisfaction of their employees if they want their organization to be successful. Pay, promotion, benefits, supervisor, co-workers, work conditions, communication, safety, productivity, and the work itself are the components which are important to job satisfaction. These variables all influence the way an employee feels about her job. A study concluded that the pay is not the most important component of job satisfaction, rather, employees are more concerned with a good working environment which they prefer. Discrepancy theory is a job satisfaction theory which was developed by Locke which suggests that an individual’s satisfaction comes from what they feel is significant instead of the fulfillment or unfulfillment of their needs. This theory suggests that job dissatisfaction takes place when an employees receive less than what they want (Kaldenberg 1999). Another theory, which is now the most popular, is the Herzberg’s theory. In the 1950’s, Frederick Herzberg asked the employees two sets of questions: 1. Think of a time when you felt especially good about your job. Why did you feel that way? 2. Think of a time when you felt especially bad about your job. Why did you feel that way? He was interested on knowing what made them satisfied and dissatisfied on their jobs. From these two essential questions, Herzberg was able to develop his theory. According to this theory, there are two essential dimensions on job satisfaction: motivation and hygiene. This theory assumes that hygiene issues does not motivate employees but only minimizes dissatisfaction if handled properly. To put it differently, hygiene issues can only dissatisfy employees if they are absent or mishandled. Hygiene issues include company rules, supervision, salary, interpersonal relations and working environment. These are dimension related to the employee’s working environment (Kaldenberg 1999). The second component of job satisfaction is motivation. This includes achievement, recognition, and the work per se, responsibility and advancement. These create satisfaction by rewarding individual’s needs for meaning and personal development. Herzberg argued that once the hygiene issues are addressed, the motivators will encourage job satisfaction and promote production. Applying Herzberg theory Company and Administrative Policies If a company or organization’s policies are vague or unnecessary, it can be a great source of frustration to employees or if it is unfairly implemented such that not everyone follows it or if there are unfair exemptions. Policies do not necessarily motivate employees but then it can help in decreasing dissatisfaction if policies are fair and applied equally to everyone (Berry 1997). It is also proper that companies should provide printed copies of policies and procedure manuals to their employees or they must post such to easily accessible areas to all the members of the staff. These manuals should also be regularly updated in order to avoid confusion among employees (Berry 1997). Supervision The most important decision one can make in this area is choosing the right person for the job. Those who are in the position to choose should bear in mind that good employees are not always good supervisors. This role is extremely difficult in that it comes with great responsibility. It needs leadership skills and the capacity to treat all employees fairly (Kaldenberg 1999). Salary Salary is not a motivation for employees but they do want to be paid fairly as goes in the old adage “you get what you pay for”. If employees feel that they are not being paid well, there is a big tendency that they are unhappy in working for that person. The remedy for this is for a company to consult salary surveys or even help-wanted advertisements in one local area in order to see if the salary and benefits one gives to her employees is competitive to those in the local area. Furthermore, an organization should have clear policies in relation to salaries, raises and bonuses (Kaldenberg 1999). Interpersonal relations It is important to remember to allow employees a fair amount of time for socialization for social contact (e.g. coffee breaks, in between patients) which will help them develop a sense of camaraderie and teamwork. Working conditions The physical environment where employees work has a great effect on the level of pride for the employees themselves and to the work that they are performing. The management should update the office equipments and facilities, remember that even a nice office table can make a difference to a worker’s psyche. As much as possible, overcrowding should be avoided so as to give employees their personal space. If the employees are in close quarters or if that they have no personal space, it is not impossible among them to have tension (Maslach et al 2001). Work Itself When an employee deems that her job is meaningful and that they really are contributing significantly to the good of the organization, this will also serve as a motivation for them. The supervisor should not forget to give positive feedbacks to them whenever necessary and one should not always focus on their mistakes (Kaldenberg 1999). Of course employees may not find all their tasks appealing or satisfying, but one should show the employee how those tasks that they are performing are essential to the general processes that make the practice succeed. One may find certain tasks that are truly redundant and can be eliminated or streamlined, resulting in greater effectiveness and satisfaction (Kaldenberg 1999). Achievement Herzbergs study is based on a premise that most individuals wants to do a good job. In order for the management to satisfy this want, they should be strategically put into positions where they can use their talents and skills and not to positions where they will surely fail. Supervisors should assist the management by setting clear, achievable goals and standards for each of the positions and that they should also guarantee that the employees know these goals and standards (Yamada 2002). Lawler Theory of Job Satisfaction According to this theory, satisfaction was driven by a motivational framework wherein an individual measures job satisfaction on the foundation of what they have versus what they think that they deserve. The difference between the exact amount a person received (not just monetary value) and what they were expecting determined their satisfaction. In other words, dissatisfaction occurs when employees feel that they are getting less than what they think they deserve. Overall, job satisfaction is an essential element when talking about an organization’s success. For an organization to be efficient and productive, the concerns of the workers should not be neglected rather it should be properly addressed. Direct Care (non-management) staff According to Yamada (2002), there are important changes which occurred over time. In the late 1980’s, home care aides are older than those in 1990’s. Direct care staffs nowadays are more educated and more likely to have children. While no data were available in nationality in the late 1980s, home care aides were notably less likely to be native-born US citizens than were nursing home and hospital aides in the late 1990s. Educational levels among aides have amplified over the past 10 years; home care aides still have less education than other aides, but almost 30 percent of nursing home aides and home care aides have at least some college education. In terms of working conditions, home care aides were more probable to work full-time and full year in the 1990s (46 percent) than in the late 1980s (29 percent), but still less expected to work full-time and full-year than nursing home aides (55 percent) and hospital aides (63 percent). Forty-two percent of part-time home care aides accounted to prefer for part-time work. On the other hand, 18 percent of part-time home care aides said they are more inclined towards a full-time job but could only find part-time jobs. Home care workers are rather more likely to have earnings from other work (23 percent) than are nursing home aides (20 percent) (Yamada, 2002). I. Burnout and its effects on worker retention Burnout is defined as the state of emotional, mental, and physical exhaustion caused by too much and long-drawn-out stress. It comes about when one feels besieged and not capable to meet unvarying demands. As the stress continues, one starts to lose the interest or inspiration that led an employee to take on a certain role in the first place Burnout causes unhappiness and detachment which can threaten one’s job, relationships and even her health. But the good news is that burnout can be healed. If its signs and symptoms have been recognized at its early stages, straightforward stress management techniques may be enough to solve the problem. In the later stages of burnout, recuperation may take more time and effort, but one can still get back her balance by reassessing her priorities, making time for herself, and seeking support. Herbert Freudenberger, an acclaimed psychologist, defines burnout as a depletion of energy and a feeling of being overwhelmed by other people’s problems. Some of the symptoms of burnout are: physical and emotional exhaustion, a desire to withdraw from people, and a reduced ability to finish things. Burnout is often defined as a severe syndrome which develops as a consequence of a prolonged stress situation in the work place. Burnout manifests itself as a syndrome which can be described as three dimensional, these are: exhaustion (emotional), cynicism (depersonalization), and professional efficacy (personal accomplishment). Maslach Burnout Inventory-General Survey (MBI-GS) was developed due to the realization that burnout is experienced in all parts of work life and it was designed by Maslach to study burnout across different occupations be it managerial or direct staffs. The Maslach Burnout Inventory-General Survey defines exhaustion as a feeling of overstrain, fatigue which resulted from emotional overtaxing work. Cynicism on the other hand refers to an apathetic attitude towards work, losing one’s interest and the meaning of work. Professional efficacy is interpreted as feelings of competence, successful achievement and accomplishment in one’s work (Maslach 1996). There are four possible successions wherein the three burnout dimensions can develop as measured by the MBI. In a study, empirical support for a process model was developed wherein depersonalization was observed to develop first as a dysfunctional management strategy in stressful situations, and it is followed by diminished personal accomplishment because of performance interference and sooner or later these all end up as emotional exhaustion (Maslach 1996). In another model, emotional exhaustion develops as a consequence of overtaxing demands of work, and as a result, an individual will try to cope with the situation by depersonalization which in the end destabilizes accomplishment. This second model was supported by the research conducted by Cordes, Dougherty, and Blum (1993). As seen in the presence of many burnout models, it can be said that there is still no consensus about the process of burnout. But then, it is important to note that almost all of the models share a basic assumption of sequentiality which means the inconsistency between a person and her work leads to burnout but still depends on the person’s way of managing it. The importance lies in knowing about the sequential process of burnout so as to know and recognize people in different phases of burning out which would in turn make possible for intervention before burnout becomes severe. As measured by the MBI, burnout over time has been tested to be quite persistent. Even though burnout is thought to develop slowly during a long time period, only few studies have actually tested this view (Maslach 1996). Tanner concluded that the evidence that she has found sustains the model that she also developed for the purpose of the study that burnout slowly develops from exhaustion, cynicism and lastly to lack of professional value. This chronological method was studied in connection with the prognostic role of job stressors in industrial occupations representing white-collar and blue-collar workers. Furthermore, the analysis of the sub groups that were included in the study substantiated the process model and is able to relate burnout to its origin. In addition, the illustration is clear that burnout is indeed an organizational problem. And it was confirmed that organizations need to take steps towards development and stress prevention of its employees, which is a better way than waiting for the employees to suffer from burnout. This will affect the organization substantially. As exhaustion is the most critical variable, and also the first symptom to appear in the burnout process, the prevention should be aimed at the triggers of exhaustion. One literature which can be helpful in this study is the research conducted by Salla Tanner entitled “The process of burnout in white-collar and blue-collar jobs: Eight-year prospective study of exhaustion” (2002). This study focused on testing three different theories on sequential process of the three dimensions of burnout which are exhaustion, cynicism and professional efficacy using the Maslach Burnout Inventory Survey (MBI-GS) as a measuring tool. The underlying order of the burnout dimensions was investigated by including job stressors as previous circumstances of burnout in structural equation models (LISREL). The prognostic effect of exhaustion on burnout dimensions 8 years later was also included in the study (Tanner 2002). Longitudinal models were tested in 2 occupational subgroups which included direct care staff/employees. The best-fitting model of the relations between the 3 burnout dimensions was achieved by a trail model where exhaustion predicted cynicism, and cynicism in turn predicted lack of professional efficacy. Symptoms of exhaustion were constant over time. There were no differences between the 2 occupational groups in the process of burnout. Work-related antecedents of burnout were very analogous in both groups (Tanner, 2002). Symptoms of Burnout According to Bywater (2008), burnout is a critical business which if unaddressed may lead to devastating levels of anxiety and depression. At the extreme level, burnout can lead to physical symptoms or even self-harm. From the perspective of an organization, burnout among employees is a significant issue. Burned out employees are less prolific, less collaborative, less imaginative, less motivated and less likely to stick around. It is therefore important to recognize burnout before it is severe – and then take measures to stop it in its tracks. Preventing burnout There are many ways that organizations can prevent employee burnout. For one, supervisors in charge can undergo training for them to be able to provide more reliant rewards to their employees. Organizations can also redesign tasks for them to facilitate employees to be more in control over their work. One should also update wages to be more closely related to the level of employee performance (Bywater 2008). Emotional Support from Support Groups Although supervisors and top level managers can be said to have a heavy workload, it should not be forgotten that they should encourage their employees if they are undergoing emotional problems. A support group can also understand them if they have problems with their patients. It is proven in psychology that to most people, sharing one’s emotions can provide relief (Bywater 2008). Counseling Emotional counselors can deal with the natural feelings that come with care giving, especially heavy duty care giving. A counselor can help greatly to help employees see things clearly and set goals for maintaining one’s set goals. They also have the educational background which can give an employee a scientifically sound advice (Bywater 2008). Supportive Supervision   Supervision Overseeing The origin of supervision can be dated back in the nineteenth century from charitable social organizations in Europe and North America. Supervision back then entailed organization and oversight of a large number of volunteers and later on, of paid workers. These volunteers were knows as ‘visitors’ and they were responsible in calling on a small number of families to iffer advice and support. Their main task was to promote self help, and the adaptation of healthy habits and behaviors. In addition to that, these volunteers were also often asked to access scarce funds through their agencies (Hawkins 1989). An ‘overseer’ is tasked to assign cases, organize works and take decision on behalf of the agencies that she is working for and hence the development of the term ‘supervisor’. It came from the Latin word super which means ‘over’ and videre, meaning, to watch or see. It was noted that part of the supervisor’s work was to ensure that the jobs were done well and it measures up to the standard. This work can be seen as an administrative task. Nonetheless, overseers also had to be teachers and innovators. These were latest forms of organization and involvement: standards were being set, new methods developed (Hawkins 1989). Administrative Supervision The main concern of administrative supervision is the correct, effective and appropriate implementation of the policies and procedures of the organization. The main goal is to make certain that employees adhere to policy and procedure (Kadushin 1992). In this type, the supervisor has been given the authority to oversee the work of the supervisee. Along with this authority is the responsibility if guaranteeing that the organizational policies are implemented, implying that there is a controlling function and a parallel responsibility to enable workers to be able to perform their jobs to the best of their ability (Kadushin 1992). Educational Supervision The main role of an educational supervisor is to dispel ignorance and upgrade skills. The orthodox process involved in this kind of supervision is to promote reflection and exploration of the work at hand. The supervisor may help the staff in understanding their clients better or help them to be more conscious of their own reactions and responses to clients or patients. They can also help employees in understanding the dynamics of employee-patient interaction and on how they intervene and the consequences of such interventions (Brown and Bourn 1995). Supportive Supervision The focus of this kind of supervision is boosting job satisfaction and the employees’ morale (Kadushin 1992). It is assumed here that employees are facing a variety of job-related stress, and they are tasked to help them overcome these problems so as not to seriously affect their work which would in turn lead to less than satisfactory service to patients. It is also important to note that supportive supervision, unlike the two mentioned above which focuses on instrumental needs, centers on expressive needs (Kadushin 1992). In this type of supervision, the supervisor is tasked to prevent the development of potentially stressful situations or at the extreme, to relieve the worker from stress, reduce the intrusion of stressors and to help the individual adjust to stress. The supervisor should be always available and approachable, and should be able to communicate confidence towards the employee. She should also have the ability to provide perspective, be able to provide positive feedback, apply sanctions and rewards fairly and grants opportunity for self-sufficient functioning and for probable success in task achievement (Brown and Bourn 1995). In the case of residential settings and all other health services, supervision provides important support for the delivery of its services. Although its importance has long been recognized, there is still the tendency for supervision to emphasize inspection and control by external supervisors. Most of the time, theses supervisors deem that employees are naturally not motivated and that they require strong controlling forces to perform their jobs properly (Brown and Bourn 1995). In recent studies, it was suggested that there is a need to use a different approach to convert supervision to a more conducive form in health workers and direct care staff. This then developed supportive supervision which expanded its scope of supervision methods by incorporating self- and peer assessment and also community input. Moreover, one important characteristic of supportive supervision is that the locus of supervisory activity is shifted away from a single official to the wider workforce. This means that supportive supervision includes process implementation not only by the officially designated supervisor but also informal supervisors, peers and direct care staff themselves. This kind of supervision will in turn encourage quality results through strengthening communication, centering on problem-solving, facilitating teamwork, and providing leadership and support to empower direct care providers to supervise and improve their own performance (Hawkins 1989). Studies show that supportive supervision is feasible. From data gathered from countries in different regions, it shows that this type of supervision is a great alternative to traditional approaches. Some of the prerequisites of supportive supervision include innovative thinking about who will do supervision when and how (Hawkins 1989). New behaviors should also be adopted by supervisors and staff alike and that there should be updated appropriated and tested tools. Most importantly, there should be the commitment of top management staff so as to decentralize decision-making (Hawkins 1989). Conclusion Supportive supervision also has its share of challenges. One is the presence of many actors with distributes workload have a tendency to make supervision a non-system with no one in charge, in other words, no one is there to make sure that supervisory responsibilities of those who are in charge takes place. Moreover, overconfidence on self-directed and self-managed teams can place unrealistic expectations on the workforce (Hawkins 1989). The experiences shown above suggest otherwise. Supportive supervision, particularly when implemented in a larger environment of quality enhancement, has been shown to boost quality of care indicators, provider contentment with the support provided by the health system, and problem-solving at the facility level. Even when the obstacles of implementing change at various (and sometimes all) levels of an organization can be cleared, sustaining such improvements over time can be an even greater challenge. Most field experiences in implementing supportive supervision are still quite recent and it is only now that there are efforts of addressing scale-up issues. References Bowers, B.(2003). Turnover reinterpreted: CNAs talk about why They Leave. Journal of Gerontological Nursing 29(3):36-43. Brown, A. and Bourne, I. (1995) The Social Work Supervisor. 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