9.9% who come from Indonesia, Vietnam and Mainland China. They work as nurse assistants in order to earn money and support their families. Therefore, they must overcome language, cultural and life differences to be competent nurse assistants. This study found that the average job stressor dimension of nursing assistants is 2.88, which indicates moderate to low levels. With reference to the studies by [12, 16], the results of job stressors for nursing assistants are similar, but the order of scores is different. The highest scores in these two studies are work control, followed by mental load and social support. The difference may be due to different workplaces. In the present study, the nursing assistants were based in a public hospital, while the participants in the studies of [12, 16] were nursing assistants in long-term care institutions. The stress factors varied. Moreover, according to the studies by [24], and the results showed that the average score of job stressor was 1.48, indicating low pressure. The reason may be due to the optimistic nature of the indigenous peoples and indigenous women who are generally responsible for the financial burden of the family which they need to work to support. Nursing assistants with foreign nationalities have their own characteristics and work differently, so they feel less pressure than Taiwanese [25]. Due to the long working hours and limited rest time, overlapping work and their living results in a high level of stress, which can be reduced by social support [12]. As a matter of fact, hospitals should provide training or related courses for newly recruited service workers to face the stress and working environment. In addition, supportive resources should be increased to assist the new nursing assistants to adapt and integrate into the workplace. It is also important to provide psychological counselling or consultation for nursing staff, to assist and support workers to face the work pressure or any problems during clinical work, in order to improve their job satisfaction.
The job satisfaction of nursing assistants in this study is above average level, which is similar to the research results of [21, 23, 24, 26]. In Lin’s study, nursing assistants were indigenous people and their job satisfaction was above average level, whereas the intrinsic satisfaction is higher than extrinsic satisfaction which may be due to different cultures.
The study investigated the job satisfaction of nursing staff by the Chinese version of the MSQ scale as the research instrument [26]. The results showed that the job satisfaction of nursing staff was above moderate level and the top three factors with the highest scores were consistent. Chang and Tang conducted another study on specialist nurses and used the Chinese version of the MSQ scale as the research instrument [23]. The research results showed that the job satisfaction of specialist nurses were above the moderate level, and the top three factors with the highest scores were consistent. However, these are different from the research by [27]. According to the results, the overall satisfaction of the assistants was 68%, which was at a moderate level. Varying satisfaction levels from these studies may be due to different research participants and instruments. When assistants perform better at work, they will have higher job satisfaction [26]. Chang et al. found that greater job competency led to higher intrinsic satisfaction. Nursing assistants’ job competency had a positive effect on extrinsic satisfaction; Greater job competency led to higher intrinsic satisfaction. Nursing assistants’ intrinsic satisfaction had a positive effect on their intention to stay [13]. Sustainable training may improve nursing assistants’ knowledge and skills, which can be applied on caregiving work [28]. Advanced training helps to improve workers’ caring skills, in order to provide better quality service and increase job satisfaction. Job satisfaction is also found to be related to job training and work skills. If the nursing assistants are provided with continuous job training on caring services and life skills, their job skills will be improved and hence, job satisfaction will be increased. The job satisfaction received by nursing assistants after job training is significantly higher than without taking on the job training. On-job training and education for sustainable development are critically related to job satisfaction or the ability of nursing assistants, which can also increase the quality of caring service [29]. Nursing assistants are very important to nursing staffs who help and care for the needed patients. Substantial rewards are influential to the nursing assistants’ satisfaction; however, promotion opportunities are generally low in the nursing industry. Organizations should provide a clear career path and promotion opportunities to increase staffs’ job satisfaction. The on-job training for nursing assistants is related to job benefits, lack of manpower would be a burden for organizations. Therefore, organizations should provide adequate training courses to increase staff’s working effectiveness and proficiency to meet the needs of patients [30]. Nurse assistants should be incorporated into cross-disciplinary teams [4]. Nursing organizations should provide staff training schemes and career paths to retain staff, and also should arrange various education training and professional courses every year for sustainable development. In addition, organizations should actively provide opportunities for promotion to team leaders and senior nursing staff, and also should provide a rewarding system to increase staffs’ working attitude, motivation, and development.
In terms of the effect of nursing assistants’ job stressors on job satisfaction, the results of this study found that social supports of the job stressors are the critical factor affecting intrinsic satisfaction, extrinsic satisfaction, and general satisfaction. Job satisfaction is correlated with job stressors [2, 24]. The lower the job stressors, the higher the job satisfaction [24]. The job satisfaction and the level of stress of nursing assistants are negatively correlated [31]. Stress is negatively associated with job satisfaction of nursing assistants, moreover, stress has a direct effect on job satisfaction [32]. Therefore, strengthening aspects of the job known to provide satisfaction may help maintain the current nursing assistants’ workforce. Nursing assistants’ job satisfaction may improve with structured approaches to address training, education, workload, and pay. It is significant to create a positive workplace and increase the concept of humanistic care, increase job satisfaction and decrease job stressors. Hospital managers must respect their feelings and establish an appropriate working environment [11].
The training and education are for the work of NAs: The nurse assistants should have the abilities to notice problems and solve problems, assist in handling an emergency, take advantage of care resources, realize the needs of activities, and take the case to do some simple activities [33]. The place where care attendants work is usually in medical institutions, nursing institutions, sanatoriums and other social welfare institutions or families, assisting patients, the disabled or the physically and mentally handicapped in daily life, providing physical, life care, and family services. As nurse assistants have to tackle a wide range of complex tasks and provide service to specific people, it is important for nurse aides to possess such work competence [4]. The nursing assistants in this study had relatively low job stress and high job satisfaction. Our hospital attaches great importance to the training of nurse assistants, arranges various education to improve skills, enhance their work competency and care quality, creates a friendly working environment, emphasizes teamwork spirit, and provides salary and benefits that are superior to government regulations and maintains daily caring. Most of the nurse assistants who work in our hospital generally regard the hospital as a second home.
Implications Of The Study
Allowing nurse assistants to jointly formulate care plans can facilitate the development of their comprehensibility, overall analytical capabilities, and ability to provide appropriate care to residents. Since this study was conducted at a hospital-based nurse institution in Taiwan and purposive sampling was employed, the results cannot be generalized to nurse assistants in non-institutional settings and regional hospitals. The nursing assistants of the hospital were outsourced workers who were jointly managed by the contractors and unit supervisors of the hospital. Thus, the responses are easily influenced by the nurse assistants’ job stressors and job satisfaction. Moreover, the structural questionnaire design made it difficult for the participants to make specific responses or allow us to gain an in-depth understanding of the scale items. We expect that more in-depth discussions should be made in the future in order to understand the relationships between the scale items.
Limitations
This study has several limitations; initially, the information was gathered from one setting at a certain time by utilizing a non-probability convenience sampling, which may restrict the generalizability. In addition, the use of the cross-sectional method significantly restricts more unexpressed and precise data.
Recommendation
It is recommended that cross-cultural studies be conducted to determine the effect of cultural differences on job satisfaction. The operators of medical institutions should understand the personal characteristics and the needs of nursing assistants, provide good management, and offer support, so that stress to be relieved, hence, job stressors reduced and professional skills increased, thereby increasing job satisfaction, and reducing staff turnover rate in order to create better medical care service. We should design strategies to control the nursing assistants’ stressors to ensure increased job satisfaction. There is an urgent need by the authorities and partners to join hands to address these role stressors for the nursing assistants to continue enjoying high job satisfaction and good performance at work.
Nursing assistants need to be trained or educated at each stage or phase, depending on their professional ability and keep up-to-date in accordance with the trend of the times, the nursing care or medical services we provide should meet or be even higher than the current needs, in order to become a model of the medical care system. We maybe use the theoretical study for further research, adopt qualitative research for verification and advance to explore the inner feelings of nursing assistants. Counseling services should be offered by trained professionals to help with various challenging situations.