Administration in Social Work

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Job Satisfaction Among Long-Term Care Staff:

Bureaucracy Isn't Always Bad

Gauri S. Rai

To cite this article: Gauri S. Rai (2013) Job Satisfaction Among Long-Term Care
Staff: Bureaucracy Isn't Always Bad, Administration in Social Work, 37:1, 90-99, DOI:
10.1080/03643107.2012.657750

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Administration in Social Work, 37:90–99, 2013
Copyright © Taylor & Francis Group, LLC
ISSN: 0364-3107 print/1544-4376 online
DOI: 10.1080/03643107.2012.657750

Job Satisfaction Among Long-Term Care Staff:

Bureaucracy Isn’t Always Bad

Gauri S. Rai
Department of Social Work, Mary Baldwin College, Staunton, Virginia, USA

The study investigated the influence of role conflict, workload, centralization, and formalization on job
satisfaction of long-term care staff. Regression analysis revealed that role conflict, workload, central-
ization, and formalization together contributed 40.0% variance in job satisfaction. Role conflict and
workload decrease job satisfaction while centralization and formalization increase it.

Keywords: centralization, formalization, long-term care, role conflict, satisfaction, workload

INTRODUCTION

Since the advent of the human relations school of thought in the early 1930s, numerous studies
have been conducted on job satisfaction of employees (Galup, Klein, & Jiang 2008) and several
reviews have appeared in the academic literature (Iffaldano & Muchinski, 1985; Six & Eckes, 1991;
Judge & Bono, 2001; Lee & Cummings, 2008). The main reason for continued interest is that
job satisfaction is likely to affect job involvement, commitment, teamwork, performance, and citi-
zenship behavior (Kemery, 2006; Singh & Dubey, 2011). Historically, research on job satisfaction
may be classified into three main groups (Schyns & Croon, 2006). First, job satisfaction is con-
sidered as an antecedent of certain organizational outcomes such as performance, intent to stay,
and citizenship behavior (Robinson & Pillemer, 2007; Severt, Xie & DiPietro, 2007; Anton, 2009).
Secondly, it is considered as the result of various organizational conditions such as leader-member
exchange, perceived organizational support, and gender roles (Moore, 2009; Dodson & Borders,
2006; Ahmed, Ali, Ahmed, Ahmed, Ahmed, & Nawaz, 2010). Thirdly, the effects of personality
characteristics on job satisfaction are considered (Dorman & Zapt, 2001; Judge & Bono, 2001).
Along with studies pertaining to business and industry, job satisfaction has also been the subject
of investigation in human service organizations, for example, churches (Kemery, 2006), universi-
ties (Al-Omari, Qublan & Khasawneh, 2009), high schools (Green & Reese, 2009), and prisons
(Lambert, Paolina & Hogan, 2006). Thus far, the majority of research in long-term care has focused
on resident satisfaction (Rai, 2007; Zwisen, Smalbrugge, Zuidema, Koopmans, Busmans, Eelsting,
Gerristen, & Pot, 2011), but only a few investigations have included staff satisfaction (Robinson &
Pillmer, 2007). Therefore, the objective of this study is to examine effects of work environment on
job satisfaction among long-term care staff.

Correspondence should be addressed to Gauri S. Rai, Department of Social Work, Mary Baldwin College, 318 Prospect
Street, Staunton, VA 24401, USA. E-mail: grai@mbc.edu

90
 JOB SATISFACTION AMONG LONG-TERM CARE STAFF 91

LITERATURE REVIEW

Job satisfaction is defined as “the feelings an employee has about the job in general” (McNeese-
Smith, 1996). There are several variables in the work environment that may affect job satisfaction.
In particular, role conflict, workload, centralization and formalization are variables frequently men-
tioned in the literature as important predictors of job satisfaction. All the studies involving these
variables will be reviewed in this section to develop hypotheses.
Kahn, Wolfe, Quinn, Snock, and Rosenthal (1964) identified role conflict as the major stres-
sor in organizational life. Role conflict is defined as the degree to which expectations of a role
are incompatible or incongruent with the reality of the role (Rizzo, House & Lirtzman, 1970).
Several meta-analytic studies have examined the relationship between role conflict and job satisfac-
tion (Jackson & Schuler, 1985; Brown & Peterson, 1993; Tuber & Collines, 2000). They revealed
that role conflict has negative influence on job satisfaction. In relatively recent studies, Kemery
(2006) reported that when role conflict is high among clergy, there is less satisfaction among them.
In a study of certified public accountants in Thailand, Ussahawanitchakit (2008) reported a signifi-
cant relationship between role conflict and job satisfaction. Jaramillo, Mulki, and Solomon (2006)
identified in a study of salespersons that lower amounts of conflict resulted in higher job satisfaction.
Lee, Joshi, and Bac (2010) found a negative relationship between role conflict and job satisfaction
among Korean information system personnel. Similarly, Singh and Dubey (2011) reported a sig-
nificant negative correlation between role conflict and job satisfaction among middle managers in
private sector organizations in India. Role conflict was found to be negatively correlated with job
satisfaction of faculty members at Jordanian public universities due to conflicting demand of teach-
ing, research, and service (Al-Omari, Kublan, & Khasaweneh, 2009). Mohr (2007) also found that
managers experiencing a high level of role conflict also report lower job satisfaction among gen-
eral managers of German-Indian ventures. All of these empirical investigations reported a negative
relationship between role conflict and job satisfaction.
Satisfaction studies have frequently included workload as one of the predictors. Workload is
defined as the perception of work demand made on the workers in terms of time, amount, and
speed. A strong negative relationship between workload and job satisfaction has been reported
in various occupational groups (Cullen, Silverstein, & Foley, 2008; Seed, Torkelson, & Alnatora,
2010; Martension, Carlsson, & Lampie, 2010). In addition, workload and satisfaction has been the
focus of investigations in several international studies. For example, in a qualitative study, Stuart,
Jarvis, and Daniel (2008) observed that an increased workload places overwhelming time pres-
sure on district nurses in the United Kingdom, and this pressure adversely affects quality and care
given to patients, making them feel guilty, stressed, and dissatisfied. Also in the UK, Graham and
Lance (2005) found that workload was related to job satisfaction among secondary school teach-
ers. Barnby (2006) reported that in the England and Wales area the issue of workload and public
behavior was found to be important in dissuading teachers from entering the profession and possi-
bly causing them to leave teaching. In Sweden, Emstrom, Ljunggren, and Lindqvst (2006) observed
that, due to increased workload, there are difficulties in recruiting and retaining nurses in elderly
care. In Pakistan, the most dissatisfying factor within the work setting is identified as high work-
load among nurses in a tertiary care university hospital (Khawaja, Merchant & Hirani, 2005). In the
Peoples Republic of China, workload accounted for 39.5% variance in job satisfaction of inten-
sive care nurses. In South Africa, public sector nurses were most dissatisfied with pay, workload,
and the resources available to them (Pillay, 2009). In Australian Disabilities Employment services,
as workload increased, psychological health decreased among its workers. (Noblet, Graham, &
Mcwilliams, 2008). In Canada among cancer care nurses, high workload was perceived to decrease
the quality of patient care and staff morale (Grunfeld, Zitzelabeaergar, Costiena, Whelan, Aspelund,
& Evans, 2005). However, Boltinghouse, Hammack, Alexander, and Dittmer (2007) reported in a
web-based survey of physicians, engineers, and air traffic controllers that there was no significant
92 RAI

correlation between mental workload and job satisfaction. Therefore, on the basis of studies done in
the United States and around the world, it is inferred that employees who perceive higher demand
workload exhibit lower levels of satisfaction. Conversely, those who perceive their work demands
as reasonable have higher job satisfaction.
Every organization uses several mechanisms to control and influence its members. According to
Weber (1947), hierarchy of authority (i.e., centralization) is one mechanism that organizations use
to achieve coordination. Centralization is defined as the degree to which power is concentrated in a
member or a group of members of the upper echelon of the organization (Price, 1972). Centralization
is also defined as members’ participation in decision making and job autonomy (Hage, 1965). In this
context, a low level of job autonomy suggests high centralization, while a high level of participation
and job autonomy suggests decentralization. In essence, centralization is power in the hands of the
upper level of the hierarchy or low member participation. The majority of these studies have found
negative relationships between centralization and job satisfaction (Ahmed, Ali, Ahmed, Ahmed,
Ahmed, & Nawaz, 2010; Lambert, Paoline, & Hogan, 2006; Annick, Buleni, & De Joghe, 2007;
Katsikea, Theodosiou, Perdikis, & Kehagias, 2001; Campbell, Fowles, & Weber, 2004). One study
has found a positive relationship between centralization and job satisfaction (Hetherington & Hewa,
1997), and few studies have found no relationship between centralization and job satisfaction (Curry,
Wakefield, Price, & Mueler, 1986; Muller, Boyer, Price, & Ivesson 1994).
Formalization is defined as the degree to which rules and procedures are followed by the
organization and employees in carrying out different activities (Rai, 1983). There are two views
regarding effects of formalization within the organization (Lambert, Paoline, & Hogan, 2006).
The Weberian model contends that rules and procedures are necessary to provide guidelines to
workers and administrators to conduct their everyday business. Because formalization limits the
employee’s discretion, workers become more efficient, which increases motivation and satisfac-
tion. On the other hand, the human relation model of management predicts that too many rules
are unnecessary. They hamper worker creativity and interfere with professional judgment, which
decreases motivation and satisfaction. Just as there are two theoretical models regarding the effects
of formalization, there are two types of empirical findings. Several investigations revealed that
formalization is positively related to job satisfaction. For example, this observation was found
among correctional officers and staff (Lambert, Paoline, & Hogan, 2006), nurses (Annick, Buelens,
& De Jorghe, 2007), and export sales managers (Katsikea, Theodosiou, Perdikis, & Kehagios,
2011). On the other hand, some of the studies reported that formalization is negatively associated
with job satisfaction. For example, this was noticed among managers of state health and human
service agencies (Dehart-Davis & Pandey, 2005), among middle level managers within pharma-
ceutical industry (Ahmed, Ali, Ahmed, Ahmed, & Nawaz, 2010), in social service departments
(Kakabadu & Worrall, 1978), and among health and welfare agency workers (Aiken & Hage,
1966). However, Campbell, Fowler, and Weber (2004) found no relationship between formal-
ization and job satisfaction in the state of Illinois’ community-based public health departments.
It appears that the relationship between formalization and job satisfaction is not consistent and may
depend upon the occupational group or organization being studied (Lambert, Paoline, & Hogan,
2006).
Overall, the review indicates that there is strong, consistent evidence that role conflict and
workload are negatively correlated with job satisfaction of staff members. Findings regarding cen-
tralization and formalization and satisfaction are mixed. To date, all four of these variables have not
been examined together in any study.

HYPOTHESES

On the basis of the literature review, the following hypotheses were formulated.
 JOB SATISFACTION AMONG LONG-TERM CARE STAFF 93

Hypothesis 1: Role conflict will be negatively related to job satisfaction.

Hypothesis 2: Workload will be negatively related to job satisfaction.

Hypothesis 3: Centralization will be negatively related to job satisfaction.

Hypothesis 4: Formalization will be negatively related to job satisfaction.

METHOD

Data was collected as part of a larger project that included nine long-term care facilities located in
different parts of a southern state in the United States. There were a total of 794 staff members, out
of which 363 people completed the questionnaire. The completion rate was 46.0%

MEASUREMENT

Role Conflict
Role conflict was measured by an index of three items chosen from a scale used by Radforn,
Hannan, Norman, and Martin (2002) in a nursing home study. An item example of role conflict is the
statement, “People within the home make conflicting demands on you.” The reliability coefficient
Cronbach’s alpha is .71 for role conflict.

Workload
Workload was measured by asking one global question: “Do you think your workload is 1) too light,
2) manageable, or 3) yoo heavy?” Respondents were asked to choose one of the three response
categories (Cole, Panchandeswaraan, & Daining, 2004).

Centralization
Centralization was measured by asking one question: “When it comes to patient care, how much
say or influence does facility management, administrator, and a director of nursing have in your
home?” The response categories were: 1) little or no influence, 2) some influence, 3) quite a bit of
influence, 4) great deal of influence, and 5) a very great deal of influence. This measure was adapted
from Patchen’s (1963) measurement of control within the organization. The reliability coefficient
Cronbach’s alpha is .86 for the three items in centralization.

Formalization
Formalization was measured by asking one question: “To what extent are rules and procedures
followed in carrying out the following matters such as patient care, staff evaluation, documenting
patient progress, and hiring and promotion of staff” (Rai, 1983)? The response categories were:
1) once in a while, 2) sometimes, 3) half of the time, 4) most of the time, and 5) all of the time. The
reliability coefficient Cronbach’s alpha is .76 for the four items in the formalization.

Job Satisfaction
Job satisfaction was measured by 15 items on the job satisfaction scale developed by Warr, Clark,
and Wall (1979) and used by Redfern, Hannon, Normal, and Martin (2002) in a nursing home study.
94 RAI

An item example is, “How satisfied or dissatisfied are you with the recognition you get from good
work?” The items were rated on a seven-point scale ranging from extremely dissatisfied to extremely
satisfied. The reliability coefficient Cronbach’s alpha is .93 for these items.

Socio-Demographic Characteristics
The socio-demographic characteristics considered were age, gender, marital status, ethnicity, edu-
cation, and tenure. Age was measured as actual age at last birthday. Gender was measured as 0 =
male and 1 = female. Marital status was assessed by using one item: 1 = single, 2 = married, 3
= separated, 4 = widowed, 5 = divorced, and 6 = living in a permanent relationship. This char-
acteristic was recoded as a dichotomous variable with two categories: married (1) and unmarried
(0). Ethnicity was measured as 1 = Caucasian, 2 = African American, 3 = Hispanic, 4 = Asian
American, 5 = Native American, and 6 = other. This response was also recoded as a dichotomous
variable with two categories: non-white (0) and white (1). Education was measured as 1 = grade
school, 2 = high school, 3 = some college, 4 = bachelor’s degree, and 5 = graduate degree. Tenure
was measured as actual length of service in the facility.

DATA ANALYSIS

Data were examined using descriptive statistics, i.e., mean, standard deviation, and range. Reliability
coefficient Chronbach’s alpha was calculated for the scales measuring role conflict, centralization,
formalization, and job satisfaction (Table 1). Pearson product moment correlations were computed
for each pair of variables. Then a forward stepwise regression analysis was performed to deter-
mine the relative and overall contribution of independent variables on job satisfaction. Further,
one-way analysis of variance was computed to examine the difference in job position groups and
job satisfaction.

RESULTS

Data were obtained from 363 staff members of nine different long-term care facilities (Table 2).
Most of the participants (88%) were female and a minority (12%) was male. A majority of them

TABLE 1
Description of Study Measures

Variables M S.D Range # of Items Alpha

Age 40.07 12.74 18–69

Gender
Marital status
Ethnicity
Education 2.17 .99 1–5
Tenure 4.64 5.91 1–38
Workload 2.27 .47 1–3
Role conflict 2.40 .83 1–5 3 .71
Centralization 3.78 1.01 1–5 3 .86
Formalization 3.84 .81 1–5 3 .77
Satisfaction 4.9 1.01 1–7 15 .93
 JOB SATISFACTION AMONG LONG-TERM CARE STAFF 95

TABLE 2
Social Demographic Characteristics of Sample∗

Number Percentage

Gender
Male 41 11.3%
Female 317 87.3%
Marital Status
Married 188 51.8%
Non-Married 170 46.8%
Age
30 years and below 89 24.5%
31–40 years 77 21.2%
41–50 years 93 15.6%
51 years and above 85 23.4%
Ethnic group
Caucasian 233 64.2%
Non-Caucasian 119 32.8%
Education
Grade school 19 5.2%
High school 127 51.5%
Some college 69 19.0%
Bachelor’s degree 63 17.4%
Graduate degree 18 5.0%
Length of service
Up to 1 year 161 44.4%
2 to 5 years 98 27.0%
6 to 10 years 51 14.0%
More than 10 years 49 13.5%
∗ Because of missing values, total does not add to 100%.

(52%) were married, 26% were single, 4% were separated, 2% were widowed, 9% were divorced,
and 5% were living in permanent relationships. The participants were predominantly Caucasian
(64%), 26% were African American, 2% were Hispanic, .6% were Native American, 2% were
Asian American, and 1.7% were other. The mean age of the respondents was 41 years old. In terms
of education, 5% had completed only grade school, 52% had graduated high school, 19% had some
college, 17% had a bachelor’s degree, and 5% had a graduate degree. The mean for organizational
tenure (i.e., length of service in the facility) was five years.
An examination of correlation matrix revealed several statistically significant relationships
(Table 3). Staff age is correlated to marital status. Gender is correlated to education and central-
ization. Marital status is correlated to education and tenure. Ethnicity is positively correlated to
education. Tenure and satisfaction are negatively correlated. Education is negatively correlated to
tenure and positively correlated to role conflict. Role conflict is positively correlated to workload
and negatively correlated to centralization. Role conflict and workload are negatively correlated to
satisfaction; and centralization and formalization are positively correlated with each other, and also
with job satisfaction. This suggests that workers who experienced more role conflict and heavy
work demands are less satisfied. Certain amounts of hierarchical control and following of rules or
procedures are conducive to the job satisfaction of the workers.
A stepwise regression analysis was performed to determine the relative and overall contribution
of independent variables on job satisfaction (Table 4). In regression equation, job satisfaction was
entered as the dependent variable. In step one, all of the demographic variables were entered in the
96 RAI

TABLE 3
Person Correlation Coefficient for All the Variables Included in the Study

1 2 3 4 5 6 7 8 9 10

Age
Gender −.08
Marital status .20∗ −.06
Ethnicity .04 .01 .08∗
Education −.11∗ −.19∗ .17∗ .32∗∗
Tenure −.31∗∗ −.01 .14∗ −.13∗ −.14∗
Role conflict −.05 −.10∗ .01 .10∗ .15∗ −.01
Workload .04 −.03 .04 −.07 .05 .18∗ .34∗∗∗
Centralization .11 −.14∗∗ −.02 .05 .08∗ −.07 −.14∗∗ −.17∗∗
Formalization .04 −.07 −.05 .06 .01 −.09 −.19∗∗ −.18∗∗ .37∗∗∗
Satisfaction .08 .08 .04 .13∗∗ .08∗ −.05 −.40∗∗∗ −.37∗∗∗ .40∗∗∗ .48∗∗∗

N = 274. Gender, marital status, and ethnicity were coded as dichotomous variables (0,1).
∗ P < .05, ∗∗ P < .01, and ∗∗∗ P < .001 (one-tailed).

TABLE 4
Hierarchical Regression Analysis for the Relationship Among Formalization, Role Conflict,
Centralization, Workload, and Job Satisfaction After Controlling for Demographic Variables

Step Variables B Beta R square R square change

1 Demographic variable .26 .11 .02 .02

2 Formalization .40 .31 .24 .22
3 Role conflict −.33 −.26 .35 .11
4 Centralization .20 .21 .39 .04
5 Workload −.40 −.18 .42 .03

equation. The result showed that overall demographic variables contributed a very small variance
(Rsquare = .02) in job satisfaction. In step two, formalization was entered into the equation and it
explained 22.0% of variance in job satisfaction. In the third step, role conflict was entered into the
equation and another 11.0% variance was explained. In step four, centralization was entered into
the equation and it accounted for another 4.0% of variance. Lastly, workload was entered in the
equation and it explained 3.0% of variance in job satisfaction. Together, formalization, role con-
flict, centralization, and workload explained 40.0% of variance in job satisfaction. As hypothesized,
formalization was the strongest predictor of job satisfaction (beta = .31, P < .001), followed by
role conflict (Beta = −.26, P < .001) and centralization (beta = .21, P < .001), and workload
(Beta = −.18, P < .001). Formalization and centralization are associated with high job satisfac-
tion. Role conflict and workload are associated with low job satisfaction. In order to determine the
degree of multi-collinearity among variables, tolerance of a variable and variable inflation factor
were examined. The tolerance values for the predictor variable were as follows: 0.83 for formal-
ization, .85 for role conflict, 0.84 for centralization, and 0.86 for workload. The corresponding VIF
values were as follows: formalization, 1.2; role conflict, 1.2; centralization, 1.5; and workload, 1.7.
These diagnostics indicated that each variable made a significant and unique contribution to job
satisfaction.
In addition to the analysis reported above, one-way ANOVA was used to examine the relation-
ship between job position and job satisfaction. All the job titles were classified into three groups:
professional, paraprofessional, and support staff. Professional includes administrator, director of
 JOB SATISFACTION AMONG LONG-TERM CARE STAFF 97

nursing, director of social services, unit supervisor, charge nurse, and the nursing staff. Nurse aides
were considered in the paraprofessional group, and the dietary and housekeeping staff were part of
the support group. One-way ANOVA revealed that there is no difference between job position and
job satisfaction among these long-term care facilities.

DISCUSSION

The objective of the study was to find the effects of role conflict, workload, centralization, and
formalization on job satisfaction of staff in long-term care facilities. Out of four hypotheses pre-
sented earlier, two of them were supported and the remaining two hypotheses yielded results in the
opposite direction. Regression analysis revealed that, after controlling for demographic variables,
role conflict, workload, centralization, and formalization together contributed to 40.0% variance in
job satisfaction. As hypothesized, workers in these long-term care facilities who experienced more
role conflict are less satisfied. This finding is consistent with earlier studies that reported that these
two variables are negatively correlated with each other (Kemery, 2006; Usschawnitchakit, 2008;
Jaramillo, Mulki, & Soloman, 2006; Lee, Joshi, & Bal, 2010; Singh & Dubey, 2011, Al-Omari,
Qablan, & Khasawneh, 2009; Mohr, 2007). Workload is another variable that is negatively corre-
lated with job satisfaction. This supports the hypothesis that workers who felt heavy demands made
upon them are also less satisfied. This finding is also consistent with studies in human service orga-
nizations and investigations conducted in other countries (Cullen, Silverstein, & Foley, 2008; Seed,
Torkelson, & Alnatorna, 2010; Mastensson, Carlsonn, & Lampia, 2011; Stuart, Jarvies, & Daniel,
2008; Graham & Lance, 2005; Klasson & Anderson, 2009; Barnby, 2006; Khawaja, Merchant, &
Hirami, 2005; Pillay, 2009; Noblet, Graftan, & McWilliams, 2008).
The hypothesis that centralization is negatively correlated with job satisfaction was not supported
with data of this study. Rather, it was found that they are positively correlated with each other. This
is consistent with earlier findings (Pugh, 1962; Hetherington & Hewa, 1997). This result suggests
that the staff of these facilities want a certain amount of control exercised by upper hierarchal levels
for direction, guidance, and coordination of different activities. Similar to centralization, formal-
ization was also positively correlated with job satisfaction. This is consistent with relatively recent
findings (Lambert, Paoline, & Hogan, 2006; Annick, Buelenus, & De Joughn, 2007; Katasikea,
Theodosion, Berdikis, & Kehagios, 2011). This correlation suggests that use of rules and pro-
cedures is healthy for the organization. Further, centralization and formalization were positively
correlated with each other. This suggests that these are two different forms of control and they
can be used simultaneously in the organization. This suggestion is in line with the Weberian for-
mulation of bureaucracy, that hierarchy of authority and rules and procedures are essential for the
smooth functioning of the organization. Therefore, these findings reveal that bureaucracy may not
always be bad for all organizations. In the long-term care facilities, staff members’ perception of the
authority of upper echelons and the rules are positively related and enhance satisfaction among its
members.
The findings might have implications for these long-term care facilities. It has been found that
centralization and formalization positively affect satisfaction. Staff members are satisfied with hier-
archical power and use of the rules and procedures. These organizations are operating on the
bureaucratic model, and they can continue to do so effectively in the future. Further, administra-
tors are advised to make some adjustments in work demands. Also, role conflict can be minimized
by communicating clear expectations.
There are a few limitations to this study. The sample consisted of nine long-term care facilities,
which is very small. Because of a smaller number of facilities and total number of staff, a random
sample was not drawn. Respondents willingly participated in the study. A cross-sectional design
was used, and therefore no causal relations among variables can be established. Only a limited
98 RAI

number of work environment variables were considered in this study. Therefore, in order to more
fully understand the dynamics of job satisfaction, further research study should include variables
such as work-family conflict, organizational justice, social support, work culture, stress, and use of
a longitudinal research design (Singh & Dubey, 2011).
Finally, it is hoped that the attempt to improve job satisfaction in long-term care should ultimately
improve the quality of life among residents in these facilities. This is a goal that everyone in the
organization can agree on.

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