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Frontline Supervisor Survey Instrument Report

Publication Date

Peter Kemper, Diane Brannon, Teta Barry and Melissa Hobbs

Pennsylvania State University, Center for Health Care and Policy Research


This report was prepared under contract #HHSP23320044303EC between the U.S. Department of Health and Human Services (HHS), Office of Disability, Aging and Long-Term Care Policy (DALTCP) and Pennsylvania State University. For additional information about this subject, you can visit the DALTCP home page at http://aspe.hhs.gov/_/office_specific/daltcp.cfm or contact the ASPE Project Officer, Marie Squillace, at HHS/ASPE/DALTCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201. Her e-mail address is: Marie.Squillace@hhs.gov.

The opinions and views expressed in this report are those of the authors. They do not necessarily reflect the views of the Department of Health and Human Services, the contractor or any other funding organization.

"

INTRODUCTION

In this report, we describe the processes that we have undertaken to develop the data collection procedures for the Frontline Supervisor Survey. These processes include: identifying our target group; collecting contact information for frontline supervisors; testing and revising the survey instrument; and specifying how the domains that are measured in the data collection will be relevant to the analysis of the direct care worker (DCW) workforce and the improvement of DCW jobs.


IDENTIFYING SUPERVISORS

We conducted a series of telephone consultations with individuals from two home health care trade associations, two home care agencies, one adult day services center, four nursing home facilities and one assisted living facility to gain a better understanding of the supervisory structures in each type of organization. We spoke with one informant in each of these organizations. These organizations represented all five states in the Better Jobs Better Care (BJBC) Demonstration -- Iowa, North Carolina, Oregon, Pennsylvania, and Vermont. We contacted mainly larger providers under the assumption that these organizations would have more elaborate supervisory structures that would make identifying the frontline supervisor more complex.

The phone calls allowed us to explore the concept of “supervisory functions” with the respondents by dividing functions into tasks, allowing us to define frontline supervisors based on the tasks they perform. The calls also allowed us to define tasks in a way that delineate higher order supervision from frontline supervision. For example, while the function of “clinical training” could be performed by a higher-level employee or an employee outside of the agency, the task of conducting on-the-job clinical training appears to be performed by frontline supervisors, the respondent of interest. As a result of these conversations, ten supervisory tasks emerged as those that best characterize frontline supervision in long-term care organizations:

  • Acting as a mentor to DCWs;
  • Ensuring that DCWs are giving proper care to clients/residents;
  • Scheduling DCWs;
  • Initiating disciplinary action;
  • Documenting DCW performance problems;
  • Recommending training for DCWs;
  • Providing feedback (positive or negative) to DCWs on job performance;
  • Conducting on-the-job clinical training activities;
  • Responding directly to client/resident complaints about DCW performance;
  • Responding directly to job concerns raised by DCWs.

Though most of the key informants at each provider readily identified employees as frontline supervisors, because of the diversity among titles and functions within organizations these tasks will be used to define the population of frontline supervisors for this study. We subsequently removed from the list “directly responds to client/resident complaints about DCW performance” because it is likely that this responsibility is carried out not only by supervisors, but by administrators at different levels within the organization. Also, this task corresponds with the responsibilities to ensure that DCWs are giving proper care to clients/residents and to document DCW performance problems.

Based on these inquiries, we learned that frontline supervisor responsibilities are sometimes shared between two individuals. Specifically, we identified three types of frontline supervisory structures:

  1. One supervisor performs all or most of the functions listed on the protocol.

  2. Two supervisors on the same level of the administrative hierarchy perform supervisory functions, with one emphasizing clinical functions and the other emphasizing administrative functions.

  3. Two supervisors on different levels of the hierarchy (e.g., supervisor and supervisor’s supervisor) share supervisory responsibility, both performing many of the supervisory functions.

When frontline supervisory tasks are performed by more than one person, all determined to be supervisors will be included in the population of frontline supervisors to be surveyed. We are including information on the tasks performed in the survey instrument itself so that we can identify the tasks performed according to the supervisor.

We also found that in smaller organizations, it is possible that the person identified as the clinical manager may also serve as the frontline supervisor. This is possible because the clinical manager is identified based on his or her position in the organization whereas the frontline supervisor is identified based on the supervisory tasks performed. These persons will be asked to complete a Clinical Manager Survey with added Supervisor Survey items to minimize respondent burden.


CLINICAL MANAGER CONTACT TO PILOT TEST SUPERVISOR REPORTING

The goals of developing the chief clinical manager contact procedures were to establish a strategy for soliciting frontline supervisor contact information and systematically reviewing the tasks that supervisors do to determine how to screen out non-supervisors from frontline supervisors. Chief clinical managers at local provider organizations similar to those in the BJBC study were contacted and asked to provide information about frontline supervisors in their respective organization. We contacted the clinical managers by telephone, briefly described the Frontline Supervisor Study, and asked if they would be willing to indicate which tasks each of their supervisors perform. If they agreed, the list of supervisory tasks was sent to the clinical manager by fax with the following comments:

Thank you so much for helping us with our project evaluating the impact of the Better Jobs, Better Care Demonstration. Please indicate the supervisor of direct care workers who is responsible for each task at [name of provider organization], and as you do so, keep in mind that the definition of a direct care worker for the Better Jobs, Better Care Demonstration is an individual who provides hands-on personal care as a significant part of their job. Although activities may sometimes overlap, we do not include LPNs or RNs in this definition. Also excluded are workers who help with cleaning, meal preparation and chores, but do not provide personal care.

Once you’ve identified the frontline supervisor(s) for your organization, please fax the completed form back to 814-865-3098. If you have any questions or would like additional information regarding this request, do not hesitate to contact me at 814-863-0170. Thank you again for your time and assistance.

Overall, we contacted 12 chief clinical managers, and nine replied. From these nine, we received supervisor task information for 22 supervisors. We learned that, according to the chief clinical managers, not all of the supervisors performed each of the tasks, but most documented DCW performance problems, recommended training for DCWs, and directly responded to job concerns raised by DCWs. Less than half of these supervisors were noted to conduct on-the-job clinical training. Out of the 22 reported to performed each of the tasks on our list:

  • 13 act as a mentor to DCWs;
  • 17 ensure that DCWs are giving proper care to clients/residents;
  • 10 schedule DCWs;
  • 13 initiate disciplinary action;
  • 17 document DCW performance problems;
  • 17 provide feedback to DCWs on job performance;
  • 18 recommend training for DCWs;
  • 13 conduct on-the-job clinical training;
  • 17 directly respond to client/resident complaints about DCW performance;
  • 18 directly respond to job concerns raised by DCWs.

Out of these 22 supervisors, we contacted five to participate in a cognitive interview to test the survey instrument. The results from the cognitive interviews are explained in the next section of this report. During the cognitive interview, supervisors were asked to indicate which tasks for which they were responsible. We compared the tasks each supervisor reported with the tasks their clinical manager reported they did. Table 1 summarizes these comparisons. The chief clinical managers under-reported job responsibilities for Supervisors #3 and #4. For Supervisor #5, the chief clinical manager over-reported job responsibilities. These findings justify the inclusion of the task list on the Frontline Supervisor Survey and support the hypothesis that supervisors’ perceptions of the work environment may differ from those of the clinical managers’.

Based on the information from providers, clinical managers, and supervisors, we developed the definition of supervisor that defines our study population. We intend to be inclusive at this stage; when we conduct the analysis, we will be able to test whether a more restrictive definition affects our finding. If one or more of the following primary supervision tasks is checked, a person qualifies as a frontline supervisor under our definition:

  • Ensure that DCWs are giving proper care to clients/residents;
  • Initiate disciplinary action;
  • Document DCW performance problems;
  • Provide feedback to DCWs on job performance;
  • Directly respond to job concerns raised by DCWs.

In addition, if a person performs at least two of the following secondary supervision tasks, the person meets our definition of frontline supervisor:

  • Act as a mentor to DCWs;
  • Schedule DCWs;
  • Recommend training for DCWs;
  • Conduct on-the-job training.

The clinical managers who participated in this testing gave us feedback on our task list distribution procedures. From their comments, we learned that it is more effective and efficient for most to receive the task list as an e-mail attachment. This approach will work for our population of clinical managers at participating BJBC provider organizations because we have e-mail addresses for most of them. For the few clinical managers that do not have e-mail addresses, we will be able to contact them by telephone and send the task list via fax. The comments that will accompany the task list can be found in Appendix A.

Each returned task list will be reviewed by the Penn State Survey Research Center project assistant. To avoid erroneously excluding supervisors, if only one of the secondary supervisory tasks is checked, she will contact the clinical manager and probe for more information about other responsibilities this person has to double check whether or not the person performs any of the other supervisory tasks.

TABLE 1. Supervisor Tasks Reported by the Chief Clinical Manager at the Pilot Test Organization and by the Supervisors Who were Cognitively Interviewed
Tasks Tasks Reported for Supervisor #1
(Home Health Facility)
Tasks Reported for Supervisor #2
(Adult Day Center)
Tasks Reported for Supervisor #3
(Nursing Home)
Tasks Reported for Supervisor #4
(Nursing Home)
Tasks Reported for Supervisor #5
(Nursing Home)
Clinical
  Manager  
  Supervisor   Clinical
  Manager  
  Supervisor   Clinical
  Manager  
  Supervisor   Clinical
  Manager  
  Supervisor   Clinical
  Manager  
  Supervisor  
Act as a mentor to DCWs X X X X X X X X X X
Ensure that DCWs are giving proper care to clients/residents X X X X X X X X X X
Schedule DCWs     X X   X        
Initiate disciplinary action X X X X         X  
Document DCW performance problems X X X X   X     X  
Provide feedback to DCWs on job performance X X X X   X   X X X
Recommend training for DCWs X X X X   X     X X
Conduct on-the-job clinical training activities X X X X   X   X X  
Directly respond to job concerns raised by DCWs X X X X X X X X X X


COGNITIVE INTERVIEW SURVEY RESULTS

We conducted five cognitive interviews with individuals who represent our target population -- three supervisors at nursing home facilities, one supervisor at an adult day services center, and one supervisor at a home care facility -- to solicit feedback on question wording, placement, and flow within the questionnaire. These supervisors were asked verbally describe their thought processes as they answered the survey questions. A staff member from the Penn State Survey Research Center recorded the respondent’s comments and suggestions.

The responses given to the items on the Frontline Supervisor Survey and comments provided by those who participated in the cognitive interviews have been summarized and are shown in Appendix B. The five supervisors who participated have been labeled as R1, R2, R3, R4, and R5. The frequencies are displayed for the purpose of looking at the responses of these five individuals. From these results, we learned which items were not clear to the respondents or were interpreted differently. The questions that our respondents had the most comments for are described below.

Question 8b: “I have the opportunity to work in teams.”

The meaning of the word “team” in question 8b differed by respondent. R1 first said "I don't know what you mean by that" but after thinking aloud she answered by defining teams as working with Hospice, Medicare, and the Office of Aging. For R2, the teams she worked with were a geriatric steering committee and a company task force team. R3 interpreted "teams" to mean an interdisciplinary group of people at the organization who develop care plans for clients. R4 understood "teams" to mean DCWs and herself carrying out their duties together.

Question 11c: The extent to which cross-training used as a management practice

R1 indicated that cross-training is done both “occasionally” and “frequently” at her organization because DCWs occasionally receive training for administering medication but frequently receive training for physical therapy. R2 said that all regular employees are required to be CPR and first-aid certified, but the requirement is not enforced for employees who work occasionally. R5 said DCWs are trained as a matter of seniority at her organization, and typically Licensed Practical Nurse (LPN) DCW receive more cross-training.

Question 11d: The extent to which self-managed work groups used as a management practice

Two of the respondents, R1 and R5, did not understand who comprised a “self-managed work group.”

Question 12: “What mechanisms are used to handle employee concerns in your organization?”

After responding to question 12, each supervisor was asked how they interpreted the term “employee concerns.” R1 understood "employee concerns" to mean any kind of concern that an employee comes to her with, whether it had to do with their employment circumstances or their ability to provide care to clients. R2 said she was thinking of disciplinary procedures when she first read the question but she then saw that the question that followed covered discipline. R3 mentioned that the organization is part of a union, and the union has a role in handling employee concerns. R4 said the mechanisms listed to handle employee concerns that she checked are available, but not necessarily used. R5 thought of employee concerns as both professional and personal.

Question 14c: “How often do DCWs in your organization write in patient/resident/client care charts?”

Respondents described procedures that were relevant to care chart documentation, and the extent to which DCWs wrote in charts varied. R1 explained that DCWs have check sheets to fill out which become part of the client's chart. R4 said DCWs at her organization always write vital statistics in the charts, but they are not allowed to document anything else. R5 explained that all DCWs can write on flow sheets, but only the LPN DCW can write in charts.

Question 16

Questions 16a and 16b asked about DCW participation in career ladder programs. None of the organizations where the supervisors we interviewed work have career ladder programs.

Question 20b: “The organizational culture encourages risk-taking.”

The meaning of the phrase “risk-taking” varied by respondent. R1 thought of risk-taking as a spontaneous change in a client's care plan to which she answered “disagree.” R2 asked if risk-taking meant exploring other avenues or new techniques. She thought the word “risk” sounded harsh. R3 thought of “risk-taking” as doing something that was related to residents' care. R4 thought “risk-taking” implied taking one's chances to make the trip into work everyday. R5 asked if “risk-taking” meant unsafe behavior and said in terms of DCW personal safety, such as lifting and moving more independently than they should, risk-taking occurs.

Using the comments and suggestions from the cognitive interviews, we examined the items relative to how they will be compared with matched items on the complimentary BJBC Direct Care Worker and Clinical Manager Surveys. In weighing the potential improvement that could be made to questions against the loss of the ability to make these direct comparisons of frontline supervisor-DCW and frontline supervisors-clinical manager responses, we feel that making changes to the wording to these questions is not warranted. However, the cognitive interview exercise helped to flag certain questions and provide information that will be helpful when analyzing responses.


SURVEY MODIFICATIONS

The following modifications to the survey have been made based on the cognitive interviews and on feedback we received from ASPE :

  • Question 7 -- the task “Directly respond to client/resident complaints about DCW performance” has been removed.

  • Question 7i -- “Conduct on-the-job clinical training activities”: The word “activities” has been removed.

  • Question 10 -- We have added the word “Training” at the top of the table for clarification.

  • Question 32 -- “Do you currently work for pay at another job as a supervisor of direct care workers?” has been changed to “What is your gender?”

  • Added “Are you of Hispanic or Latino origin?” before we ask the respondent to indicate their race, and “Hispanic or Latina/Latino” has been removed as a category to check for race.

  • The categories for race have been reordered alphabetically.

The revised version of the survey is shown in Appendix C.


SCOPE OF DOMAINS MEASURED

The domains included for the Supervisor Survey are adopted from the BJBC Clinical Manager and Direct Care Worker Surveys, thereby allowing frontline supervisors (a middle layer) to respond to questions about the activities related to BJBC interventions. The overlap in the domains from the larger study is intentional. Responses will be used to enhance the validity of the data in determining the effects of BJBC interventions on DCW job outcomes, as well as to determine the role supervisors play in the effectiveness of interventions. Table 2 summarizes the domains associated with the three broader research questions, and Appendix D lists the survey items associated with each domain. We will use the domains to compare what clinical managers think is happening to what supervisors are really doing. We will use the information about supervisors to see the extent to which clinical managers and frontline supervisors agree on management practices. Domains will be used to determine: (a) how the agreement between clinical managers and supervisors’ perceptions affect DCW outcomes; and (b) how frontline supervisors perceptions of management practices affect DCW job quality and turnover.

TABLE 2. Research Domains
Research Questions Domains
1. Are intended management practices implemented at the front lines? Training
Management Practices
Job Characteristics
Perceptions of Organizational Culture  
BJBC Perceptions
Job Improvements
2. Do management practices affect the quality of supervision of DCWs? Competence
Satisfaction
Perception of Quality
Job Rewards
Job Concerns
Respect I
Intent to Leave
3a. Do management practices affect DCW turnover? 3b. Do management practices affect DCWs’ perceptions of job quality? Perceptions of Organization Culture
BJBC Perceptions
Job Improvements
Training
Management Practices
Job Characteristics


APPENDIX A: Memo to Accompany Task List and Task List

Dear [clinical manager],

As part of the data collection for the Better Jobs, Better Care Demonstration evaluation, we are preparing to survey staff members who have a role in supervising direct care workers at participating provider organizations. I would like to ask for your help in identifying staff at [name of provider organization] who are responsible for carrying out specific tasks. Attached is a form that will take about 5 minutes to complete. On this form, please indicate the staff member(s) responsible for each task listed.

As you complete the form, keep in mind that the definition of a direct care worker for the Better Jobs, Better Care Demonstration is an individual who provides hands-on personal care as a significant part of their job. Although activities may sometimes overlap, we do not include LPNs or RNs in this definition. Also excluded are workers who help with cleaning, meal preparation and chores, but do not provide personal care.

Once you’ve identified the staff member(s) who performs these tasks for your organization, please send a reply email and include the completed form as an attachment or fax the completed form to my attention at (814) 865-3098. If necessary, you may make copies of the form in order to include all relevant staff. Space is also provided for comments if you would like to further clarify how the tasks on the list are carried out at your organization.

If you have any questions or would like additional information regarding this request, do not hesitate to contact me at (800) 648-3617. Thank you again for your time and assistance.

Jennifer Sheaffer
BJBC MIS and Survey Coordinator
SSRI, Survey Research Center
The Pennsylvania State University
327 Pond Lab
University Park, PA 16802-6201
Tel: 1(800) 648-3617
Fax: 1(814) 865-3098

Supervisory Tasks List
Provider Organization Name:
Under the name of each staff member listed, please put an X next to the tasks they perform. If you need more space to write in the staff members who are responsible for these tasks, you can copy this form.
Tasks Staff Member Responsible for Tasks
Name:
Title:
Staff Member Responsible for Tasks
Name:
Title:
Staff Member Responsible for Tasks
Name:
Title:
Staff Member Responsible for Tasks
Name:
Title:
Act as a mentor to DCWs        
Ensure that DCWs are giving proper care to clients/residents        
Schedule DCWs        
Initiate disciplinary action        
Document DCW performance problems        
Provide feedback (positive or negative) to DCWs on job performance        
Recommend training for DCWs        
Conduct on-the-job clinical training activities        
Directly respond to job concerns raised to DCWs        
Comments:


APPENDIX B: Responses and Comments from Cognitive Interviews

FREQUENCIES COMMENTS
q1 How long have you worked as a supervisor of direct care workers? (years) R5 -- has been a supervisor of DCWs off and on for 40 years. She wasn’t sure how to quantify her time.
  Frequency  
Valid 7.75
10.50
13.00
30.00
Missing
Total
1
1
1
1
1
5
q2 Have you ever worked as a direct care worker? R1 -- has been a nurse for 30 years, and a long time ago DCW duties were art of her nurse duties.
  Frequency  
Valid 1 Yes 5
q3 How long have you worked for his employer? (years) R4 -- has worked at the same place for 13 years, but the facility was taken over by a new employer 4 months ago.
  Frequency  
Valid 7.75
10.25
10.50
13.00
24.00
Total
1
1
1
1
1
5
q4 How long have you worked as a supervisor for this employer?  
  Frequency  
Valid 1.25
2.00
3.00
10.50
13.00
Total
1
1
1
1
1
5
q5 How many DCWs do you typically supervise?  
  Frequency  
Valid 2
3
16
17
40
Total
1
1
1
1
1
5
q6 Do any DCW supervisors report to you? R5 -- all LPN team leaders report to her.
  Frequency  
Valid 1 yes
2 no
Total
2
3
5

Q7


q7a Responsibility to act as a mentor to DCWs.
R1 -- felt Q7 covered the responsibilities supervisors perform at her organization and could not think of other responsibilities to add. Because she shares responsibilities, we asked who she shares them with. She mentioned a nurse who was not included on the list of supervisors we received for this organization.
R4 -- None of the responsibilities listed for Q7 are her alone.
R1 -- nurses and DCWs perform this function in her organization.
R5 -- understood mentoring to include both personal and professional advising.
  Frequency  
Valid 2 My responsibility but others do this too 5
q7b Responsibility to ensure that DCWs are giving proper care to clients/residents. R1 -- relies on input from nurses and clients to ensure proper care.
  Frequency  
Valid 1 My responsibility alone
2 My responsibility but others do this too
Total
2
3
5
q7c Responsibility to interview DCW applicants.  
  Frequency  
Valid 1 My responsibility alone
4 I never do this
Total
2
3
5
q7d Responsibility to schedule DCWs. R1 -- gives advice on scheduling DCWs but her org. has a full-time person to schedule.
  Frequency  
Valid 1 My responsibility alone
2 My responsibility but others do this too
3 Not my responsibility but I sometimes do this
4 I never do this
Total
1
1
1
2
5
q7e Responsibility to provide feedback to DCWs on job performance. R1 -- sometimes other nurses give feedback on DCW performance.
R5 -- commented that her feedback is both informal and formal.
  Frequency  
Valid 1 My responsibility alone
2 My responsibility but others do this too
Total
1
4
5
q7f Responsibility to document DCW performance problems.  
  Frequency  
Valid 1 My responsibility alone
2 My responsibility but others do this too
3 Not my responsibility but I sometimes do this
Total
2
2
1
5
q7g Responsibility to initiate disciplinary action.  
  Frequency  
Valid 1 My responsibility alone
2 My responsibility but others do this too
3 Not my responsibility but I sometimes do this
4 I never do this
Total
2
1
1
1
5
q7h Responsibility to recommend training for DCWs. R2 -- her supervisor providers her with information to recommend training.
  Frequency  
Valid 1 My responsibility alone
2 My responsibility but others do this too
3 Not my responsibility but I sometimes do this
Total
1
3
1
5
q7i Responsibility to conduct on-the-job clinical training activities. R1 -- other nurses occasionally do this.
R2 -- a nurse at the organization instructs training activities, such as infection control.
R3 -- the word “activities” confused her. She does not think of training as an “activity.”
  Frequency  
Valid 1 My responsibility alone
2 My responsibility but others do this
Total
1
4
5
q7j Responsibility to directly respond to client/ resident complaints about DCW performance. R1 -- responsibility is split between herself and another nurse.
  Frequency  
Valid 1 My responsibility alone
2 My responsibility but others do this too
Total
2
3
5
q7k Responsibility to directly respond to job concerns raised by DCWs. R2 -- DCWs can go to her supervisor about concerns if necessary.
  Frequency  
Valid 2 My responsibility but others do this too 5

Q8


q8a I have learned the skills necessary to do my job well.
R2 -- she and DCWs at her organization are required to have inservice training yearly and a certain numbers of hours in training. She strongly agreed with all of the items for Q8.
R5 -- said “I don’t know what you’re looking for. Do you mean education? She then explained she is certified in gerontological nursing and has been since the late 1980s, but she also sees her life experiences as important. She didn’t give an answer.
  Frequency  
Valid 3 Somewhat agree
4 Strongly agree
Missing
Total
1
3
1
5
q8b I have the opportunity to work in teams. R1 -- first said “I don’t know what you mean by that” but after thinking about she answered by defining teams as working with Hospice, Medicare, and the Office of Aging.
R2 -- the teams she identified with were a geriatric steering committee and a company task for team.
R3 -- interpreted “teams” to mean an interdisciplinary group of people at the organization who develop care plans for clients.
R4 -- understood “teams” to mean DCWs and herself carrying out their duties together.
  Frequency  
Valid 4 Strongly agree 5
q8c I am confident in my ability to do my job well.  
  Frequency  
Valid 4 Strongly agree 5
q8d I could get a job that paid more than this job. R1 -- mentioned that she would be paid a higher wage for the same type of job if she was living in a larger city.
  Frequency  
Valid 3 Somewhat agree
4 Strongly agree
Total
3
2
5
q9 Overall, how satisfied are you with your job? R2 -- she is extremely satisfied with the job but not with the wages.
  Frequency  
Valid 1 Extremely satisfied
2 Somewhat satisfied
Total
1
4
5

Q10


q10a During the past year, did you receive any formal training on communicating effectively with other employees.
R5 -- has received a lot of formal training over the 40 years she’s been a nurse. She feels she’s at a point where she’s done the trainings all of the trainings offered and, therefore, hasn’t been attending any lately.
  Frequency  
Valid 1 Yes
2 No
Total
2
3
5
q10a_yes Training on communicating effectively with other employees was … R4 -- suggested labeling the table column with the word “Training.”
  Frequency  
Valid 3 Very useful
Skipped
Total
2
3
5
q10b During the past year, did you receive any formal training on communicating effectively with patients/residents/clients. R2 -- her organization refers to clients as “participants” not patients/residents/clients.
  Frequency  
Valid 1 Yes
2 No
Total
3
2
5
q10b_yes Training on communicating effectively with patients/residents/clients was …  
  Frequency  
Valid 3 Very useful
Skipped
Total
3
2
5
q10c During the past year, did you receive any formal training on diversity or cultural issues.  
  Frequency  
Valid 1 Yes
2 No
Total
1
4
5
q10c-yes Training on diversity or cultural issues was …  
  Frequency  
Valid 4 Extremely useful
Skipped
Total
1
4
5
q10d During the past year, did you receive any formal training on effective disciplinary procedures.  
  Frequency  
Valid 1 Yes
2 No
Total
1
4
5
q10d_yes Training on effective disciplinary procedures was …  
  Frequency  
Valid 3 Very useful
Skipped
Total
1
4
5
q10e During the past year, did you receive any formal training on skills for managing people.  
  Frequency  
Valid 1 Yes
2 No
Total
2
3
5
q10e_yes Training on skills for managing people was …  
  Frequency  
Valid Total 1 Not at all useful
3 Very useful
Total
Skipped
1
1
2
3
5

Q11


q11a Management practices used for DCWs -- Permanent assignment to patients/residents/ clients.
R1 -- For the Q11 statement “clinical practices” made more sense than “management practices” to her.
R2 -- understood “management practices” to mean her responsibilities in managing DCWs.
R2 -- no one is assigned to a particular client, but on occasion one of the clients may need special attention.
R5 -- her personal belief is to do this, but it isn’t always feasible because of DCW schedules.
  Frequency  
Valid 1 Never
2 Seldom
3 Occasionally
4 Frequently
Total
1
1
1
2
5
q11b Management practices used for DCWs -- Rotation of assignments to different services or units. R2 -- said “I’m not quite sure what you mean by different services.” She didn’t think the question applied to adult day service facilities, but she mentioned that workers fill in for each other when necessary.
R5 -- said this is done to balance the needs in the organization, but she prefers not to do this.
  Frequency  
Valid 3 Occasionally
4 Frequently
Total
3
2
5
q11c Management practices used for DCWs -- Cross-training R1 -- indicated both occasionally and frequently as her response because DCWs occasionally receive training for administering medication but frequently received training for physical therapy.
R2 -- all regular employees are required to be CPR and first-aid certified, but requirement isn’t enforced for employees who work occasionally.
R2 -- LPNs are trained as a matter of seniority at her organization.
  Frequency  
Valid 2 Seldom
3 Occasionally
4 Frequently
Total
1
3
1
5
q11d Management practices used for DCWs -- Self-managed work groups that include direct care workers. R1 -- first response was “I don’t know what that means” referring to self-managed work groups. She answered never.
R5 -- said “I’m not sure what you’re looking for” and asked if this meant without her. She didn’t provide and answer.
  Frequency  
Valid 1 Never
2 Seldom
3 Occasionally
Missing
Total
1
2
1
1
5
q11e Management practices used for DCWs -- Flex time for direct care workers. R2 -- she plans the work schedule a month in advance and employees can request changes is necessary.
R5 -- said that the organization has always had flex time as an option, but it is only occasionally used.
  Frequency  
Valid 2 Seldom
3 Occasionally
5 Always
Total
1
3
1
5

Q12


q12_1 Talk with supervisor
R1 -- understood “employee concerns” to mean any kind of concern that an employees comes to her with, whether it has to do with their employment circumstances or their ability to provide care to clients.
R2 -- was thinking of disciplinary procedures when she first read the questions but she then saw that Q13 covered discipline.
R3 -- noted the organization is part of a union, and the union has a role in handling employee concerns.
R4 -- said the mechanisms to handle employee concerns she checked are available, but not necessarily used.
R5 -- She thought of employee concerns as both professional and personal.
  Frequency  
Valid 1 Selected 5
q12_2 Toll-free hotline  
  Frequency  
Valid 0 Not selected
1 Selected
Total
1
4
5
q12_3 Organizational ombudsman  
  Frequency  
Valid 0 Not selected
1 Selected
Total
2
3
5
q12_4 Mediation  
  Frequency  
Valid 0 Not selected
1 Selected
Total
3
2
5
q12_5 Arbitration  
  Frequency  
Valid 0 Not selected
1 Selected
Total
3
2
5
q12-6 Other R5 -- mentioned employee assistance programs and informal referrals/support.
  Frequency  
Valid 0 Not selected
1 Selected
Total
4
1
5
q12_7 Do not use any specific method  
  Frequency  
Valid 0 Not selected 5
q13_1 Counseling by supervisor in the work unit  
  Frequency  
Valid 0 Not selected
1 Selected
Total
1
4
5
q13_2 Counseling by senior manager  
  Frequency  
Valid 0 Not selected
1 Selected
Total
1
4
5
q13_3 Written documentation  
  Frequency  
Valid 1 Selected 5
q13_4 Final warning conference  
  Frequency  
Valid 0 Not selected
1 Selected
Total
1
4
5
q13_5 Probation  
  Frequency  
Valid 0 Not selected
1 Selected
Total
1
4
5
q13_6 Suspension  
  Frequency  
Valid 1 Selected 5
q13_7 Termination  
  Frequency  
Valid 1 Selected 5
q13_8 Other  
  Frequency  
Valid 0 Not selected 5
q13_9 Do not use any specific method  
  Frequency  
Valid 0 Not selected 5
q14a How often do DCWs in your organization have input into changes in patient/resident/client care plans R1 -- at her organization a nurse develops care plan buy gets feedback from DCWs.
R5 -- says they always have input on flow sheets and assignment sheets.
  Frequency  
Valid 2 Seldom
4 Frequently
5 Always
Total
1
2
2
5
q14b How often do DCWs in your organization actively participate in developing patient/ resident/client care plans R1 -- modified the question to read “Actively participate in developing patient/resident/client initial care plans.”
  Frequency  
Valid 1 Never
2 Seldom
3 Occasionally
5 Always
Total
2
1
1
1
5
q14c How often do DCWs in your organization write in patient/resident/client care charts R1 -- explained that DCWs have check sheets to fill out which become part of the client’s chart.
R4 -- DCWs at her organization always write vital statistics in the charts, but they aren’t allowed to document anything else.
R5 -- all can write on flow sheets, and LPN DCW can write in charts.
  Frequency  
Valid Missing
Total
2 Seldom
4 Frequently
5 Always
Total
System
1
1
2
4
1
5
q14d How often do DCWs in your organization communicate in writing with other DCWs to relay information about residents/patients/clients R1 -- some clients have a book in their home where DCWs can record information, such as how much the client ate that day, etc.
  Frequency  
Valid 1 Never
3 Occasionally
5 Always
Total
1
2
2
5
q14e How often do DCWs in your organization communicate verbally with other DCWs to relay information about residents/patients/clients  
  Frequency  
Valid 3 Occasionally
5 Always
Total
2
3
5
q14f How often do DCWs in your organization communicate information either in writing or verbally about residents/patients/clients by reporting to their supervisors  
  Frequency  
Valid 4 Frequently
5 Always
Total
2
3
5
q14g How often do DCWs in your organization meet formally or informally with a supervisor to discuss patient/resident/client care issues  
  Frequency  
Valid 4 Frequently
5 Always
Total
3
2
5
q14h How often do DCWs in your organization receive verbal feedback about their everyday job performance  
  Frequency  
Valid 3 Occasionally
4 Frequently
5 Always
Total
2
1
2
5
q14i How often do DCWs in your organization receive written feedback about their everyday job performance R1 -- written feedback is given at the time of the annual performance evaluation. On the survey she didn’t provide and answer but wrote “yearly” next to the Occasionally choice.
  Frequency  
Valid
Missing
Total
2 Seldom
3 Occasionally
Total
System
2
2
4
1
5
q15 Estimate the overall competency level of DCWs you supervise  
  Frequency
Valid 8
9
Total
3
2
5
q16a What percentage of DCWs you supervise currently participate in a career ladder program for the DCW to advance to a higher level of DCW R1 -- no career ladder program at organization.
R2 -- no career ladder program at organization.
R3 -- no career ladder program at organization.
R4 -- no career ladder program at organization.
R5 -- no career ladder program at organization.
  Frequency  
Valid 1 None 5
q16b What percentage of DCWs you supervise currently participate in a career ladder program for the DCW to become a LPN R1 -- although no career ladder program at the organization, several DCWs working there have become LPNs.
  Frequency  
Valid 1 None 5
q16c What percentage of DCWs you supervise currently have a designated peer menter  
  Frequency  
Valid 1 None
4 51-75%
Total
4
1
5
q16d What percentage of DCWs you supervise participate in formal inservice programs beyond those required for certification  
  Frequency
Valid 1 None
2 1-25%
3 26-50%
Total
2
1
2
5
q17a During the past year, what percentage of DCWs you supervise have completed a self-directed educational video or computer-based training program while at work R5 -- her organization used to offer this type of training, but no longer.
  Frequency  
Valid 1 None
2 1-25%
5 76-100%
Total
3
1
1
5
q17b During the past year, what percentage of DCWs you supervise have attended a conference or workshop away from work  
  Frequency  
Valid 1 None
2 1-25%
3 26-50%
5 76-100%
Total
1
2
1
1
5
q17c During the past year, what percentage of DCWs you supervise received formal training on communicating effectively with other employees  
  Frequency  
Valid 1 None
2 1-25%
3 26-50%
Total
3
1
1
5
q17d During the past year, what percentage of DCWs you supervise received formal training on communicating effectively with patients/ residents/clients  
  Frequency  
Valid 2 1-25%
3 26-50%
5 76-100%
Total
2
1
1
4
q17e During the past year, what percentage of DCWs you supervise received formal training on diversity or cultural issues  
  Frequency  
Valid 1 None
2 1-25%
5 76-100%
Total
3
1
1
5
q18 Would you recommend taking a job as a DCW at the place where you work to a family member or friend?  
  Frequency  
Valid 1 Definitely recommend it
2 Probably recommend it
Total
2
3
5
q19 Would you recommend getting care from the place where you work to a family member or friend? R4 -- wasn’t comfortable with the choices. She said she would “possibly” recommend taking a job as a DCW where she works depending on the unit in the facility.
  Frequency  
Valid 1 Definitely recommend it
2 Probably recommend it
Total
3
2
5
q20a Employees take personal responsibility for their behavior. R5 -- agreed that her DCWs take personal responsibility, but she neither agreed not disagreed that all DCWs at the organization take personal responsibility.
  Frequency  
Valid 4 Agree 5
q20b The organizational culture encourages risk-taking. R1 -- first responded “I don’t know exactly what you mean by that” referring to risk-taking. She thought of risk-taking as a spontaneous change in a client’s care plan to which she answered “disagree.”
R2 -- said “I’m not sure what you mean by that” referring to risk-taking. She asked if risk-taking meant exploring other avenues or new techniques. She thought the work “risk” sounded harsh.
R3 -- thought of “risk-taking” as something that was related to residents’ care.
R4 -- thought “risk-taking” implied taking one’s chances to make the trip into work everyday, because you never know what will happen.
R5 -- did not understand what was meant by risk-taking. She asked if it meant unsafe behavior. She said in terms of DCW personal safety, such as lifting and moving more independently than they should, risk-taking occurs.
  Frequency  
Valid
Missing
Total
2 Disagree
4 Agree
Total
System
2
1
3
2
5
q20c The organizational culture encourages continuous improvement. R1 -- no formal policies, encouraged only by word of mouth.
R5 -- said that the organization is willing to work around DCW schedules, especially when they are taking courses towards improving their skills.
  Frequency  
Valid 2 Disagree
4 Agree
5 Strongly agree
Total
1
2
2
5
q20d Senior management has presented a clear vision of the future of the organization. R2 -- felt the vision for the future depends greatly on the client census, which is out of management’s control. If the number of clients isn’t stable, it’s hard to maintain a clear vision.
  Frequency  
Valid 1 Strongly disagree
3 Neither agree nor disagree
4 Agree
Total
2
2
1
5
q20e The organization rewards staff for being innovative. R1 -- individuals in the organization reward staff, but the organization doesn’t.
R2 -- the organization rewards for years for service, but is currently looking into other types of rewards.
  Frequency  
Valid 1 Strongly disagree
2 Disagree
3 Neither agree nor disagree
4 Agree
Total
1
2
1
1
5
q20f Management communicates effectively with staff in all levels of the organization.  
  Frequency  
Valid 2 Disagree
3 Neither agree nor disagree
4 Agree
5 Strongly agree
Total
1
1
2
1
5
q20g Management solicits input from all levels of staff when deciding on purchases related to care delivery.  
  Frequency  
Valid 1 Strongly disagree
2 Disagree
4 Agree
Total
1
1
2
4
q20h Management solicits input from all levels of the organization when deciding on policies and protocols.  
  Frequency  
Valid 2 Disagree
3 Neither agree nor disagree
4 Agree
5 Strongly agree
Total
2
1
1
1
5

Q21


q21a Helping others is …
R4 -- For many of the Q21 items, she commented that it would be nice if these things were possible. For example, Q21l, she said that having the power you need to get your job done without permission from someone else doesn’t happen where she works, but she answered by checking “extremely rewarding” because she thought it would be nice if that was the case.
  Frequency  
Valid 4 Very rewarding
5 Extremely rewarding
Total
3
2
5
q21b Being able to work on your own is …  
  Frequency  
Valid 3 Somewhat rewarding
4 Very rewarding
5 Extremely rewarding
Total
1
2
2
5
q21c Getting credit for your work is …  
  Frequency  
Valid 4 Very rewarding
5 Extremely rewarding
Total
2
3
5
q21d Finding your work interesting is …  
  Frequency  
Valid 4 Very rewarding
5 Extremely rewarding
Total
2
3
5
q21e Liking your coworkers is …  
  Frequency  
Valid 4 Very rewarding
5 Extremely rewarding
Total
2
3
5
q21f Making a difference in other peoples lives is …  
  Frequency  
Valid 4 Very rewarding
5 Extremely rewarding
Total
1
4
5
q21g Feeling a sense of accomplishment and competence from doing your job is …  
  Frequency  
Valid 4 Very rewarding
5 Extremely rewarding
Total
3
2
5
q21h Having your job fit your skills is … R5 -- said she has the skills to do more. She chose very rewarding.
  Frequency  
Valid 4 Very rewarding
5 Extremely rewarding
Total
3
2
5
q21i Having the chance to learn new things is … R5 -- did not give an answer. She says that she is at a point where she isn’t learning new things.
  Frequency  
Valid 4 Very rewarding
5 Extremely rewarding
Missing
Total
1
3
1
5
q21j Being valued by supervisors and management is …  
  Frequency  
Valid 4 Very rewarding 5
q21k Being needed by others is …  
  Frequency  
Valid 3 Somewhat rewarding
4 Very rewarding
5 Extremely rewarding
Total
2
1
2
5
q21l Having the power you need to get your job done without getting permission from someone else is …  
  Frequency  
Valid 4 Very rewarding
5 Extremely rewarding
Total
2
3
5
q21m Having a lot of different things to do is …  
  Frequency  
Valid 3 Somewhat rewarding
4 Very rewarding
5 Extremely rewarding
Total
1
1
3
5
q21n Getting support from coworkers is …  
  Frequency  
Valid 3 Somewhat rewarding
4 Very rewarding
5 Extremely rewarding
Total
1
2
2
5
q21o Having your job fit your interest is …  
  Frequency  
Valid 3 Somewhat rewarding
4 Very rewarding
5 Extremely rewarding
Total
1
2
2
5
q21p The income you earn is … R1 -- modified the statement to read “The income you earn for this area is …”
  Frequency  
Valid 3 Somewhat rewarding
4 Very rewarding
Total
1
4
5
q21q Being valued by residents or clients and their families is …  
  Frequency  
Valid 3 Somewhat rewarding
4 Very rewarding
5 Extremely rewarding
Total
1
1
3
5
q21r Having the freedom to decide how to do your work is …  
  Frequency  
Valid 4 Very rewarding
5 Extremely rewarding
Total
4
1
5
q21s The team spirit in your work group is …  
  Frequency  
Valid 3 Somewhat rewarding
4 Very rewarding
5 Extremely rewarding
Total
1
3
1
5
q22a Having too much work to do is …  
  Frequency  
Valid 1 Not at all a problem
2 Somewhat a problem
4 An extremely big problem
Total
1
3
1
5
q22b Having to deal with emotionally hard situations is …  
  Frequency  
Valid 1 Not at all a problem
2 Somewhat a problem
3 A big problem
Total
2
2
1
5
q22c Not having support from your supervisor in your job is …  
  Frequency  
Valid 1 Not at all a problem
3 A big problem
Total
4
1
5
q22d Finding your job boring or doing too much of the same thing is … R5 -- commented that she feels there’s way too much paperwork.
  Frequency  
Valid 1 Not at all a problem
2 Somewhat a problem
Total
3
2
5
q22e Having your job take too much out of you is … R5 -- said somewhat a problem because she has very bad arthritis in her hips and her answer is health-related
  Frequency  
Valid 2 Somewhat a problem
4 An extremely big problem
Total
4
1
5
q22f Having little change to get promoted is …  
  Frequency  
Valid 1 Not at all a problem
3 A big problem
Total
2
3
5
q22g Dealing with unrealistic expectations from your supervisor for your work is …  
  Frequency  
Valid 1 Not at all a problem
2 Somewhat a problem
4 An extremely big problem
Total
1
3
1
5
q22h Not having the job use our skills is …  
  Frequency  
Valid 1 Not at all a problem
2 Somewhat a problem
Total
4
1
5
q22i Catching an illness is … R2 -- said “illness” is a vague term and felt the degree of illness influences the response to the question
  Frequency  
Valid 1 Not at all a problem
2 Somewhat a problem
3 A big problem
Total
1
1
3
5
q22j Not having the chance to develop job skills is …  
  Frequency  
Valid 1 Not at all a problem
2 Somewhat a problem
3 A big problem
Total
2
1
2
5
q22k Not being valued by your supervisor for your work is …  
  Frequency  
Valid 1 Not at all a problem
3 A big problem
Total
4
1
5
q22l Being on your own too much is …  
  Frequency  
Valid 1 Not at all a problem 5
q22m Getting hurt is … R1 -- asked if getting hurt meant physically getting hurt.
R2 -- felt the degree to which you are hurt can influence the response chosen.
  Frequency  
Valid 1 Not at all a problem
2 Somewhat a problem
3 A big problem
4 An extremely big problem
Total
1
2
1
1
5
q22n The physical conditions at your job is …  
  Frequency  
Valid 1 Not at all a problem
2 Somewhat a problem
4 An extremely big problem
Total
3
1
1
5
q22o Not having enough help when you need it is …  
  Frequency  
Valid 2 Somewhat a problem
3 A big problem
4 An extremely big problem
Total
2
1
2
5
q22p That your supervisor is not good at her/his job is …  
  Frequency  
Valid 1 Not at all a problem
3 A big problem
Total
4
1
5
q22q That the job is physically hard is …  
  Frequency  
Valid 1 Not at all a problem
2 Somewhat a problem
4 An extremely big problem
Total
2
2
1
5
q22r The time it takes to get to work is …  
  Frequency  
Valid 1 Not at all a problem 5
q23a Residents/clients families respect me as part of the health care team.  
  Frequency  
Valid 2 Agree somewhat
3 Agree a great deal
Total
1
4
5
q23b Residents/clients respect me as part of the health care team. R2 -- a number of clients at her facility have dementia or Alzheimer’s disease and they often don’t know anything about her.
  Frequency  
Valid 2 Agree somewhat
3 Agree a great deal
Total
2
3
5
q23c DCWs respect me as part of the health care team.  
  Frequency  
Valid 3 Agree a great deal 5
q23d My supervisor respects me as part of the health care team.  
  Frequency  
Valid 1 Not at all agree
2 Agree somewhat
3 Agree a great deal
Total
1
1
3
5
q24a Residents/clients families respect me as part of the management team.  
  Frequency  
Valid 1 Not at all agree
2 Agree somewhat
3 Agree a great deal
Total
1
1
3
5
q24b Residents/clients respect me as part of the management team. R2 -- a number of clients at her facility have dementia or Alzheimer’s disease and they often don’t know anything about her.
  Frequency  
Valid 1 Not at all agree
2 Agree somewhat
3 Agree a great deal
Total
1
2
2
5
q24c DCWs respect me as part of the management team.  
  Frequency  
Valid 1 Not at all agree
3 Agree a great deal
Total
1
4
5
q24d My supervisor respects me as part of the management team.  
  Frequency  
Valid 1 Not at all agree
3 Agree a great deal
Total
1
4
5
q25 How likely is it that you will leave this job in the next year? R5 -- answered very likely because she is planning to retire.
  Frequency  
Valid 1 Not at all agree
2 Agree somewhat
3 Agree a great deal
Total
2
1
2
5
q26 How often do you think about quitting?  
  Frequency  
Valid 1 All of the time
2 Some of the time
3 Rarely
Total
1
2
2
5
q28 What is the single most important thing your employer could do to improve the job of DCWs? R2 -- didn’t have an answer for this question but felt the question was fine
  Frequency  
Valid No answer
More staffing -- staff should always be at a maximum to reduce # of incidents
Clone them so that they have more help.
Increase wages or mileage reimbursement
Show some appreciation for the hard work
Total
1
1
1
1
1
5
q29 What is the single most important thing your employer could do to improve your ability to do your job as a supervisor of DCWs? R2 -- didn’t have an answer for this question but felt the question was fine
  Frequency  
Valid No answer
Have more staff on the floor
Clone me -- I could use 3 of me to get everything done
Provide adequate staff
Total
2
1
1
1
5
q30 In your current job with this employer, what is your hourly wage?  
  Frequency  
Valid Missing
Total
10.17
15.00
21.50
27.00
Total
System
1
1
1
1
4
1
5
q31 Do you receive health insurance through this employer?  
  Frequency  
Valid I receive health insurance through the employer
Employer offers health insurance but I’m not enrolled
Total
3
2
5
q32 Do you currently work for pay at another job as a supervisor of DCWs?  
  Frequency  
Valid No 5
q33 What is your age?  
  Frequency  
Valid 25-34
45-54
55-64
Total
1
2
2
5
q34 Did you earn a high school diploma/GED?  
  Frequency  
Valid Yes 5
q34a What is your highest level of education? R2 -- has a 1-year LPN degree which doesn’t fit into the categories
  Frequency  
Valid Some college/trade school
College grad/post-college
Total
3
2
5
q35 Are you a nurse?  
  Frequency  
Valid No
Yes
Total
1
4
5
q35a What type of nurse?  
  Frequency  
Valid LPN
RN
Diploma
RN
Total
2
1
2
5
q36 Please indicate your race/ethnicity  
  Frequency  
Valid White
White & American Indian
Total
4
1
5


APPENDIX C: BJBC Supervisor Survey

This appendix is a recreation of the questions asked on the survey.
See the PDF version at http://aspe.hhs.gov/daltcp/reports/2008/FSSinst.pdf for a copy of the actual survey.

Better Jobs Better Care
Building a Strong Long-Term Care Workforce

Tell Us About Your Job

Your employer is one of over 130 that are part of the Better Jobs, Better Care Demonstration -- People like you in the state of Iowa, North Carolina, Oregon, Pennsylvania, and Vermont are being asked to complete this important survey. Your answers to these questions are very important to the success of this project. Please answer them as honestly as you can. Remember that your answers will be kept completely confidential. Your employer will not see any of your responses. Your answers will go directly to the Penn State Survey Research Center and you will not be identified.

A Confidential Survey
Conducted by the Survey Research Center at Penn State

Paperwork Reduction Act Statement

A federal agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Public reporting burden for this collection of information is estimated to be 30 minutes per response.

INSTRUCTIONS: If circles are provided, please completely fill in the circle next to your answer (example: Yes No). If boxes are provided, write your numeric answer in the boxes (example: ). If you are asked to specify an answer, please clearly print your response in the space provided.

  1. How long have you worked as a supervisor of direct care workers? _______years _______months

  2. Have you ever worked as a direct care worker? _______Yes _______No

  3. How long have you worked for this employer? _______years _______months

  4. How long have you worked as a supervisor for this employer? _______years _______months

  5. How many direct care workers do you typically supervise? _______

  6. Do any direct care worker supervisors report to you? _______Yes _______No

  7. Please indicate the extent of your responsibility as a direct care worker supervisor to perform the following tasks.

      My responsibility alone My responsibility but others do this too Not my responsibility but I sometimes do this I never do this
    a. Act as a mentor to direct care workers.        
    b. Ensure that direct care workers are giving proper care to clients/residents.        
    c. Interview direct care worker applicants.        
    d. Schedule direct care workers.        
    e. Provide feedback to direct care workers on job performance.        
    f. Document direct care worker performance problems.        
    g. Initiate disciplinary action.        
    h. Recommend training for direct care workers.        
    i. Conduct on-the-job clinical training        
    j. Directly respond to job concerns raised by direct care workers.        
  8. For each statement below, please indicate if you strongly disagree, somewhat disagree, somewhat agree, or strongly agree.

      Strongly disagree Somewhat disagree Somewhat agree Strongly agree
    a. I have learned the skills necessary to do my job well.        
    b. I have the opportunity to work in teams.        
    c. I am confident in my ability to do my job.        
    d. I could get a job that paid more than this job.        
  9. Overall, how satisfied are you with your job?
    _______Extremely satisfied
    _______Somewhat satisfied
    _______Somewhat dissatisfied
    _______Extremely dissatisfied
    _______Don't know

  10. During the past year, did you receive any formal training (inservice, workshop, etc.) on ...

    Training If yes, how useful was it?
    Not At All Useful Somewhat Useful Very Useful Extremely Useful
    a. Communicating effectively with other employees _______Yes -->
    _______No
           
    b. Communicating effectively with patients/residents/clients _______Yes -->
    _______No
           
    c. Diversity or cultural issues _______Yes -->
    _______No
           
    d. Effective disciplinary procedures _______Yes -->
    _______No
           
    e. Skills for managing people _______Yes -->
    _______No
           
  11. How often are the following management practices used for the direct care workers you supervise?

      Never Seldom Occasionally Frequently Always
    a. Permanent assignment to patients/residents/clients.          
    b. Rotation of assignments to different services or units.          
    c. Cross-training (learning new skills not traditionally used by direct care workers, such as medication administration or assisting with physical therapy).          
    d. Self-managed work groups that include direct care workers.          
    e. Flex time for direct care workers.          
  12. What mechanisms are used in your organization to handle employee concerns? (Mark all that apply)
    _______Talk with supervisor
    _______Toll-free "hotline"
    _______Organizational ombudsman
    _______Mediation
    _______Arbitration
    _______Other:_________________________
    _______Don't use any specific method

  13. What approaches are used to handle poor performance or negative behaviors at your organization? Mark all that apply)
    _______Counseling by supervisor in the work unit
    _______Counseling by senior manager
    _______Written documentation
    _______Final warning conference
    _______Probation
    _______Suspension
    _______Termination
    _______Other:_________________________
    _______Don't use any specific method

  14. How often do direct care workers in your organization ...

      Never Seldom Occasionally Frequently Always
    a. Have input into changes in patient/resident/client care plans          
    b. Actively participate in developing patient/resident/client care plans          
    c. Write in patient/resident/client care charts          
    d. Communicate in writing with other direct care workers to rely information about residents/patients/clients          
    e. Communicate verbally with other direct care workers to relay information about residents/patients/clients          
    f. Communicare information either in writing or verbally about residents/patients/clients by reporting to their supervisors          
    g. Meet formally or informally with a supervisor to discuss patient/resident/client care issues          
    h. Receive verbal feedback about their everyday job performance          
    i. Receive written feedback about their everyday job performance          
  15. Please estiamte the overall competency level of direct care workers you supervise using the following benchmark:
    _______0 = All require constant supervision and guidance
    _______1
    _______2
    _______3
    _______4
    _______5 = All have an average level of competency for the position
    _______6
    _______7
    _______8
    _______9
    _______10 = All perform their jobs well with minimal guidance

  16. Approximately what percentage of the direct care workers you supervise ...

      None 1-25% 26-50% 50-75% 76-100%
    a. Currently participate in a career ladder program for the direct care worker to advance to a higher level of direct care worker (for example, team leader or dementia care specialist)          
    b. Currently participate in a career ladder program for the direct care worker to become a Licensed Practical Nurse          
    c. Currently have a designated peer mentor          
    d. Participate in formal inservice programs beyond those required for certification          
  17. During the past year, approximately what percentage of the direct care workers you supervise ...

      None 1-25% 26-50% 50-75% 76-100%
    a. Have completed a self-directed educational video or computer-based training program while at work          
    b. Have attended a conference or workshop away from work          
    c. Received formal training (inservice, workshop, etc.) on communicating effectively with other employees          
    d. Received formal training (inservice, workshop, etc.) on communicating effectively with patients/residents/clients          
    e. Received formal training (inservice, workshop, etc.) on diversity or cultural issues          
  18. If a friend or family member asked your advice about taking a job as a direct care worker at the place where you work, would you ...
    _______Definitely recommend it
    _______Probably recommend it
    _______Probably not recommend it
    _______Definitely not recommend it

  19. If a friend or family member needs care and asked your advice about getting care from the place where you work, would you ...
    _______Definitely recommend it
    _______Probably recommend it
    _______Probably not recommend it
    _______Definitely not recommend it

  20. Now, we'd like to ask if you agree or disagree with the following statements about your organization. It is important that your confidential responses to these questions be honest and accurate.

      Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
    a. Employees take personal responsibility for their behavior.          
    b.The organizational culture encourages risk-taking.          
    c. The organizational culture encourages continuous improvement.          
    d. Senior management has presented a clear vision of the future of the organization.          
    e. The organization rewards staff for being innovative.          
    f. Management communicates effectively with staff in all levels of the organization.          
    g. Management solicits input from all levels of staff when deciding on purchases related to care delivery.          
    h. Management solicits input from all levels of the organization when deciding on policies and protocols.          
  21. Think about your job right now. Fill in the circle that best indicates how much, if at all, each of the following is a rewarding part of your job. Is it not at all rewarding, somewhat rewarding, very rewarding, or extremely rewarding?

      Does not apply to my job Not at all rewarding Somewhat rewarding Very rewarding Extremely rewarding
    a. Helping others is ...          
    b. Being able to work on your own is ...          
    c. Getting credit for your work is ...          
    d. Finding your work interesting is ...          
    e. Liking your coworkers is ...          
    f. Making a difference in other people's lifes is ...          
    g. Feeling a sense of accomplishment and competence from doing your job is ...          
    h. Having your job fit your skills is ...          
    i. Having the chance to learn new things is ...          
    j. Being valued by supervisors and management is ...          
    k. Being needed by others is ...          
    l. Having the power you need to get your job done without getting permission from someone else is ...          
    m. Having a lot of different things to do is ...          
    n. Getting support from coworkers is ...          
    o. Having your job fit your interests is ...          
    p. The income you earn is ...          
    q. Being valued by residents or clients and their families is ...          
    r. Having the freedom to decide how to do your work is ...          
    s. The team spirit in your work group is ...          
  22. Continue thinking about your job right now. Indicate how much, if at all, each of the following is a problem or concern in your job. Is it not at all a problem, somewhat a problem, a big problem, or an extremely big problem?

      Not at all a problem Somewhat a problem A big problem An extremely big problem
    a. Having too much work to do is ...        
    b. Having to deal with emotionally hard situations is ...        
    c. Not having support from your supervisor in your job is ...        
    d. Finding your job boring or doing too much of the same thing is ...        
    e. Having your job take too much out of you is ...        
    f. Having little chance to get promoted is ...        
    g. Dealing with unrealistic expectations from your supervisor for your work is ...        
    h. Not having the job use your skills is ...        
    i. Catching an illness is ...        
    j. Not having the chance to develop job skills is ...        
    k. Not being valued by your supervisor for your work is ...        
    l. Being on your own too much is ...        
    m. Getting hurt is ...        
    n. The physical conditions (equipment, temperature, smell, etc.) at your job is ...        
    o. Not having enough help when you need it is ...        
    p. That your supervisor is not good at her/his job is ...        
    q. That the job is physically hard is ...        
    r. The time it takes to get to work is ...        
  23. Please indicate the degree to which you agree with the following statements about how you are respected as a part of your organization's health care team (those who provide clinical services) by filling in the appropriate circle.

      Not at all a problem Agree somewhat Agree a great deal
    a. Residents' or clients' families respect me as part of the health care team.      
    b. Residents or clients respect me as part of the health care team.      
    c. Direct care workers respect me as part of the health care team.      
    d. My supervisor respects me as part of the health care team.      
  24. Please indicated the degree to which you agree with the following statements about how you are respected as a part of your organization's management team (those who establish and maintain work-related policies) by filling in the appropriate circle.

      Not at all a problem Agree somewhat Agree a great deal
    a. Residents' or clients' families respect me as part of the management team.      
    b. Residents or clients respect me as part of the management team.      
    c. Direct care workers respect me as part of the management team.      
    d. My supervisor respects me as part of the management team.      
  25. How likely is it that you will leave this job in the next year?
    _______Very likely
    _______Somewhat likely
    _______Not at all likely

  26. How often do you think about quitting?
    _______All of the time
    _______Some of the time
    _______Rarely
    _______Never

  27. Now, we'd like to ask if you agree or disagree with the following statements about your organization in the context of the Better Jobs, Better Care project.

      Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
    a. The Better Jobs, Better Care project is being supported by a senior level executive in your organization.          
    b. All levels of management are committed to the Better Jobs, Better Care project.          
    c. Senior management has clearly articulated the need for the Better Jobs, Better Care project.          
    d. The Better Jobs, Better Care project conflicts with other major activities going on in the organization.          
    e. The programs that are part of the Better Jobs, Better Care project have been well executed.          
    f. The Better Jobs, Better Care project's overall impact on this organization will be positive.          
  28. What is the single most important thing your employer could do to improve the job of direct care workers? _________________________

  29. What is the single most important thing your employer could do to improve your ability to do your job as a supervisor of direct care workers? _________________________

  30. In your current job with this employer, what is your hourly wage? $_______ per hour

  31. Do you receive health insurance through this employer?
    _______Yes, I receive health insurance through my employer.
    _______My employer offers health insurance to me, but I am not enrolled.
    _______My employer does not offer health insurance to me.

  32. What is your gender?
    _______Male
    _______Female

  33. What is your age?
    _______Less than 25 years old
    _______25-34
    _______35-44
    _______45-54
    _______55-64
    _______65 or older

  34. Did you earn a high school diploma or GED?
    _______No
    _______Yes ––>

    34a. If yes, what is your highest level of education?
       _______High School or GED
       _______Some college/trade school
       _______College graduate or post-college
  35. Are you a nurse?
    _______No
    _______Yes ––>

    35a. If yes, are you a ...
       _______LPN
       _______RN
       _______Diploma RN
       _______BSN
       _______MSN
       _______Advanced Practice Nurse
  36. Are you of Hispanic or Latino origin?
    _______No
    _______Yes

  37. Please indicate your race. (Please select one or more)
    _______American Indian or Alaska Native
    _______Asian
    _______Black or African American
    _______Native Hawaiian or Other Pacific Islander
    _______White


APPENDIX D: Research Domains and Associated Survey Items

Domain Supervisor Survey Item
Background information How long have you worked as a supervisor of direct care workers?
Have you ever worked as a direct care worker?
How long have you worked for this employer?
How long have you worked as a supervisor for this employer?
How many direct care workers do you typically supervise?
Do any direct care worker supervisors report to you?
DCW supervisor responsibilities Act as a mentor to direct care workers.
Ensure that direct care workers are given proper care to clients/residents.
Interview direct care worker applicants.
Schedule direct care workers.
Provide feedback to direct care workers on job performance.
Document direct care worker performance problems.
Initiate disciplinary action.
Recommend training for direct care workers.
Conduct on-the-job clinical training activities.
Directly respond to client/resident complaints about direct care worker performance.
Directly respond to job concerns raised by direct care workers.
Competence I have learned the skills necessary to do my job well.
I have the opportunity to work in teams.
I am confident in my ability to do my job.
I could get a job that paid more than this job.
Satisfaction Overall, how satisfied are you with your job?
Training During the past year, did you receive any formal training on communicating effectively with other employees.
During the past year, did you receive any formal training on communicating effectively with patients/residents/clients.
During the past year, did you receive any formal training on diversity or cultural issues.
During the past year, did you receive any formal training on effective disciplinary procedures.
During the past year, did you receive any formal training on skills for managing people.
Management practices How often are the following management practices used for the direct care workers you supervise …
  • Permanent assignment to patients/residents/clients.
  • Rotation of assignments to different services or units.
  • Cross-training.
  • Self-managed work groups that include direct care workers.
  • Flex time for direct care workers.
What mechanisms are used in your organization to handle employee concerns?
What approaches are used to handle poor performance or negative behaviors are your organization?
DCW information How often do direct care workers in your organization … Have input into changes in patient/resident care plans.
How often do direct care workers in your organization … Actively participate in developing patient/resident/client care plans.
How often do direct care workers in your organization … Write in patient/ resident/client care plans.
How often do direct care workers in your organization … Communicate in writing with other direct care workers to relay information about residents/ patients/clients.
How often do direct care workers in your organization … Communicate verbally with other direct care workers to relay information about residents/ patients/clients.
How often do direct care workers in your organization … Communicate information either in writing or verbally about residents/patients/clients by reporting to their supervisors.
How often do direct care workers in your organization … Meet formally or informally with a supervisor to discuss patient/resident/client care issues.
How often do direct care workers in your organization … Receive verbal feedback about their everyday job performance.
How often do direct care workers in your organization … Receive written feedback about their job performance.
Estimate the overall competence level of direct care workers you supervise.
During the past year, approximately what percentage of the direct care workers you supervise … Currently participate in a career ladder program for the DCW to advance to a higher level of DCW worker.
During the past year, approximately what percentage of the direct care workers you supervise … Currently participate in a career ladder program for the DCW to become a LPN.
During the past year, approximately what percentage of the direct care workers you supervise … Currently have a designated peer mentor.
During the past year, approximately what percentage of the direct care workers you supervise … Participate in formal inservice programs beyond those required for certification.
During the past year, approximately what percentage of the direct care workers you supervise … Have completed a self-directional educational video or computer-based training program while at work.
During the past year, approximately what percentage of the direct care workers you supervise … Have attended a conference or workshop away from work.
During the past year, approximately what percentage of the direct care workers you supervise … Received formal training on communicating effectively with other employees.
During the past year, approximately what percentage of the direct care workers you supervise … Received formal training on communicating effectively with patients/residents/clients.
During the past year, approximately what percentage of the direct care workers you supervise … Received formal training on diversity issues.
Perception of quality Would you recommend taking a job as a direct care worker at the place where you work?
Would you recommend getting care from the place where you work?
Perceptions of organizational culture Employees take personal responsibility for their behavior.
The organizational culture encourages risk-taking.
The organizational culture encourages continuous improvement.
Senior management has presented a clear vision of the future of the organization.
The organization rewards staff for being innovative.
Management communicates effectively with staff in all levels of the organization.
Management solicits input from all levels of staff when deciding on purchases related to care delivery.
Management solicits input from all levels of the organization when deciding on policies and protocols.
Job rewards How rewarding is … Helping others.
How rewarding is … Being able to work on your own.
How rewarding is … Getting credit for your work.
How rewarding is … Finding your work interesting.
How rewarding is … Liking your coworkers.
How rewarding is … Making a difference in other people’s lives.
How rewarding is … Feeling a sense of accomplishment and competence from doing your job.
How rewarding is … Having your job fit your skills.
How rewarding is … Having the chance to learn new things.
How rewarding is … Being valued by supervisors and management.
How rewarding is … Being needed by others.
How rewarding is … Having the power you need to get your job done without getting permission from someone else.
How rewarding is … Having a lot of different things to do.
How rewarding is … Getting support from coworkers.
How rewarding is … Having your job fit your interests.
How rewarding is … The income you earn.
How rewarding is … Being valued by residents or clients and their families.
How rewarding is … Having the freedom to decide how to do your work.
How rewarding is … The team spirit in your work group.
Job concerns How much of a problem is … Having too much work to do.
How much of a problem is … Having to deal with emotionally hard situations.
How much of a problem is … Not having support from your supervisor.
How much of a problem is … Finding your job boring or doing too much of the same thing.
How much of a problem is … Having your job take too much out of you.
How much of a problem is … Having little chance to get promoted.
How much of a problem is … Dealing with unrealistic expectations from your supervisor for your work.
How much of a problem is … Not having the job use your skills.
How much of a problem is … Catching an illness.
How much of a problem is … Not having the chance to develop job skills.
How much of a problem is … Not being valued by your supervisor for your work.
How much of a problem is … Being on your own too much.
How much of a problem is … Getting hurt.
How much of a problem are … The physical conditions at your job.
How much of a problem is … Not having enough help when you need it.
How much of a problem is … Your supervisor not being good at her/his job.
How much of a problem is … The job being physically hard.
How much of a problem is … The time it takes to get to work.
Respect Do you agree that … Resident’s or client’s families respect you as part of the health care team.
Do you agree that … Residents or clients respect you as part of the health care team.
Do you agree that … Direct care workers respect you as part of the health care team.
Do you agree that … Your supervisor respects you as part of the health care team.
Do you agree that … Resident’s or client’s families respect you as part of the management team.
Do you agree that … Residents or clients respect you as part of the management team.
Do you agree that … Direct care workers respect you as part of the management team.
Do you agree that … Your supervisor requests you as part of the management team.
Intent to leave How likely is it that you will leave your job in the next year?
How often do you think about quitting?
BJBC perceptions The BJBC project is being supported by a senior level executive in your organization.
All levels of management are committed to the BJBC project.
Senior management has clearly articulated the need for the BJBC project.
The BJBC project conflicts with other major activities going on in the organization.
The programs that are part of the BJBC project have been well executed.
The BJBC project’s overall impact on this organization will be positive.
Job improvements What is the single most important thing your employer could do to improve the job of direct care workers?
What is the single most important thing your employer could do to improve your ability to do your job as a supervisor of direct care workers?
Other employment information In your current job with this employer, what is your hourly wage?
Do you receive health insurance through this employer?
Do you currently work for pay at another job as a supervisor of direct care workers?
Socio-demographics What is your age?
Did you earn a high school diploma or GED?
What is your highest level of education?
Are you a nurse?
If you are a nurse, what kind?
Are you of Hispanic/Latino descent?
What is your race/ethnicity?