This study explores the link between management characteristics of home care agencies and the involvement of informal caregivers in caregiving. Based on a study of policy documents of two agencies and semi-structured interviews with five team managers and 31 formal caregivers, we conclude that, although the importance of involving informal caregivers is emphasized in official documentation, actual contact with informal caregivers is often lacking. Comparison of the work processes of the two agencies shows that contact with informal caregivers and their potential involvement are enhanced by smaller teams, less task division, and clarity about the responsibilities of formal caregivers.
The present study develops our understanding of the micro-level dynamics of decoupling by addressing how and why various occupational groups, that is, managers and professionals, are involved in decoupling in response to institutional complexity. Our conceptualization of occupational groups' involvement in decoupling emerges from an in-depth qualitative study * This chapter is based on:
Members of frontline low-status occupational groups often have access to a vast pool of knowledge, expertise, and experience that may be valuable for organizations. However, previous research has shown that members of these occupational groups are often reluctant to exhibit voice behavior due to their low position in the organizational hierarchy and perceived status differences. Drawing on in-depth interviews with auxiliary nurses (ANs) who participated in a development trajectory, as well as with their colleagues and supervisors, we demonstrate how members of this low-status occupational group develop voice behavior. Our findings show how acquiring three different types of knowledge and acting on this knowledge can lead to forming new and different types of relationships with members of higher status occupational groups in the organization. Subsequently, these relational changes enhanced voice behavior, as the ANs under study became more skillful in navigating the organization and felt better equipped to share their ideas, concerns, and perspective. We contribute to the literature on voice behavior by members of low-status occupational groups by moving beyond the findings of previous studies that have shown that low-status employees are unlikely to exhibit voice behavior. We detail how the development of knowledge, as well as relationships between different occupational groups, is crucial for the enhancement of voice behavior that transcends hierarchical levels. Moreover, we add to the literature on upward influence of subordinates by showing how such voice allows subordinates to exert upward influence in their organizations and initiate change that benefits their own occupational group.
Aims
To identify crucial programme characteristics and group mechanisms of, and lessons learned from hindrances in an empowerment programme for certified nursing assistants and contribute to the development of similar programmes in other care settings.
Design
Exploratory qualitative study.
Methods
Between May 2017 and September 2020, we used in‐depth interviews and participant observations to study four groups participating in an empowerment programme for certified nursing assistants (N = 44).
Results
We identified three crucial empowerment‐enhancing programme characteristics: (1) inviting participants to move outside their comfort zone of caregiving; (2) stimulating the use of untapped talents, competencies and interests; (3) supporting the rediscovery of participants' occupational role and worth. Crucial group mechanisms encompassed learning from and with each other, as well as mechanisms of self‐correction and self‐motivation. Hindrances included a perceived lack of direction, and a lack of organizational support and facilitation.
Conclusion
We showed the significance of creating an inviting and stimulating environment in which participants can explore and function in ways they otherwise would not. Likewise, we identified how this can help participants learn from, critically correct and motivate one another.
Impact
The programme under study was uniquely aimed to empower certified nursing assistants. Our insights on crucial programme characteristics and group mechanisms may benefit those who develop empowerment programmes, but also policymakers and managers in supporting certified nursing assistants and other nursing professions in empowerment endeavours. Such empowerment may enhance employee retention and make occupational members more likely to address challenges affecting their occupational group and the long‐term care sector.
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