Effects of Emotional Labor and Job Stress on the Intention to Turnover of Nursing Care Workers in Nursing Homes in China

Kong Chen ,Gi-Yong Jung

（1.Business Management Major,Sehan University,Dangjin 31746；2.Business Management Major,Sehan University,Mokpo 58447）

Abstract：This study aims to prevent the intention of caregivers to change their jobs due to emotional labor and to improve the quality of service of skilled workers by reducing turnover rate.To this end,research models and hypotheses were established based on previous research and the Stress Strain Outcome (SSO) model of Koeske and Koeske (2000).In order to conduct an empirical research,883 nursing care workers at welfare-nature nursing homes in China were involved.The major findings of this study are as follows.First,emotional labor of caregivers has been identified as having a direct effect on their turnover intentions.Second,emotional labor has been found to have a direct static effect on job stress.Thirdly,job stress has a static effect on turnover intentions.

Key words:Job stress;Nursing care workers;Nursing homes;Turnover intention

Around the world,the turnover rates of long-term care workers,such as social workers,nurses,and caregivers working in longterm care institutions,are generally at 20 to 30 percent every year,with the highest turnover rate estimated at more than 47.5 percent.Data show that in 2000,the population aged 65 and above in China reached 88.11 million,and the population aged 60 and above reached 130 million,accounting for 7% and 10% of the total population respectively,which has reached the standard set by the United Nations as an aging society,and the total number and growth rate of China's aging population have been increasing.First,the proportion of the elderly population has been increasing year by year.In 2017,population aged 60 or above in China reached 241 million,accounting for 17.3 percent of the total population.In 2018,the number of people aged 60 or above reached 249 million,an increase of 0.6 percent.By the end of 2019,population aged 60 or above in China was 254 million,accounting for 18.1 percent of the total population.Second,the total number of elderly people in China has increased substantially.The size of the elderly population in China surges from about 140 million in 2015 to 240 million in 2030 and 365 million in 2050.It is expected to reach the peak in 2055-2060,when aging growth rate of China will rank first in the world,accounting for about 20% of the total elderly population in the world.That is to say,In the next 20 to 40 years,the elderly in China will account for 1/4 to 1/5 of the total population in China and the world,which will reach about 100 million,and the elderly who live in empty nests or live alone at home will account for more than half of the total population in China.Third,the total size of the elderly population is expanding and the increment is accelerating,and so does the burden of social old-age security .

The high turnover rate of caregivers results in a decline in the quality of care services,such as blocking the continuity of services,hindering the provision of professional services tailored to individual characteristics of the elderly,and increasing emotional anxiety in theprocess of interaction with caregivers.The purpose of this study is to analyze and verify the impact of emotional labor and job stress on turnover intentionof nursing caregivers at nursing homes for the elderly.

Hochschild (1983) Emotional labor is generally referred to as‘emotional labor' when one has to make necessary facial expressions and gestures according to the rules required by the organization,regardless of the actual emotions one wants to express in an effort to control one's emotions.

Price (1977) defined turnover as a concept that includes all movements within the organization,including“all acts of leaving the organization as well as entering the organization”.Mobley (1982)defines this as“the termination of an individual’s qualifications as a member within an organization”and limits the qualifications of the membership to distinguish between movement and turnover within the organization.The SSO model by Koeske ＆ Koeske (1991)is suitable for human service workers who work primarily on people or relationships,focusing on how stress causes tension,and what outcome variables this eventually leads to (Koeske ＆ Koeske,2000).

Subject of this research:From June 1,2022 to July 31,2020,In-service nursing staff of welfare pension institutions in China were randomly sampled 1000 questionnaires,and among which 117 questionnaires were invalid.Cronbach's ɑ .883.

1 Characteristics of the Study Subjects

As shown in the table,555 women (62.9%),women aged 40 or older 637(72.1%),and 531 people (86.01%) graduated from high school or below.The total experience of long-term care institutions for senior citizens was 336 people (38.3%) in less than one to three years,and contract workers 387 (43.8%) in employment types.

2 Characteristics of Study Variables

The results of technical analysis of emotional labor,job stress,and turnover intention of caregivers are shown in Table 1.The mean value of emotional labor,an independent variable,was 3.04 (SD=.564),the mean value of job stress was 2.87 (SD=.684),and the mean value of turnover intention,a dependent variable,was 3.58 (SD=.611).

Table 1 Demographic Characteristics（N＝883）

Table 2 Characteristics of Major Variables(N=883)

Table 3 Correlations among Major Variables (N=883)

3 Relationships between Strangers

Table 3 presents a correlation analysis between emotional labor,job stress and turnover intentions of caregivers.Emotional labor and turnover intentions of caregivers were shown to be statically correlated(r=0.802,p<0.001),job stress and turnover were shown to be statically correlated (r=0.834,p<0.001),and emotional labor and job stress were shown to be statically correlated (r=0.882,p<0.001).

This study was conducted to study the influence of variables on the intention of caregivers working in long-term care institutions for the elderly.

Long-term care services are not easy to standardize like stereotyped expression rules such as kindness and smile because they expect sincere attention and emotional support like family members in caring.Nevertheless,a standardized manual of expression rules should be established for the management of emotional labor of caregivers.If individual caregivers are left to handle emotional labor just because it is difficult to standardize,the level of emotional labor will become more severe,resulting in negative consequences such as large turnover rates.If standardized rules of expression are set,the emotional behavior of caregivers and unnecessary emotional consumption will be reduced,which can eventually reduce the level of emotional labor.

In order to reduce job stress for caregivers,staffing standards should be readjusted according to realistic job analysis.Although there is a lack of systematic and standardized standards for the role of caregivers in the organization,nursing care providers’ training courses and standard textbooks clearly state it.Nevertheless,the fact that role conflicts,role ambiguity,and various factors are affecting the intention to change jobs,which is a result of the lack of proper job analysis of caregivers.

The issue of low level of social awareness and professionalism of caregivers is still prominent.In particular,the lack of skilled personnel due to frequent turnover of caregivers makes quality professional care difficult.Institutional support and professional trainingcan greatly prevent the leaving of skilled and specialized caregivers,which are also urgent tasks.