Organizational Power, Work Design, and Burnout Among Certified Nurse Aides in Long-Term Care

• In Event: Aging and the Life Course Section Roundtables
  In Refereed Roundtable (90 minute): 13: Institutional Care Arrangements and Experiences

Abstract

Long-term care facilities in the United States are experiencing persistent workforce instability marked by high turnover, chronic understaffing, and emotional strain among frontline workers. Certified Nurse Aides, who provide the majority of direct resident care in nursing homes, occupy structurally marginalized positions within hierarchical healthcare organizations. This dissertation examines how organizational power and work design conditions shape emotional exhaustion, retention intentions, and absenteeism among CNAs. Drawing on Weberian theories of bureaucratic authority, Foucauldian concepts of disciplinary power, and structural empowerment theory, the study conceptualizes burnout as a structural outcome embedded in institutional arrangements rather than an individual-level deficit. Using a cross-sectional survey of CNAs employed in North Texas nursing homes, this research develops and tests the “Organizational Production of Exhaustion” model. The model posits that organizational characteristics including staffing adequacy, supervisory support, work design, and structural empowerment shape psychosocial working conditions that predict emotional exhaustion. Emotional exhaustion, in turn, influences turnover intentions and absenteeism, two key indicators of workforce instability. The analysis further examines immigration status, job precarity, and work–family conflict as moderating factors that may intensify the effects of organizational conditions on workforce outcomes.
The dissertation advances medical sociology by integrating organizational power, labor stratification, and psychosocial work conditions into a unified framework of healthcare workforce instability. Empirically, it centers CNAs, an essential yet understudied group in long-term care. The findings contribute to theoretical debates on power and inequality in healthcare organizations and offer policy-relevant insights for improving retention, strengthening workplace conditions, and enhancing continuity of care in nursing homes.

Author

• Momna Rani, University of North Texas