The Dual Effect of Work-to-Family and Family-to-Work Stressors on Interpersonal Conflict, Burnout, and Intention to Quit Among Providers in Extended Care Facilities

Background/Purpose: Service providers in chronic or long-term care settings are primarily women who identify as single, of low-income, and predominantly serving persons living with disabilities or seniors. Unique features of long-term care settings include physically demanding schedules and the necessity for providers to be physically present with interdependent roles that limit remote or facilitative workplace policies that could grant them more flexibility. Supportive work environments make it easier for providers to discharge their duties while balancing the needs of their family or home life. When stressors or work conditions spill over to affect family life and vice versa, both segments of the provider’s life suffer, affecting well-being and performance. This study examined the paths between workplace/family factors to provider wellbeing and career decisions.

Methods: Data was obtained from the Work Family and Health Study, focusing on eligible employees of extended-care facilities. Latent construct (work factors) comprised scales including control over work time, psychological job demands, work-to-family conflict, family-to-work conflict, non-supportive supervisor practices, non-specific psychological distress, and perceived stress. Another latent construct (outcome factors) comprised scales of items: interpersonal conflict, burnout, and intention to quit. We used exploratory and confirmatory factor analysis and structural equation modeling to test models based on a priori information about the data structure and link concepts of the hypothesis that certain latent variables underlying workplace situations affect employee well-being.

Results: The final sample was n=4,588, 87% female. There were high correlation coefficients among the items, for instance, psychological distress and perceived stress (.68.), family-to-work and work-to-family conflict (.42). Both latent constructs coefficient (0.91) was statistically significant, illustrating how work factors (e.g. stress, control) affect employees and the workplace outcomes (such as intention to quit or emotional exhaustion). Although this correlation does not say much about the direction of influence between these constructs, there is little concern that the relationship is spurious.

Following modifications, the chi²(33) = 977.04, p<0.001, suggests the model fails significantly to account for the information in the observed covariance matrix. The fit statistics, RMSEA was 0.079, less than 0.08, SRMR = 0.049, and CFI = 0.90, indicate the model fits the data well. Modification indices on the measurement loadings present the biggest modification index as 39.72 for Work outcomes ->intention to quit and psychological job demands (195.83) for Work factors.

Implications: The study highlights the contributions of different work factors to provider well-being and the subsequent paths to different outcomes. It was significant to note that the intention to quit was low despite stressors and burnout, indicating either the need for income or commitment to work. More studies are needed to understand how these factors interact to influence outcomes. This study is significant as it highlights the unique direct and indirect effects of different factors and reinforces the need for underlying workplace practices and policies that affect providers' work, family life, health outcomes, and the choices providers make even when they are detrimental to their well-being.