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J Am Geriatr Soc. 2010 Apr;58(4):731-7. doi: 10.1111/j.1532-5415.2010.02781.x.

Immigrant status and intention to leave of nursing assistants in U.S. nursing homes.

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Cecil G. Sheps Center for Health Services Research, Chapel Hill, North Carolina, USA.



To better understand the characteristics and perceptions of immigrants working as nursing assistants in U.S. nursing homes and to determine whether immigrant status is linked to job turnover.


Analysis of interview data from a nationally representative sample of nursing assistants working in U.S. nursing homes.


Five hundred eighty-two nursing homes included in the 2004 National Nursing Assistant Survey.


Two thousand eight hundred eighty-one nursing assistants.


Proportion of respondents who were non-U.S. born or naturalized citizens and relationship between these characteristics and measures of job satisfaction and intention to leave within the subsequent year.


Fourteen percent (13.9%) of nursing assistants employed in U.S. nursing homes were immigrants. Immigrants tended to be better educated; more often male, nonwhite, and Hispanic; and concentrated in large, urban facilities than nonimmigrants. They reported feeling less respected by residents and families but not less respected by supervisors, and they were more likely to report intention to leave the job within 1 year. In multivariate analyses, demographic factors, length of time on the job, and noncitizen status were independently associated with plans to leave within a year.


Attention to the unique factors associated with immigrant status, such as the need to improve communication and garner respect from patients and families, can assist policy-makers, facility administrators, and medical directors in more effectively attracting, training, and supporting this growing segment of the nursing assistant labor pool.

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