Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)




Dr. Margaret Black


The purpose of this case study was to describe registered nurses' experiences of working with the cognitively impaired elderly in three nursing homes in Southern Ontario. Interviews were conducted with registered nurses, the Directors of Care and the Educators at each of the nursing homes. A semi-structured questionnaire was used was used to elicit information regarding the nurses' choice to work in a nursing home, the nurses' experiences working with the cognitively impaired elderly, and factors that contribute to job satisfaction, dissatisfaction and commitment to remain working at the nursing home. Information was also collected from the nursing home database on turnover rates, absenteeism rates, RN salary scales and the number of educational sessions provided annually by the nursing homes. Thematic coding was used to identify themes within each case (registered nurse). A cross case analysis was conducted to determine relationships and explanations across the cases. A sub case analysis was also carried out, to identify patterns and themes present across the three nursing homes. Two major findings emerged from this study. The first finding was that registered nurses chose to work in a nursing home primarily as a 'job of convenience', i.e., no other positions in nursing were available in their desired geographical area; or they needed to find part-time work in their immediate geographical area in order to supplement their income. However, characteristics of the organizational environment played a major role in their remaining. Those characteristics were: a 'supportive environment' that included provision of opportunities for professional development, the presence of supportive colleagues, and flexible work scheduling practices. The second finding was the importance that the nurses placed on the caring relationship with the residents at the nursing home. All of the RNs described the enjoyment and the satisfaction that they obtained when caring for these residents. The primacy of 'caring' occurred even in the presence of some adverse characteristics of the work environment. The opportunity for 'caring' also influenced the nurses' choice to remain at the nursing home.

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Nursing Commons