First-Line Managers’ Perceptions of Their Psychosocial Work Environment in Nursing Homes: A Qualitative Analysis of the Influence of Ownership Type

Abstract

In the wake of welfare sector reforms and the increasing marketisation of eldercare services, nursing home first-line managers (FLMs) are confronted with escalating work demands within streamlined organisations. Given this background, the aim was to investigate FLMs’ perceptions of their psychosocial work environment and of differences between nursing home ownership types. Nineteen managers from three Swedish municipalities from municipal, outsourced, and private nursing homes participated in semi-structured interviews focused on job demands, job resources, and ownership differences. The FLMs’ perceptions were interpreted as forming two themes. Navigating challenges: striving to cope with demands highlighted various challenges, including recruitment, workload, and lack of organisational support. Key stressors encompassed personnel struggles, time constraints, and complex interactions. Influence of ownership dynamics on the work environment explored variation across ownership types. Private nursing home managers enjoyed more decision-making autonomy but faced more scrutiny than did municipal ones. FLMs in outsourced homes described unique stressors, notably uncertainty and increased workload due to the procurement process. These findings underscore the potential need for tailored systemic changes across different ownership types. The policy implications include enhancing communication and support in municipal homes, reducing the span of control in private homes, and revising the procurement process in outsourced homes. These insights suggest that further research outlining differences between ownership types, particularly private and outsourced nursing homes, is warranted. Such research could aid in formulating specific strategies tailored to each ownership type in order to enhance the psychosocial work environment for FLMs in nursing homes.