Significance: Certified nursing assistants (CNAs) provide direct care to those who live in long-term care facilities. As the population ages, the need for CNAs has grown. Nurse researchers have studied turnover and occupational stress, but no studies have examined racial/ethnic differences in CNA stress in East Texas.

Design / Purpose Statement: A convergent parallel mixed methods study was planned to address occupational stress experienced by CNAs in East Texas long-term care facilities. The Work Stress Scale and demographic questions were used to compare levels of reported occupational stress between racially diverse CNAs. However, lack of response to interview invitations necessitated a change to a cross-sectional quantitative study.

Theory: The Demand-Control Model of Occupational Stress was the basis for the research.

Methods: A convenience sample of CNAs (n = 140) was recruited from multiple long-term care facilities. Results from the Work Stress Scale were analyzed to determine levels of occupational stress. A hierarchical binary logistic regression model was used to analyze relationships between demographic variables, diversity climate, and occupational stress.

Findings: In bivariate analysis, occupational stress was related to CNA race. However, at the multivariate level, race was no longer significant, but occupational stress was significantly related to participant age, gender, and higher scores on the Diversity Climate Scale.

Conclusion: These findings show the need for continued research to explain CNA occupational stress. A qualitative or mixed methods study could potentially explain the problem further.

Date of publication


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Committee members

Beth Mastel-Smith, PhD, RN; Danice Greer, PhD, RN; Bonnie Rogers, PhD, RN


Doctor of Philosophy in Nursing

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Nursing Commons