This study explores motivations, job satisfaction, and overall perceived occupational mobility for African immigrants working in low-wage direct health care occupations. The study uses qualitative semi-structured interviews with a sample of thirty African immigrant workers in the greater Pittsburgh metropolitan area. Results show that four major themes captured the motivations of interviewees for doing direct care work: passion for care work, quick money, easily obtained employment, and direct care work as a pathway to other health occupations. The majority of the interviewees were satisfied with their jobs, yet almost all of them saw their occupations as temporary or transitional employment. Most of the interviewees also saw their jobs as lacking occupational mobility. In light of the increased national demand for direct care workers, the growing numbers of immigrants in the direct care labor force, and the high turnover and low retention rates of direct care workers overall, the study suggests that more must be done to make direct care work attractive and rewarding for African immigrant workers.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
Bureau of Labor Statistics. Occupational Outlook Handbook 2012–13.
Khatutsky G, Wiener J, Anderson W, Akhmerova V, Jessup EA, Squillace M. Understanding direct care workers. Washington, DC: U.S. Department of Health and Human Services; 2011.
US Census Bureau. Current Population Survey, March 2014 supplement.
Stone R. The direct care worker: the third rail of home care policy. Annu Rev Public Health. 2004;25:521–37.
Mittal V, Rosen J, Leana C. A dual-driver model of retention and turnover in the direct care workforce. Gerontologist. 2009;49(5):623–34.
American Health Care Association. Report of findings, 2007 AHCA Survey, nursing staff vacancy and turnover in nursing facilities; 2008.
Paraprofessional Healthcare Institute. Workforce Strategies No. 3; 2005. http://phinational.org/research-reports/role-training-improving-recruitment-and-retention-direct-care-workers-long-term.
US Census Bureau: Poverty Thresholds 2014.
Bureau of Labor Statistics. National occupational employment and wage estimates. 2014.
Committee on the Future Health Care Workforce for Older Americans, Institute of Medicine: Retooling for an Aging America. Building the health care workforce. Washington, DC: National Academies Press; 2008.
Chou R, Robert S. Workplace support, role overload, and job satisfaction of direct care workers in assisted living. J Health Soc Behav. 2008;49(2):208–22.
Chou R. Resident-centered job satisfaction and turnover intent among direct care workers in assisted living: a mixed-methods study. Res Aging. 2012;34(3):337–64.
Barry TT, Brannon D, Mor V. Nurse aide empowerment strategies and staff stability: effects on nursing home resident outcomes. Gerontologist. 2005;45(3):309–17.
Bowers BJ, Esmond S, Jacobson N. The relationship between staffing and quality in long-term care facilities: exploring the views of nurse aides. J Nurs Care Qual. 2000;14(4):55–64.
McCabe K. US in focus: foreign-born health care workers in the United States. Migration Information Source: Migration Policy Institute; 2012.
Lowell B, Martin S, Stone R. Ageing and care giving in the United States: policy contexts and the immigrant workforce. J Popul Ageing. 2010;3(1–2):59–82.
Elo IT, Frankenberg E, Gansey R, Thomas D. Africans in the labor market. Demography. 2015;52:1513–42.
Hurtado DA, Sabbath EL, Ertel KA, Buxton OM, Berkman LF. Racial disparities in job strain among American and immigrant long-term care workers. Int Nurs Rev. 2012;59:237–44.
Creese G, Wiebe Brandy. ‘Survival employment’: gender and deskilling among African immigrants in Canada. Int Migr. 2009;50(5):56–76.
Dovlo D. Migration of nurses from Sub-Saharan Africa: a review of issues and challenges. Health Serv Res. 2007;42(3):1373–88.
Johnson J. Stopping Africa’s medical brain drain: the rich countries of the north must stop looting doctors and nurses from developing countries. BMJ (Clin Res Ed). 2005;331(7507):2–3.
Showers F: Nursing the nation: globalization, gender, race, state and African immigrant women in health care work in the United States of America. Dissertation. Syracuse University; 2013.
American Community Survey. 2013 one-year estimates.
Bernard R. Social research methods: qualitative and quantitative approaches. Thousand Oaks: Sage; 2012.
Thomas K. Racial and ethnic disparities in education-occupation mismatch status among immigrants in South Africa and the United States. Int Migr Integr. 2010;11:383–401.
CDC. National Center for Health Statistics: National Nursing Assistant Survey, 2004–2005, Table 2.
This study was funded by a 2013–2014 Small Grant from the Center for Poverty Research at the University of California, Davis.
Rights and permissions
About this article
Cite this article
Covington-Ward, Y. African Immigrants in Low-Wage Direct Health Care: Motivations, Job Satisfaction, and Occupational Mobility. J Immigrant Minority Health 19, 709–715 (2017). https://doi.org/10.1007/s10903-016-0400-8
- Direct care
- Nursing aides
- Home health aides