Jobs or Careers?: Mobility among Low-Wage Workers in Healthcare Organizations

Frontline healthcare workers constitute over half of the U.S. healthcare workforce and provide the majority of direct care services for patients. While frontline healthcare workers are employed across all healthcare settings and perform a variety of tasks (e.g., direct care, administrative, and entry-level job tasks), these workers face many of the same challenges in their jobs and careers, including low wages, few opportunities for advancement, and few resources for managing work/family conflicts. In my dissertation I have two primary aims: (1) to examine how health care organizations are improving frontline worker jobs by creating career ladders for frontline workers, and (2) to examine frontline worker wage growth and career mobility using a nationally representative sample. To achieve Aim 1, I qualitatively and quantitatively examined the impact of policies and practices related to career advancement implemented by 23 health care organizations. I found that practices such as tuition remission, educational release time, and organizational support for education and training improved workers' perceptions of their career potential. To address Aim 2, I used the Study of Income and Program Participation (SIPP) to examine wage growth among frontline healthcare workers and found that wage mobility among these workers is relatively low. While many researchers have noted the potential of hospitals and other healthcare organizations to help low-wage workers advance their careers, effective career ladders in the United States do not appear to be widespread, especially in comparison to other developed countries. However, growing demand for healthcare (and workers) and a growing emphasis on quality of care may motivate organizations to improve worker recruitment, retention, and skills through education, training, and career advancement.