Table 2: Characteristics of included studies.

First author, journal (year) Study design Location/sample/subjects Data collection methodExplanatory variables studied (individual variables)Job satisfaction instrument Quality
Job satisfaction measure(s)ReliabilityValidity

Quantitative studies (n = 37)

Albanese [46], Thesis
(1995)
Cross-sectional (single group)Country: USA 
Sample size:  n = 255  
Subjects: CNAs employed in 14 residential care facilities
QuestionnaireSocial organizational variables: 
number of beds, occupancy rate, immediate supervisor status, NA employment status, CNA overtime hours, NA night shift, nursing director length of employment, nursing director professional membership, administrator education, proportion of Medicaid residents, proportion of Medicare residents, number of children living with NA, CNA satisfaction with religious life 
Work role relations variables: 
positive and negative resident relations, positive and negative supervisor relations, positive and negative visitor relations 
CNA job stress
Quinn and Staines Job Satisfaction Scale = 0.76Not reportedWeak

Allensworth-Davies [47],  
Health Care Management Review
(2007)
Cross-sectional survey (single group)Country: USA.
Sample size:  n = 135  
Subjects: NAs at 4 new England’s residential care facilities
Questionnaire(i) Workplace cultural competency 
(ii) Age 
(iii) Racioethnicity 
(iv) Autonomy
General satisfaction scale from the Job Diagnostics Survey (5 items)Not reportedNot reportedWeak

Berg [48],
Scandinavian Journal of Rehabilitation Medicine (1976)
Cross-sectional survey (single group)Country: Sweden 
Sample size:  n = 233  
Subjects: CNAs in one geriatric LTC hospital (20 wards)
Questionnaire(i) Determinants for the mean scores of the seven scales (one of them “satisfaction with the work itself”): age, length of employment, and training course passed yes/no 
(ii) Determinants for the overall JS question (the seven questionnaire scales): (1) satisfaction with the work itself, (2) perceived strain, (3) adjustment to geriatric work, (4) relation with colleagues and supervisors, (5) perceived need for info., (6) perceived demand for physical and psychic strength, and (7) perceived need for education
53 items (7 scales) in the entire questionnaire; 4 items in one scale were related to JSNot reportedNot reportedWeak

Blackmon [49], Thesis
(1993)
Before-and-afterCountry: USA.
Sample size:  n = 188  
(sample size reduced to 88 in regression due to application of the listwise procedure) 
Subjects: CNAs (number of residential care facilities not reported)
Questionnaire(i) Intervention: training 
(ii) Regression: tested knowledge of how to perform care tasks, perceived knowledge of how to perform care tasks, sex, age, education, length of employment, race, and degree of religiosity
Each of the 3 items were borrowed from the JS scale developed by Kahn (1964) [50]Not reportedNot reportedWeak

Braun [51],
Journal of Elder Abuse and Neglect (1997)
Before-and-afterCountry: USA 
Sample size:  n = 105  
Subjects: CNAs (number of NHs not reported)
Questionnaire Elder abuse and neglect prevention training (locally developed program consisting of videos, booklet, and interactive workshop)Asked to rate their level of JS on a scale from 1 to 10Not reportedNot reportedWeak

Burgio [52],
The Gerontologist (2004)
Cross sectional (between groups quasi-comparison design)Country: USA 
Sample size:  n = 178 
Subjects: CNAs from 4 NHs
(i) Direct structured observation 
(ii) Structured questionnaires 
(iii)Analysis of resident records
(i) Permanent versus rotating shift assignment 
(ii) Isolated and combined effects of work shift
Job Satisfaction Index (JSI) = 0.69–0.89 in a previous studyNot reportedLow moderate

Choi [53],  
Research in Nursing and Health
(2012)
Secondary analysis of cross-sectional survey data Country: USA 
Sample size:  n = 2,254 
Subjects: CNAs within 516 NHs
Computer-assisted telephone interviewing (CATI) system where interviewers asked questions over the telephone 
(Data from the existing National Nursing Assistant Survey and National Nursing Home Survey)
Fixed effects work-related factors  
Level 1 (individual CNA) Supportive supervision, perception of being valued, work-related injury, hourly wage, employee benefits, health insurance 
Level 2 (residential care facilities) 
Bed sizes, for-profit/nonprofit, location (metropolitan, micropolitan, rural), percent of Medicare residents, percent of Medicaid residents, RN HPPD, LPN HPPD, CNA HPPD  
Personal factors
Age (years), white/nonwhite, education level (high school or less), number of jobs in the past 5 years (0–5+)
A single-item measure for an overall measure of JS. The item was scored using a 4-point Likert-type scale, ranging from 1 (extremely dissatisfied) to 4 (extremely satisfied)Not reportedNot reportedHigh moderate

Cready [54],
Journal of Gerontological Nursing (2008)
Cross-sectional (single group)Country: USA 
Sample size:  n = 434 
Subjects: HCAs and nurses from 10 NHs
QuestionnaireEmpowerment (low, medium, or high)Not reported—authors stated that “when available, items were taken from previous studies [55]” Not reportedNot reportedWeak

Friedman [56],
The Gerontologist (1999)
Cross-sectional (two-group comparison; quasi-experimental) surveyCountry: USA 
Sample size:  n = 349 
Subjects: CNAs in 10 NHs (5 PACE, 5 non-PACE)
Questionnaire(i) Demographics (age, education, experience with elderly in childhood) 
(ii) Job description 
(iii) Working in PACE versus regular residential care facilities
(i) Minnesota Satisfaction Questionnaire 
(ii) Two questions rated on a scale from 1–5 on: 
(iii) “how satisfied they were with their current job”  
(iv) “how likely they were to leave their job in the next year”
= 0.90Stated validity in previous studiesHigh moderate

Garland [57], Journal of Aging Studies (1989)Cross-sectional survey (single group)Country: USA 
Sample size:  n = 138 
Subjects: NAs from 45 NHs
QuestionnaireFifteen items broken down into four groups:   
(i) Supervision (having necessary supplies; enough time; amount of work manageable; access to necessary info; knowing how supervisor is evaluating you; not knowing what supervisor expects; being sure of what supervisor wants; conflicting orders from people in authority) 
(ii) Personal recognition (supervisor asks for your opinion; others care how well you do your job) 
(iii) Family/work conflict (job interferes with family life; family life interferes with job) 
(iv) Qualifications (wish for more training; feel qualified)
Modification of Kahn et al. (1964) [50] Job Satisfaction Scaleα = 0.74Not reportedLow moderate

Gittell [58],
Human Resource Management Journal (2008)
Cross-sectional survey (single group)Country: USA 
Sample size:  n = 252  
Subjects: CNAs from 2 specific units at 15 different LTC facilities (10 nonprofit and 5 for-profit)
Questionnaire(i) Demographics  
(ii) Facility characteristics (size and ownership)
(iii) Relational coordination (communication and relationships)
One JS item “overall, how satisfied are you with your job?”Not reportedNot reportedLow moderate

Goldwasser [59],
Journal of Mental Health and Aging
(1996)
RCT 
(with four groups)
Country: USA 
Sample size:  n = 27 
Subjects: CNAs in one LTC facility
Questionnaire(i) Model of care (reminiscence versus present focused)  
(ii) Present during resident interviews versus not present during interviews
Short form of the Minnesota Satisfaction Questionnaire (20 items)Internal consistency coefficients of the subscales range from 0.80 s to 0.90 sNot reportedWeak

Grieshaber [60],
The Health Care Supervisor (1995)
Cross-sectional survey design (2 groups)Country: USA 
Sample size:  n = 79 
Subjects: CNAs
Questionnaire(i) Facility type (urban versus suburban) 
(ii) Age 
(iii) Education 
(iv) Job tenure 
(v) Occupation tenure
Short form of the Minnesota Satisfaction QuestionnaireReliable in other studies, but no numbers were reportedStated valid in other studiesWeak

Gruss [61],
Thesis
(2007)
Cross-sectional survey (single group)Country: USA 
Sample size:   n = 42 
Subjects: CNAs from 3 dementia care units in 3 LTC facilities
QuestionnaireIV = empowerment: 
(i) Structural empowerment (summary score of 4 subscales: opportunity, information, support, resources) 
(ii) Psychological empowerment
Abridged Job Description Index (25 items)Not indicated for this sample, referred to other studies without reporting numbersNot indicated for this sample, referred to other studies Low moderate

Holtz [62],  
Journal of Gerontological Nursing (1982)
Cross-sectional survey (single group)Country: USA 
Sample size:  n = 31  
Subjects: HCAs from 3 level II and III residential care facilities
Questionnaire (i) Administrative policies  
(ii) Supervision  
(iii) Salary  
(iv) Interpersonal relationships  
(v) Working conditions  
(vi) Achievement  
(vii) Recognition  
(viii) The work itself  
(ix) Responsibility  
(x) Advancement
Questionnaire based on Herzberg’s motivation-hygiene factors 20 items: 2 for each of the 10 Herzberg items Pilot with 10 subjects (split-half reliability was 0.80) Not reportedWeak

House [63],  
Thesis
(1990)
Cross-sectional survey (single group)Country: USA 
Sample size:  n = 148  
Subjects: CNAs from 10 NHs
Questionnaire(i) Motivation factors: achievement, recognition, work itself, responsibility, possibility of growth, and advancement 
(ii) Hygiene factors: salary, technical supervision, company policy, interpersonal relationships with peers, interpersonal relationships with supervisors, working conditions, security, status, personal life, and interpersonal relationship with nurse
Modified version of the JS instrument developed by Kroen which incorporates motivation/hygiene theoryJS scale has a reliability of 0.84 and the JDS scale has a reliability of 0.79 (as tested by Kroen)Reported valid in previous studiesLow moderate

Kostiwa [64],
Clinical Gerontologist (2009)
Cross-sectional survey (single group)Country: USA 
Sample size:  n = 60  
Subjects: CNAs from 12 residential care facilities
Questionnaire(i) Service quality 
(ii) Psychological empowerment
The Benjamin Rose Job Satisfaction Survey (JSS; 18 items)α = 0.93 (overall score)Not reportedLow moderate

Kovach [9],
Research in Gerontological Nursing
(2010)
Cross-sectional survey (single group)Country: USA 
Sample size:  n = 177  
Subjects: CNAs in 3 residential care facilities
Questionnaire(i) Personality traits, for example, adjustment, prudence, likeability, being excitable, being dutiful 
(ii) Job performance
The General Job Satisfaction Scale (5 items)The internal consistency of the GJS for this sample was 0.57Prior evidence of construct validity: negative relations to organizational size and positive relations with job level, tenure, performance, and motivational fit with workStrong

Kuo [10],
Journal of Clinical Nursing
(2008)
Cross-sectional survey (single group)Country: Taiwan 
Sample size:  n = 114 
Subjects: NAs from 28 residential care facilities
Questionnaire(i) Organizational empowerment 
(ii) Demographic variables, for example, nationality, age, marital status, educational level, work duration at a facility
Short form of the Minnesota Satisfaction Questionnaire (MSQ; 20 items)α = 0.87 (overall score)Not reportedLow moderate

Lerner [65],  
Journal of
Nursing Administration
(2011)
Cross-sectional survey (single group)Country: USA.
Sample size:  n = 556  
Subjects: NAs from 12 skilled nursing facilities
Survey pre- and postintervention(i) Skilled nursing facility site  
(ii) Age 
(iii) Gender 
(iv) Education 
(v) Years of experience 
(vi) Self-esteem 
(vii) Self-efficacy 
(viii) Outcome expectations for performance of restorative care activities 
(ix) Observed performance of restorative activities
Job attitude scale (17 items) measuring 5 components; pay factors, organizational factors, task requirements, job status, and autonomy Response options range from 1 (strongly disagree) to 5 (strongly agree)Not reportedValidity in previous studies by significant relation between its scores and scores of the Minnesota Satisfaction ScaleLow moderate

Liu [66],
Geriatric Nursing (2007)
Cross-sectional survey (single group)Country: Taiwan 
Sample size:  n = 244  
Subject: CNAs from 17 residential care facilities
Questionnaire(i) Marital status 
(ii) Full time versus part time 
(iii) Length of tenure 
(iv) Feelings toward the job 
(v) Intention to quit 
(vi) JS Facet 2 (work performance and rewards)
Designed by author according to relevant theoretical literatures and addressed 5 main dimensions of job satisfactionα = 0.81Not reportedHigh moderate

McGilton [67], Journal of
Nursing Administration
(2007)
Cross-sectional survey (single group)Country: Canada 
Sample size:  n = 222 
Subjects: CNAs in 10 LTC facilities
Questionnaire(i) CNA characteristics (age, gender, education, experience working in LTC, ethnicity [origin of birthplace, Canadian versus non-Canadian and first language, English versus non-English]) 
(ii) Job stress 
(iii) Supervisory support
Nursing Job Satisfaction Scale (42 items)α = 0.89 (total scale)  α = 0.88–0.95 (subscales)Not reportedHigh moderate

Parmelee [68],
Journal of American
Medical Directors Association
(2009)
Cross-sectional survey (single group)Country: USA
Sample size:  n = 188 
Subjects: NAs registered at the 2006 conference of the National Association of Health Care Assistants
Questionnaire(i) Perceived barriers to job performance 
(ii) Teamwork 
(iii) Job stress 
(iv) Respect 
(v) Workload 
(vi) Exclusion 
(vii) New NAs
Benjamin Rose Institute Nurse Assistant Job Satisfaction Scale (18 items)α = 0.95Not reportedHigh moderate

Parsons [33],
Journal of Gerontological Nursing (2003)
Cross-sectional survey (single group)Country: USA 
Sample size:  n = 550 
Subjects: HCAs from 70 LTC facilities
Questionnaire(i) Demographics: age, race, sex, marital status, education and education goals, family responsibilities, work characteristics (does not specify what) 
(ii) Seven factors: (1) task rewards, (2) social rewards, (3) supervision, (4) benefits, (5) personal opportunity, (6) coworker support, (7) salary and management keeping employees informed 
(iii) Turnover
Developed their own: overall satisfaction (3 items)Not reportedNot reportedWeak

Proenca [69],
Academy of Management Annual Meeting Proceedings (2008)
Cross-sectional survey (single group)Country: USA 
Sample size:  n = 129 
Subjects: CNAs from 6 residential care facilities
Questionnaire(i) Work-family conflict, burnout 
(ii) Burnout 
(iii) Supportive supervision 
(iv) Supportive coworkers
Subscales from the Job Diagnostic Survey and the Michigan Org. Assessment Questionnaire were used to measure job satisfaction and turnover intentionsα’s >0.80Not reportedLow moderate

Purk [70],
Journal of
Housing for the Elderly (2006)
Cross-sectional survey (single group)Country: USA 
Sample size:  n = 34 
Subjects: CNAs from 5 facilities
Questionnaire(i) Pay, promotion, supervision, work on present job, people at work 
(ii) Perceived emotional and physical stress 
(iii) Intent to quit within the next 3 months 
(iv) Intent to quit within the next year
The Job Descriptive Index (JDI) and the Job in General Scale (JIG)Not reportedNot reportedWeak

Ramirez [71],
Journal of Mental Health and Aging
(1998)
Cross-sectional survey (single group)Country: USA 
Sample size:  n = 337 
Subjects: HCAs from 20 residential care facilities
Structured (face-to-face interviews)Work related demands and stressors
(i) NA workload 
(ii) NA perceived bias 
(iii) Work environment evaluation 
Work resources
(i) NA training 
(ii) Work-related support 
Individual resources
Years working as a NA 
SCU Assignment
Adaption of Cantor and Chichin Job Satisfaction Scale (5 items)Internal consistency coefficient for the 5-item set was 0.41 in this studyNot reportedLow moderate

Resnick [72],
Geriatric Nursing (2004)
Quasi-experimental (single-group repeated measure design)Country: USA 
Sample size:  n = 13  
Subjects: HCAs from 1 facility
QuestionnaireImplementation of the Res-Care pilot intervention (restorative care philosophy)Job Attitude Scale (17 items)Not reportedReferred to a previous study, items on the JAS related to items on Minnesota Satisfaction ScaleLow moderate

Simpson [73], Thesis
(2010)
Cross-sectional survey (single group) (second analysis of Resnick 2007) Country: USA 
Sample size:  n = 504  
Subjects: CNAs employed in 12 residential care facilities
NAIndividual factors: age, experience 
Psychosocial factors: self-esteem, self-efficacy, outcome expectations, knowledge of restorative care  
CNA job performance (i.e., performance of restorative care)
The Nursing Assistant Job Attitude Scale (NAJAS) (17 items): 5 components: pay factors, organizational factors, task requirements, job status, and autonomy α = 0.94Convergence validity: “prior use of the NAJAS in a sample of 286 certified nurse aides resulted in findings similar to those found by other measures of job satisfaction” High moderate

Snow [74],
Nursing   Homes/Long
Term Care
Management (2007)
Cross-sectional survey
(single group)
Country: USA 
Sample size:  n = 121 
Subjects: HCAs at assisted living and skilled nursing facilities
Questionnaire(i) Pursuing education 
(ii) Expansion of scope of practice
Not reportedNot reportedNot reportedWeak

Solomon [75], Thesis
(2009)
Cross-sectional survey (single group)Country: USA 
Sample size:  n = 66 
Subjects: CNAs, 5 RNs, and 1 administrator in one residential care facility
QuestionnaireLeadership characteristics of administrators and registered nurses: 
(i) Modeling the way  
(ii) Inspiring a shared vision  
(iii) Challenging the process  
(iv) Enabling others to act  
(v) Encouraging the heart
The Benjamin Rose Nurse Assistant Job Satisfaction SurveyNot reportedNot reportedLow moderate

Tannazzo [76],
Alzheimer’s Care Today (2008)
pre/post-test interventionCountry: USA 
Sample size:  n = 301 
Subjects: CNAs from 4 residential care facilities
QuestionnaireEducation intervention, knowledge of Alzheimer’sGeneral Job Satisfaction (GJS) (5 items) and a Grau Satisfaction Scale (GSS; 2 items) measuring intrinsic satisfaction and satisfaction with benefitsGJS: α = 0.45–0.58 
GSS: α = 0.81–0.84
Not reportedLow moderate

Thompson [77],
Journal of Gerontological Nursing (2011)
Cross-sectional survey Country: USA 
Sample size:  n = 40  
Subjects: NAs in 1 skilled nursing facility
Mailed questionnaireWork content, quality of care, training, coworkers, supervisors, work demands, workload, rewards, global ratingAdapted Nursing Home Nurse Aide Job Satisfaction Questionnaire [31]Not reported. Content validity—instrument based on the literature; a panel of experts and cognitive testing were also conductedWeak

Tyler [78],
Health Care Management Review (2006)
Mixed methods (qualitative ground theory and quantitative cross-sectional survey)Country: USA 
Sample size:  n = 1146 (surveys) 
n = 144 (interviews) 
n = 37 (participant observations) 
Subjects: CNAs, RNs, management at 20 facilities
Qualitative: 
ethnographic interviews and participant observations 
Quantitative: questionnaire
(i) Skill variety 
(ii) Task identity 
(iii) Task significance 
(iv) Autonomy 
(v) Intrinsic feedback
Modified version of the Job Diagnostic Survey (JDS)α = 0.35–0.71Not reportedLow moderate/strong

Walborn [79],
Thesis
(1996)
Cross-sectional survey (single group) Country: USA 
Sample size:  n = 185 
Subjects: HCAs and charge nurses from one residential care facility
Questionnaire(i) Demographic variables (age, education, number of years since training, years of experience) 
(ii) Job performance variables 
(iii) Absenteeism variables 
(iv) Variables of perceptions of the work environment
The Job Descriptive Index (JDI) and the Job in General Scale (JGS) and 2 items from the Quality of Employment survey (QES) measuring overall JSJDI: α = 0.74 (overall) 
α = 0.67–0.92 (for 5 subscales) 
JGS:  
α = 0.86 (overall)
Reported as valid in previous studiesWeak

Webb [80],
Thesis (2003)
Quasi-experimental (nonequivalent control group design with pre- and posttest)Country: USA 
Sample size:  n = 178 
Subjects: CNAs from 2 residential care facilities
QuestionnaireRecognition and rewards training program The Nurse Assistant Assessment Survey Instrument: Job Satisfaction which was developed by Iowa CareGivers Association and Hill Simonton Bell (1998) (48 items)α = 0.87 (pretest) 
α = 0.88 (posttest)
Content validity by 3 expertsWeak

Yeatts [55],
The Gerontologist (2007)
Mixed methods (before-and-after with small amount of qualitative data)Country: USA 
Sample size:  not reported 
Subjects: work teams of 5 residential care facilities with intervention implemented and 5 work teams from 5 other residential care facilities as control
Quantitative: 
questionnaires  
Qualitative: 
(i) Participating observations, of over 270 CNA team meetings 
(ii) Examination of weekly team-meeting summaries for management and management’s responses
Empowerment Index in CNA survey (details of items not reported)CNA survey indices ranged from 0.60 to 0.85 (specific index for JS not reported)Factor analysis to determine items in all survey indicesWeak

Qualitative studies  (n = 7)

Ball [81],
Journal of Aging Studies (2009)
Long qualitative ground theory Country: USA 
Sample size:  n = 43 
Subjects: management staff members and DCWs in 2 ALFs
(i) Participant observation 
(ii) In-depth and informal interviews
(i) No predefined individual variables 
(ii) Open-ended interviews were used to find out what individual variables are important from the participants’ perspectives
Participant observations and qualitative interviewsN/AN/AStrong

Bye [82],
Nursing Homes and Senior
Citizen Care
(1987)
Qualitative cross-sectional interview Country: USA 
Sample size:  n = 30 
Subjects: NAs from 3 residential care facilities
Semistructured cross-sectional interview study(i) No predefined individual variables 
(ii) Open-ended interviews were used to find out what individual variables are important from the participants’ perspectives
Asked participants for their subjective perceptions of what satisfied them in their jobsN/AN/AWeak

Karner [83],
Journal of Gerontological Nursing (1998)
Qualitative cross-sectional ground theory Country: USA 
Sample size:  17  
Subjects:CNAs (article focused on CNAs but respondents included other staff members)
Semistructured guided intensive interviews(i) No predefined individual variables 
(ii) Open-ended interviews were used to find out what individual variables are important from the participants’ perspectives
Asked participants for their subjective perceptions of what impacts their satisfactionN/AN/ALow moderate

Moyle [84],
Journal of Clinical Nursing (2003)
Qualitative cross-sectional interview studyCountry: Australia 
Sample size:  n = 13 
Subjects: CNAs (plus 9 RNs and 5 ENs)
Focus group interviews(i) No predefined individual variables 
(ii) Open-ended focus groups were used to find out what individual variables are important from the participants’ perspectives
Focus groups: subjective views and opinions of the interviewed individuals or group meanings, respectivelyN/AN/AStrong

Quinn [85],
Thesis
(2002)
Mixed methods: qualitative long interview study with surveyCountry: USA 
Sample size:  n = 14 
Subjects: CNAs of one residential care facility
Semistructured, open-ended interviews(i) No predefined individual variables 
(ii) Open-ended interviews were used to find out what individual variables are important from the participants’ perspectives
Asked participants for their subjective perceptions of what satisfied them in their jobs. Started with 2 open-ended job satisfaction questions N/AN/AStrong

Tyler [78],
Health Care Management Review (2006)
Mixed methods: grounded theory and cross-sectional surveyCountry: USA 
Sample size:  n = 1146 (surveys) 
n = 144 (interviews) 
n = 37 (participant observations) 
Subjects: CNAs, RNs, management at 20 facilities
Qualitative: 
ethnographic interviews and participant observations 
Quantitative: questionnaire
(i) Skill variety 
(ii) Task identity 
(iii) Task significance 
(iv) Autonomy 
(v) Intrinsic feedback
Modified version of the Job Diagnostic Survey (JDS)α = 0.35–0.71Not reportedLow moderate/strong

Yeatts [55],
The Gerontologist (2007)
Mixed methods: before-and-after with small amount of qualitative dataCountry: USA 
Sample size:  not reported 
Subjects: CNAs
Quantitative: 
questionnaires  Qualitative: 
(i) Participating observations, of over 270 CNA team meetings 
(ii) Examination of weekly team-meeting summaries for management and management’s responses
Empowerment Index in CNA survey (details of items not reported)CNA survey indices ranged from 0.60 to 0.85 (specific index for JS not reported)Factor analysis to determine items in all survey indicesWeak

These studies are listed as both quantitative and qualitative as they employed a mixed methods study design.
The overall study design is quasi-experimental. The explanatory variables from these studies used in our analysis are the independent variables, not the experimental variable(s).
ALF: assisted living facility, CNA: certified nursing assistant, DCW: direct care worker, EN: enrolled nurses, HCA: health care aides, HPPD: hours per patient day, JS: job satisfaction, LTC: long-term care, NA: nursing assistant, PACE: Program of All-Inclusive Care for the Elderly, RN: registered nurse, and SCU: special care unit.