Violence and harassment at work is a serious concern in the healthcare sector in Canada and elsewhere. A 2019 report prepared for the House of Commons Canada states that healthcare workers are exposed to workplace violence significantly more than any other profession in Canada [1]. Thus, violence and harassment are increasingly recognized as critical determinants of healthcare workers’ well-being and career decisions [2,3]. This paper examines the relationship between personal support workers’ (PSWs) job demands that result in violence and harassment at work, personal resource of self-esteem, job resources of workplace violence training and challenging task training, PSWs’ well-being of stress, career decisions and organizational outcome of intention to stay in the organization. The analysis utilizes a resource perspective, bringing together job demands and resources theory [4] and conservation of resources theory [5]. Violence and harassment in healthcare workplaces can lead to detrimental worker outcomes related to stress [3] and organizational outcomes of turnover intentions [2]. Training is a job resource used to prevent or alleviate the negative outcomes of violence and harassment in the healthcare sector [6]. Research on workplace violence training in the healthcare sector, however, shows inconclusive results. For example, a study conducted in community care organizations found that there was no difference in workplace violence and harassment exposure among those who received workplace violence training and those who did not [7]. On the other hand, Nachreiner et al. [8] demonstrated that workplace training increased the probability of exposure to workplace violence. Understanding the effectiveness of specialized training related to violence and harassment in the healthcare sector is imperative in reducing stress and retaining PSWs.

While training as a job resource is important in shaping PSWs’ experience of violence and harassment at work, the resource perspective argues that violence and harassment at work as work stressors can be ameliorated with the interplay of the personal resource of self-esteem and the job resource of training. Specifically, we examine the buffering roles of self-esteem as a personal resource and workplace violence training and challenging task training as job resources in the relationship between PSWs’ exposure to violence and harassment at work, stress, and intention to stay. Furthermore, we investigate the reciprocal relationship among self-esteem, workplace violence training, and challenging task training to apprehend how different resources may be associated with each other. Our data comes from 1401 PSWs in Ontario, Canada.

Our study has important contributions to theory and knowledge. The study contributes to theory by shedding light on the resource perspective. Furthermore, we contribute to practitioner knowledge by examining the effectiveness of two types of training received by PSWs: workplace violence training and challenging task training. It is important to understand the effectiveness of these trainings not only for improving the well-being of PSWs but also for retaining PSWs in their workplaces.

1.1. Background to the StudyThere is an increased demand for home and community care services in Canada and most industrialized countries due to demographic shifts and healthcare sector restructuring [9]. PSWs play a key role in addressing the demand for home and community care services. They provide care to individuals such as post-acute patients, older people, and people with disabilities who need support with their everyday tasks to live independently. PSWs are also known in other countries as health support workers, social and healthcare assistants, home healthcare aides, home healthcare workers, and home care workers. PSWs’ workplaces include care recipients’ dwellings, supportive housing programs, and community care, long-term care, and retirement homes. In accordance with the need for their services, PSWs constitute the largest group of providers in the Canadian home and community care sector. PSWs, as frontline workers in the home and community care sector, experience violence and harassment at work [10]. Violence and harassment at work can be at least partially avoided by allocating necessary job resources to workers. Thus, human resource policies regarding organizational resources can shape PSWs’ exposure to violence and harassment at work. The topic receives extensive attention by all stakeholders, including the health and safety associations providing health and safety training and resources to healthcare employers, unions, and workers, though the extent of training uptake by workers is not known. The PSWs included in this study work in Ontario, Canada. Ontario has occupational health and safety legislation (e.g., Occupational Health and Safety Act, R.S.O. 1990, c. O.1) that designate responsibilities of healthcare organizations to address workplace violence and harassment. Nevertheless, these responsibilities, including training addressed to alleviate the adverse effect of workplace violence and harassment, are vague and left to employer discretion [6]. Thus, training of PSWs is a high-priority issue for the home care sector in Canada [9], especially because it is an important determinant of retention [11]. The challenges of violence and harassment experienced by the PSWs and the interest of their employing organizations, unions, and professional organizations in assisting the workers, along with the provincial government’s interest in documenting this phenomenon, are the impetus for our study. 1.2. TheoryThe theoretical foundation of this study is based on the resource perspective, which is the integration of the job demands and resources (JD-R) and conservation of resources (COR) theories [12]. According to the JD-R theory, work environment characteristics can be categorized into two groups, as job demands and job resources [4]. Both job demands and resources can be physical, social, psychological, or organizational [13]. The JD-R theory states that job demands lead to strain but job resources can buffer the impact of job demands on strain. Bakker and Demerouti [4] offer an extended model based on the JD-R theory where personal resources are incorporated into the model. In this model, job resources and personal resources interact and act as a buffer between job demands and strain [4]. According to the COR theory, the prime motivation of human beings is to gain, protect, and accumulate resources such as health, well-being, and personal characteristics that may assist in dealing with stress [5,14]. Furthermore, individuals attempt to acquire resources to recover from losses [15] In the workplace context, workers use their personal resources to cope with job demands [16]. Workers may experience stress when job demands exceed personal resources [5]. The model developed in this paper is guided by the organizational health framework developed by Hart and Cooper [17]. Hart and Cooper’s [17] framework argues that organizational and individual characteristics interact to shape employee well-being, which in turn, affects organizational outcomes. We build on this framework using the resource perspective [12] and develop the model of violence and harassment at work, training, self-esteem, stress, and intention to stay relationships for PSWs. The model integrates job demand (violence and harassment at work), job resources (challenging task training and workplace violence training), personal resources (self-esteem), employee well-being (stress), and organizational performance (intention to stay). In applying the JD-R theory to PSWs in our study, we argue that when PSWs experience violence and harassment at work, self-esteem acts as a buffer reducing the effect of violence and harassment at work. The model can be seen in Figure 1. Self-esteem is one’s evaluations of self in life [18] and is a personal resource according to the JD-R theory [13,14,15,19]. The JD-R theory states that job demands lead to strain [4], which can then manifest itself as stress. The relationship between home care workers’ exposure to workplace violence and stress was previously documented in Canada [10]. As presented in our model (see Figure 1), we argue that violence and harassment at PSWs’ work increase their level of stress. Thus, we hypothesize that:Hypothesis 1a (H1a):

Violence and harassment at work is negatively associated with self-esteem.

Hypothesis 1b (H1b):

Violence and harassment at work is positively associated with stress.

As PSWs are exposed to violence and harassment at work, they face the risk of losing an important personal resource: self-esteem. We argue that challenging task training and workplace violence training, the types of workplace training examined in this paper, can contribute to self-esteem. Challenging task training is essentially a critical thinking skills training that is broad enough to cover a number of challenging circumstances that PSWs might experience at work and provides skills to identify and resolve those challenges. Challenging tasks training can include assisting with the complex healthcare needs of clients, dealing with irritated clients whose needs are not being met, training to manage too many different tasks at the same time while delivering good quality care, and training to care for clients too sick to be at home. Workplace violence training can help to increase PSWs’ awareness of risky situations and prevent problems from happening before they further escalate [20]. Workplace violence training can include recognizing and knowing how to respond to the threat of, attempt to, or exercise of physical strength against the PSW. This may be physical violence (i.e., scratching, pinching, pushing, spitting, slapping/hitting, kicking, biting, punching, restraining) or sexual violence. Workplace violence training can also include recognizing and knowing how to respond to harassing behavior that demeans, humiliates, annoys, alarms, or verbally abuses the PSW or is considered by the PSW as unwelcome. This harassing behavior may be words, gestures, intimidation, bullying, or other inappropriate activities. PSWs who are trained in recognizing workplace violence and harassment and taking measures to prevent the occurrence of violence and harassment have higher self-esteem, with training positively contributing to self-esteem. Thus, training can be an important job resource that enhances PSWs’ personal resource of self-esteem. Therefore, we hypothesize that:Hypothesis 2a (H2a):

Challenging task training is positively associated with self-esteem.

Hypothesis 2b (H2b):

Workplace violence training is positively associated with self-esteem.

Stress occurs as a result of interaction between individuals and their environments [5,14]. This implies that job demands, personal resources, and job resources interact to influence stress. According to the JD-R theory, job demands may lead to stress, and job resources and personal resources buffer this relationship [4] The COR theory states that the loss of personal resources such as self-esteem can lead to stress [15]. For example, Yang, Ju, and Lee [21] demonstrated the negative relationship between job stress and self-esteem. Thus, job resources, including challenging task and workplace violence training, are expected to have a negative relationship with stress. Furthermore, the personal resource of self-esteem should have a negative relationship with stress. Therefore, we hypothesize that:Hypothesis 3a (H3a):

Challenging task training is negatively associated with stress.

Hypothesis 3b (H3b):

Workplace violence training is negatively associated with stress.

Hypothesis 3c (H3c):

Self-esteem is negatively associated with stress.

The JD-R model argues that job resources can act as a buffer between job demands and strains [4]. For example, Xanthopoulou et al. [22] demonstrated the mutual relationship between job and personal resources. However, how job demands, job resources, and personal resources interact to shape strain has not been definitively explained [4]. Demerouti and Bakker [23] suggested that personal resources can be included in the JD-R model as mediator. According to the resource perspective [12], it is possible that personal resources can have a multiple mediator role. Specifically, we argue that the personal resource of self-esteem mediates the relationship between job demands of violence and harassment at work and stress as well as the relationship between the job resources of challenging task training and workplace violence training and stress. As such, we hypothesize that:Hypothesis 4a (H4a):

Self-esteem mediates the relationship between violence and harassment at work and stress.

Hypothesis 4b (H4b):

Self-esteem mediates the relationship between challenging task training and stress.

Hypothesis 4c (H4c):

Self-esteem mediates the relationship between workplace violence training and stress.

Both job resources and personal characteristics can shape turnover intention in organizations [24]. Intention to stay is a strong indicator of actual turnover behavior [25,26], which is an important outcome considering the potential adverse impact of turnover behavior on organizational outcomes. Previous research showed that stress can lower intention to stay [27]. Furthermore, it was found that stress has a positive relationship with intention to quit [28]. While intention to stay and intention to quit may not be exactly opposite, there is a high level of similarity between them. Thus, we hypothesize that:Hypothesis 5 (H5):

Stress is negatively associated with intention to stay.