**Background:** Care workers in nursing homes frequently perform administrative and indirect care activities (e.g., documentation, coordination, stock management) that are perceived as burdensome and as detracting from direct resident care. High turnover rates (19–55% internationally; 28% in Swiss nursing homes vs. 17% in hospitals) threaten staffing stability and quality of care. While individual, work environment, and organizational factors have been linked to negative care worker outcomes, the specific role of administrative burden in nursing homes had not been systematically studied.
**Methods:** This multicenter cross-sectional study analyzed survey data from the Swiss Nursing Homes Human Resources Project (SHURP) 2018. A convenience sample of 118 nursing homes and 2,207 care workers (registered nurses with 3+ years of education; licensed practical nurses with 2–3 years of education; working at least 20%) from German- and French-speaking Switzerland was included. The mean response rate was 66% (range 12.7–98.2%). Care workers completed questionnaires assessing administrative tasks and burden, staffing and resource adequacy, leadership ability, implicit rationing of nursing care, and care worker characteristics and outcomes. Administrative burden was measured as the mean score of six items derived from prior qualitative work: (1) filling out resident’s health record, (2) coordinating activities/exams/appointments, (3) managing admissions/discharges, (4) exchanging information, (5) evaluating residents with assessment instruments, and (6) ordering supplies/stock management (Cronbach’s α = 0.83). Four outcomes were assessed: job dissatisfaction (single item, 4-point scale), emotional exhaustion (single item from Maslach Burnout Inventory, 7-point scale), intention to leave the current job (3-item Michigan Organizational Assessment Questionnaire, sum score 0–12, α = 0.89), and intention to leave the profession (single item, 5-point scale). Generalized linear mixed models (2-level binomial) accounting for clustering within facilities were used, with unadjusted models and two adjusted models (Model 1: administrative burden + control variables without work environment/rationing; Model 2: full adjustment including staffing adequacy, leadership, and implicit rationing).
**Key Results:** Overall, 73.9% (n = 1,561) of care workers felt strongly or rather strongly burdened by administrative tasks; 36.6% (n = 787) reported spending 2+ hours on a normal day performing administrative tasks—48.2% of registered nurses vs. 25.5% of licensed practical nurses (p < 0.001). Ratings for individual administrative tasks ranged from 75.3% (n = 1,621; filling out resident’s health record) to 42.6% (n = 884; ordering supplies/stock management). Registered nurses reported significantly higher burden than licensed practical nurses on five of six tasks (all p < 0.05 except ordering supplies). Regarding outcomes: 17.9% (n = 383) reported job dissatisfaction; 18.8% (n = 414) reported emotional exhaustion once a week or more; 70.1% (n = 1,536) had intention to leave their current job; and 25.5% (n = 561) intended to leave the profession. In Model 1 (adjusted for facility, unit, and care worker characteristics), higher administrative burden was significantly associated with all four outcomes: job dissatisfaction (OR 1.32; 95%CI: 1.09–1.61), emotional exhaustion (OR 1.66; 95%CI: 1.36–2.03), intention to leave current job (OR 1.42; 95%CI: 1.21–1.66), and intention to leave the profession (OR 1.52; 95%CI: 1.28–1.81). In Model 2 (fully adjusted including staffing adequacy, leadership, and rationing), administrative burden remained a significant independent predictor only for intention to leave the profession (OR 1.24; 95%CI: 1.02–1.50). Staffing and resources adequacy was the strongest and most consistent protective factor across all outcomes. Intraclass correlations (ICCs) for outcomes were low (< 0.05 for job dissatisfaction, emotional exhaustion, and intention to leave the profession), while ICCs for administrative burden (0.066), leadership (0.135), staffing adequacy (0.201), and rationing (0.151) indicated substantial between-facility variation.
**Clinical Implications:** This is the first study to systematically describe administrative burden in nursing homes and link it to care worker outcomes. The finding that administrative burden independently predicted intention to leave the profession—even after adjusting for staffing, leadership, and rationing of care—suggests that reducing burdensome administrative tasks could improve workforce retention. Registered nurses bore a disproportionate burden, spending nearly twice as much time on administrative tasks as licensed practical nurses. Strategies such as delegating non-clinical tasks (e.g., ordering supplies) to administrative personnel, streamlining documentation through adequate IT systems (only half of care workers reported sufficient computers), and enabling mobile documentation at the bedside could reduce burden. The most burdensome task was filling out resident health records (75.3%), followed by resident assessment with standardized instruments (73.0%), suggesting that electronic health record usability and integration are critical targets. However, because staffing adequacy and leadership showed stronger and more consistent associations with outcomes, interventions addressing administrative burden should complement—not replace—efforts to improve staffing levels, leadership support, and reduce rationing of care.