The Importance of Work Environment

Improving Retention of Home Health Nurses: Fostering Outcome Sustainability Through an Innovative Orientation and Mentorship Program

Home healthcare plays an increasingly vital role in contemporary postacute healthcare. Staffing instability and lack of perceived organizational support is a stimulus for nursing attrition from the organization with far-reaching impact on staff morale, patient care, agency budgets, and relationships with other healthcare settings. The purpose of this article is to describe a redesign of an agency's nursing orientation and the development of a mentorship program for newly hired home healthcare nurses within a large Midwestern integrated health system. During this time frame, 154 nurses completed the newly designed orientation program and, of those, 91 participated in the mentorship program. In this article, we evaluate 1-year new-hire nursing retention rates over a 4-year period, examine new-hire job satisfaction and perceptions of preceptors and mentors during their first year, and discuss issues of outcome sustainability. Agency-wide turnover rates for all home healthcare nurses decreased from 15.4% in 2016 to 10.1% in 2018, demonstrating the associated impact of these initiatives on staffing stabilization.

Factors Associated With Stability of Health Nursing Services for Children With Medical Complexity

The objectives of our study are to: (1) identify the factors associated with lack of stable home healthcare nursing services for children with medical complexity, and (2) describe the implications of unstable home healthcare nursing for children, caregivers, nurses, and home healthcare agencies. We collected qualitative data in 20 semistructured in-depth interviews (15 English, 5 Spanish) with 26 primary caregivers of children with medical complexity, and 4 focus groups of 18 home healthcare nurses inquiring about their experiences about home healthcare nursing services for children with medical complexity. During an iterative analysis process, we identified recurrent themes related to stability of home healthcare nursing. Lack of stability in home healthcare nursing was common. These include: (1) not finding nurses to cover shifts, (2) nurse turnover, (3) nurses calling out frequently, and (4) nurses being fired by caregivers. Reasons for lack of stability of home healthcare nursing services were multifactorial and included: nurse-level, child-level, caregiver-level, residence-level, agency-level, and system-level factors. Lack of stable home healthcare nursing affected the well-being of children with medical complexity, and contributed to substantial caregiver burden. There were negative implications of unstable home healthcare services for nurses and home healthcare agencies as well. Lack of stable home healthcare nursing services is a major problem in the home care of children with medical complexity. Although some of the factors for unstable home healthcare nursing services are not modifiable, there are others that are potentially modifiable. Ensuring stable home healthcare nursing services will likely improve care of children and reduce caregiver burden.

Impact of Organizational Attributes on Nurse Satisfaction in Home Health

With the nursing shortage continuing to worsen, the retainment of current nursing staff becomes increasingly important for health care organizations. Specific organizational attributes have been found to have a significant relationship with nurse satisfaction in the acute care setting. Results from this study demonstrate a significant relationship between certain organizational attributes and nurse satisfaction in the home health care setting.

How does collegial support increase retention of registered nurses in homecare nursing agencies? a qualitative study

Background

Collegial workplace support has been linked to higher registered nurse (RN) retention in various clinical settings. In Japan, homecare agencies experience high RN turnover. The purpose of this study was to develop a conceptual framework to describe how perceived support from colleagues affects RNs’ decision to remain in an agency.

Methods

A qualitative research method based on grounded theory was used. Participants were RNs with at least 4 years of experience at the same homecare agency. Participants were theoretically sampled via managers of 12 homecare nursing agencies. Semi-structured interviews and supplementary participant observations were conducted. Data were analyzed using a constant comparative technique, and the process of how workplace support affected participants’ decision to remain at their agency was clarified.

Results

In total, 26 RNs were interviewed, 23 of whom were observed in their practice setting. Participants’ perception of support from colleagues was framed as being “encouraged to grow in one’s own way”, which comprised practicing with protected autonomy in an insight-producing environment. Participants reported that they were able to practice with protected autonomy, receiving 1) mindful monitoring, 2) semi-independent responsibility, 3) help as needed, and 4) collegial empathy and validation. RNs also felt supported in an insight-producing environment by 1) enlightening dialogue, 2) being set for one’s next challenges, and 3) being able to grow at one’s own pace. Reportedly, these were defining characteristics in their decision to continue working in their agencies.

Conclusions

For RNs to willingly stay at a homecare nursing agency, it is essential that they are able to practice with protected autonomy in an insight-producing environment that encourages them to grow in their own way. Further research is needed to explore ways to create and enhance such environments to lower RN turnover.

Residency Programs for Home Health and Hospice Nurses

The Institute of Medicine’s report, “The Future of Nursing: Leading Change, Advancing Health,” calls for “transition-to-practice” residencies for new nurses and nurses transferring to new types of settings. In this study, we examine the current residency landscape for home health and hospice nurses and compare it with responses from their peers in hospitals and nurse-led primary care clinics. We find that just 2% of surveyed home health and hospice settings offer residencies, while almost 49% of hospitals and 11% of nurse-led primary care clinics provide them. Major barriers cited include lack of available preceptors and financial costs. We discuss ways in which the federal government could help spur the development of residencies in this sector.

The Correlates of Nursing Staff Turnover in Home and Hospice Agencies

Using data from the 2007 National Home and Hospice Care Survey, this study provides an update of nursing staff turnover at U.S. home health and hospice agencies and explores correlates of nursing staff turnover. Results show that the three-month turnover rates of registered nurses (RNs), licensed practice nurses (LPNs), home health aides (HHAs), and certified nursing assistants (CNAs) in 2007 were 10.2%, 14.3%, 12.5%, and 12.9%, respectively. A higher nurse staffing level reduced the odds of RN and HHA turnover; the availability of communication aids reduced the odds of LPN turnover. Moreover, among benefit programs, the provision of partial insurance for family reduced the odds of HHA turnover; dental or vision health insurance reduced the odds of RN turnover; mileage reimbursement or agency car reduced the odds of LPN turnover. The provision of a 401k plan and a paid-time-off program increased the odds of RN turnover. The study results suggest that high staffing levels and benefit programs (e.g., health insurance) may reduce the odds of experiencing nursing staff turnover. Initiatives to minimize nursing staff turnover should consider these factors.

Views on the future of nursing and home healthcare: the future of nursing in home healthcare is now

"My view you know is that the ultimate destination is the nursing of the sick in their own homes. ... I look to the abolition of all hospitals and workhouse infirmaries. But it is no use to talk about the year 2000." -Florence Nightingale, 1867 ().

Model for consideration: retaining the experienced aging workforce in home care

As the nursing workforce in the United States ages, home health agencies must step up efforts to retain their experienced and mature nurses. Satisfying positions for the aging experienced nursing workforce are lacking. The model for consideration has 3 levels of nursing practice, including those of nurse case managers, comprehensive data assessment nurses, and visiting nurses.

Meeting the demographic challenges ahead: Toward culture change in an ageing New Zealand

There are several innovative service delivery models in the United States (US) relevant to long-term care policy development and implementation in New Zealand. An especially fruitful source of innovation has been the culture change movement, which originated in the US but has begun to spread to New Zealand and other OECD countries. The culture change philosophy requires that providers respond to the values, preferences, and needs of care recipients. It also requires devolving authority to direct care workers who know their clients best, in addition to transitioning from sterile 'clinical' settings to more homelike environments. New Zealand has a more favourable policy context for improving long-term care than the US. Thus, it is critical that it build upon these short term advantages to promote further dissemination of the culture change ethos, thereby placing caregivers in a better position to meet current care challenges, not to mention those posed by growth in the elderly population ahead.

The rural nurse work environment and structural empowerment

Rural health care organizations struggle to attract and retain nurses, yet much of the research has focused on characteristics of the nurse work environment or empowerment in urban hospitals. The purpose of this study was to examine the nurse work environment in rural areas across settings by describing the relationship between structural empowerment and characteristics of the nurse work environment. Nurses ( N = 97) working in home care agencies and hospitals were surveyed. Significant differences were found between the groups, with home care nurses having significantly higher empowerment scores than medical/surgical nurses. A strong correlation was found between characteristics of the nurse work environment and empowerment. Policy makers are using evidence to guide development of policies, but much of the research has been conducted in urban hospital settings. This study begins to provide evidence that differences exist between urban and rural areas and between practice settings.

The Essentials of Magnetism for Home Health

OBJECTIVE

The purpose of this study was to determine what home health nurses perceived to be the Essentials of Magnetism in the home healthcare setting.

BACKGROUND

Research in the acute care setting has established relationships between organizational attributes, nurse satisfaction, and quality outcomes. However, little is known in the home health setting on the importance and the impact of these relationships. More research is needed to further understand the implications to home healthcare.

METHODS

Registered nurses (N = 260) were asked to identify the top 10 attributes from the 37-item Dimensions of Magnetism instrument developed by Kramer and Schmalenberg. The top 10 Essentials of Magnetism attributes were obtained by tabulation of the number of respondents to each question.

RESULTS

The results showed that 7 of the top 8 Essentials of Magnetism items chosen by the home health nurses (n = 106) were the same Essentials of Magnetism items chosen by acute care nurses in previous studies. A test-retest of the top 10 items revealed a high level of reliability (.77).

CONCLUSION

Although the results demonstrate similar attributes as those identified in the acute care setting, noted differences need further review to understand their role in registered nurse satisfaction and quality.

Employer retention strategies and their effect on nurses' job satisfaction and intent to stay

Faced with a nursing shortage and anticipated increase in demand, home care agencies are implementing retention strategies with little knowledge of their effectiveness. The purpose of this study is to describe the strategies implemented and their effect on nurse job satisfaction and intention to leave. Data were collected from a random sample of 123 New England agencies during in-person interviews. Most agencies reported implementing multiple recruitment and retention strategies. Regression results suggest that the effects of employer retention strategy on nurses' intent to stay are the indirect result of its effects on job satisfaction. The only retention intervention that made a statistically significant difference in job satisfaction was shared governance, and no retention strategy directly affected nurses' intention to stay in their jobs.