Community nursing workforce factors ‘affect care standards’

District community elderly blood home patient dressing wound care
Credit: Sam Irvin

Source:  Samuel Irvin

Better working environments, including time to care and access to training, are linked with better patient and workforce outcomes in community nursing, according to the first study of its kind.

US nurse researchers examined the factors influencing the likelihood of missed nursing care in home care settings. They said their findings indicated that home care nurses with poor working environments were more likely to miss required care, in a similar way to previous evidence for acute settings.

“Having enough time to provide patient education and counselling helps nurses feel they are making a difference in the community”

Olga Jarrin

The researchers analysed survey data collected from nearly 3,500 home care registered nurses in over 800 US home care agencies between 2006 and 2007.

Among other questions, nurses were asked whether they had omitted any required or necessary care activities due to a lack of time.

The quality of the work environment was determined from survey responses regarding nurses’ autonomy, health and safety, opportunities for professional development, quality of nursing management, and other standards of workplace excellence.

As has been found in hospitals, nurses working in agencies with poor work environments were more likely to report not having enough time to complete necessary patient teaching, counselling, and care co-ordination.

Categorising agencies into poor, mixed, and better work environments, the researchers found those in in better environments were less than half as likely to report missing necessary care co-ordination, counselling, or education of patients and their carers, compared to those in poor settings.

They also identified an impact on nursing staff as well. Specifically, nurses in the best work environments were less than one-third as likely to experience burnout, job dissatisfaction, or intend to leave their jobs, compared with nurses working in the worst work environments.

“Having enough time to provide patient education and counseling helps nurses feel they are making a difference in the community and reduces burnout,” said lead study author Dr Olga Jarrín, an assistant professor at Rutgers University’s school of nursing in New Jersey.

She noted that, not only would ensuring that nurses have supportive work environments and manageable workloads improve care quality, but it could also improve staff retention.

Such attention to quality care was particularly significant in community nursing, where a lack of good nursing care could lead to avoidable admissions and institutionalisation, she added.

The workplace factors assessed in the study were based on those promoted by a US system of nurse accreditation, called the Pathway to Excellence Program.

The programme is run by the American Nurses Credentialing Center, which also oversees the Magnet accreditation system specifically for nursing in hospitals and that several NHS trusts are currently seeking to achieve.

The Pathway to Excellence Program, which is newer than the Magnet scheme, was originally devised in Texas in 2003 to help boost nurse retention before being extended to other parts of the US in 2007. It was revised last year and measures a broader range of healthcare settings than Magnet.

It is based on 12 standards linked to nursing and, at present, Nursing Times is aware of at least one health service organisation, Northampton General Hospital NHS Trust, that has signed up to the scheme.

The programme is intended to recognise healthcare providers that create positive work environments where nurses can excel in their practice and patient care, said the authors of the new study.

They said their findings validated the Pathway to Excellence standards as “important to patient care quality and nursing workforce outcomes in home care”.

Dr Jarrín said: “There has been a lot of research on the topic of hospital work environments, but very little on home care.

“Given that the homebound elderly and community dwelling disabled are a particularly vulnerable population, our question was, to what extent is the work environment in home care agencies related to the quality of care nurses provide to patients in their homes,” she said.

University of Pennsylvania School of Nursing

Community nursing workforce factors ‘affect care standards’

Source: Penn Nursing

Olga Jarrín and Linda Aiken

“This study provides the best evidence to date that better home care agency work environments and patient care can be expected from home care agencies that achieve Pathway to Excellence designation,” she added.

The senior researcher on the study was highly respected UK nurse academic professor Linda Aiken, who is currently based at the University of Pennsylvania school of nursing’s Center for Health Outcomes and Policy Research.

“The pursuit of pathway credentialing holds promise for recognising nursing excellence in home care organisations and as a blueprint for moving more home care organisations into the highest levels of patient care excellence,” said Professor Aiken.

The study has been published in Nursing Outlook, the journal of the American Academy of Nursing and the Council for the Advancement of Nursing Science.

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