1
|
Candon M, Bergman A, Rose A, Song H, David G, Spetz J. The Relationship Between Scope of Practice Laws for Task Delegation and Nurse Turnover in Home Health. J Am Med Dir Assoc 2023; 24:1773-1778.e2. [PMID: 37634547 PMCID: PMC10735229 DOI: 10.1016/j.jamda.2023.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE Nurse turnover can compromise the quality and continuity of home health care. Scope of practice laws, which determine the tasks nurses are allowed to perform and delegate, are an important element of autonomy and vary across states. In this study, we used human resource records from a multistate home health organization to examine the relationship between nurse turnover and whether nurses can delegate tasks to unlicensed aides. DESIGN A retrospective, cross-sectional analysis. SETTING AND PARTICIPANTS The study sample included 1820 licensed practical nurses and 3309 registered nurses, who spanned 30 states. The study period was 2016 through 2018. METHODS We used weighted least squares to study the relationship between nurse turnover for registered and licensed practical nurses and task delegation across state-years. We measured task delegation continuously (0-16 tasks) and as a binary variable (14 or more tasks, which indicated the state was in the top half of the distribution). RESULTS Across state-years, the turnover rate was 30.8% for licensed practical nurses and 36.8% for registered nurses. Although there was no significant relationship between task delegation and turnover among registered nurses, we found that states in which nurses could delegate the most tasks had lower turnover rates among licensed practical nurses. CONCLUSION AND IMPLICATIONS The ability to delegate tasks to unlicensed aides was correlated with lower turnover rates among licensed practical nurses, but not among registered nurses. This suggests that the ability to delegate tasks is more likely to affect the workload of licensed practical nurses. This also points to a potential and unexplored element of expanding the scope of practice for nurses: reduced turnover. Given the added work-related hazards associated with home health care, including working in isolation, a lack of social recognition, and inadequate reimbursement, states should consider whether changes in their policy environment could benefit nurses working in home health.
Collapse
Affiliation(s)
- Molly Candon
- Departments of Psychiatry and Health Care Management, Perelman School of Medicine and the Wharton School, University of Pennsylvania, Philadelphia, PA, USA.
| | - Alon Bergman
- Departments of Medical Ethics and Health Policy and Health Care Management, Perelman School of Medicine and the Wharton School, University of Pennsylvania, Philadelphia, PA, USA
| | - Amber Rose
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Hummy Song
- Department of Operations, Information, and Decisions, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA
| | - Guy David
- Departments of Medical Ethics and Health Policy and Health Care Management, Perelman School of Medicine and the Wharton School, University of Pennsylvania, Philadelphia, PA, USA
| | - Joanne Spetz
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| |
Collapse
|
2
|
Bergman A, Song H, David G, Spetz J, Candon M. The Role of Schedule Volatility in Home Health Nursing Turnover. Med Care Res Rev 2022; 79:382-393. [PMID: 34311619 PMCID: PMC9122113 DOI: 10.1177/10775587211034310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite considerable research on nursing turnover, few studies have considered turnover among nurses working in home health care. Using novel administrative data from one of the largest home health care organizations in the United States, this study examined turnover among home health nurses, focusing on the role of schedule volatility. We estimated separation rates among full-time and part-time registered nurses and licensed practical nurses and used daily visit logs to estimate schedule volatility, which was defined as the coefficient of variation of the number of daily visits in the prior four weeks. Between 2016 and 2019, the average annual separation rate of home health nurses was over 30%, with most separations occurring voluntarily. Schedule volatility and turnover were positively associated for full-time nurses, but not for part-time nurses. These results suggest that reducing schedule volatility for full-time nurses could mitigate nursing turnover in home health care.
Collapse
Affiliation(s)
- Alon Bergman
- University of Pennsylvania, Philadelphia, PA, USA
| | - Hummy Song
- University of Pennsylvania, Philadelphia, PA, USA
| | - Guy David
- University of Pennsylvania, Philadelphia, PA, USA
| | - Joanne Spetz
- University of California, San Francisco, CA, USA
| | - Molly Candon
- University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
3
|
Katz IM, Rauvola RS, Rudolph CW. Feedback environment: A meta‐analysis. INTERNATIONAL JOURNAL OF SELECTION AND ASSESSMENT 2021. [DOI: 10.1111/ijsa.12350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Ian M. Katz
- Department of Psychology Old Dominion University Norfolk Virginia USA
| | | | - Cort W. Rudolph
- Department of Psychology Saint Louis University St. Louis Missouri USA
| |
Collapse
|
4
|
Whittam S, Torning N, Patching J. A narrative inquiry approach to understanding senior intensive care nurses' experiences of working with new graduate nurses. J Clin Nurs 2021; 30:3314-3329. [PMID: 34021641 DOI: 10.1111/jocn.15844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES To report a qualitative inquiry exploring senior registered nurses' stories of experience working with new graduate nurses in the intensive care unit. BACKGROUND While new graduate nurses' perceptions of transitioning into professional practice in the intensive care unit have been examined, few studies have explored the experiences of the senior registered nurses working alongside them. DESIGN A narrative inquiry methodology informed by Dewey's (1938) theory of experience. METHODS Individual in-depth, unstructured, interactive interviews were conducted with five senior registered nurses. The inquirer co-composed individual narrative accounts with each participant. Narrative inquiry's three commonplaces of temporality, sociality and place formed the lens of analysis. Thematic analysis identified two overarching threads that resonated across the narrative accounts. This inquiry adheres to COREQ checklist reporting. RESULTS The overarching threads 'Reverberations' and 'Caring' depict the experiences of senior registered nurses. 'It's Dangerous', 'Patrolling Like Surf Lifesavers', 'We Carry Them', 'Survival Mode' and 'Enjoyable Moments' are minor threads describing the challenges, while 'I've Been There', 'They Must Ask Questions' and 'Not In My Backyard' reveal their insights. CONCLUSIONS Working with new graduate nurses increased senior registered nurses' patient surveillance and workload, contributing to stress, pressure and feeling overwhelmed. However, senior registered nurses felt an obligation to care for new graduate nurses, who they perceived as still acquiring the skills to autonomously care for critically ill patients. Therefore, senior registered nurses require support themselves. RELEVANCE TO CLINICAL PRACTICE Senior registered nurses perceive workplace constraints as impeding their capacity to provide sufficient support and surveillance to new graduate nurses. The gap between new graduate nurses' clinical capacity and patients' needs underpins senior registered nurses' recommendation that new graduate nurses should not be placed in intensive care units unless additional workforce support is provided, safeguarding their development as well as patient safety.
Collapse
Affiliation(s)
- Susan Whittam
- School of Nursing, University of Notre Dame Australia, Sydney, NSW, Australia
| | - Nerilee Torning
- School of Nursing, University of Notre Dame Australia, Sydney, NSW, Australia
| | - Joanna Patching
- School of Nursing, University of Notre Dame Australia, Sydney, NSW, Australia
| |
Collapse
|
5
|
Rakhshanderou S, Safari-Moradabadi A, Ghaffari M. Structural Equation Modeling of the Spirituality and Self-efficacy Among College Students. JOURNAL OF RELIGION AND HEALTH 2021; 60:488-499. [PMID: 31960356 DOI: 10.1007/s10943-020-00984-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The present research is a descriptive analytical study which is conducted on 540 students. Multistage random sampling method was used. Data gathered by questionnaire consist of demographic factors and spirituality assessment questionnaire and self-efficacy questionnaire. Data were analyzed using statistical tests including t test, Chi-square, one-way ANOVA and correlation between variables through SPSS16 and EQS6.1 Software. Positive coefficients in regression equations showed positive relationship of spiritual capability (P < 0.001, r = 0.932) and spirituality with perceived self-efficacy (P < 0.001, r = 0.394) so that an increase in one of them will lead to increase in another one; this result is matched with research hypothesis. It is recommended to officials and managers of universities to create some mechanisms in order to improve and promote spirituality in university to promote self-efficacy of students and also to adopt a spiritual approach in curriculums of higher education.
Collapse
Affiliation(s)
- Sakineh Rakhshanderou
- Religion and Health Studies Center, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Safari-Moradabadi
- Student Research Committee, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohtasham Ghaffari
- Environmental and Occupational Hazards Control Research Center, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
6
|
Morioka N, Okubo S, Yumoto Y, Ogata Y. Training opportunities and the increase in the number of nurses in home-visit nursing agencies in Japan: a panel data analysis. BMC Health Serv Res 2019; 19:398. [PMID: 31221149 PMCID: PMC6585138 DOI: 10.1186/s12913-019-4225-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 06/06/2019] [Indexed: 11/11/2022] Open
Abstract
Background A training opportunity in which ongoing education is encouraged is one of the determinants in recruiting and retaining nurses in home-visit nursing care agencies. We investigated the association between ensuring training opportunities through scheduled training programs and the change in the number of nurses in home-visit nursing agencies using nationwide panel data at the agency level. Methods We used nationwide registry panel data of home-visit nursing agencies from 2012 to 2015 in Japan. To investigate the association between planning training programs and the change in the number of nurses in the following year, we conducted fixed-effect panel data regression analysis. Results We identified 4760, 5160 and 5025 agencies in 2012, 2013, and 2014, respectively. Approximately 60–80% of the agencies planned training programs for all staff, both new and former, during the study period. The means and standard deviations of the percentage change in the number of full time equivalent (FTE) nurses in the following year were 4.2 (19.8), 5.7 (23.5), and 5.8 (25.1), respectively. Overall, we found no statistically significant association between scheduled training programs and the change in the number of FTE nurses in the following year. However, the associations varied by agency size. Results of analysis stratified by agency size suggested that the first and second quartile sized agencies (2.5–4.0 FTE nurses) with scheduled training programs for all employees were more likely to see a 9.0% (95% confidence interval [CI]: 4.5, 13.5) and 8.5% (95% CI: 2.4, 14.5) increase in the number of FTE nurses in the following year, respectively. Similarly, the first and second quartile sized agencies with scheduled training programs for new employees were more likely to see a 4.7% (95% CI: 2.1, 7.2) and 3.3% (95% CI: 0.4, 6.2) increase in the number of FTE nurses in the following year, respectively. Conclusions Ensuring training opportunities through scheduled training programs for all staff, both new and former, in relatively small-sized home-visit nursing agencies might contribute to an increase in the number of nurses at each agency. Electronic supplementary material The online version of this article (10.1186/s12913-019-4225-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Noriko Morioka
- Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Suguru Okubo
- Institute of Ars Vivendi, Ritsumeikan University, 56-1 Toji-in Kitamachi, Kita-ku, Kyoto, 603-8577, Japan
| | - Yoshie Yumoto
- Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Yasuko Ogata
- Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| |
Collapse
|
7
|
Nonogaki A, Nishida T, Kobayashi K, Nozaki K, Tamura H, Sakakibara H. Factors associated with patient information sharing among home-visiting nurses in Japan: a cross-sectional study. BMC Health Serv Res 2019; 19:96. [PMID: 30717740 PMCID: PMC6360686 DOI: 10.1186/s12913-019-3924-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/23/2019] [Indexed: 11/11/2022] Open
Abstract
Background Home-visiting nurses are expected to enhance their ability to provide adequate nursing care in a relatively isolated work environment. However, the isolated work environment leads to less opportunity to share patient information. We investigated factors relevant to better patient information sharing among home-visiting nurses, which would contribute to the improved care performance of these nurses. Methods A cross-sectional study with anonymous self-administered questionnaire was conducted between June 2015 and September 2015 in two districts of Japan. Home-visiting nurses who were working at home health care agencies were recruited. The questionnaires consisted of items on demographic data, job-related variables, communication in the workplace, the current state of patient information sharing, opportunities (or measures) of patient information sharing in the workplace, and job satisfaction. Descriptive analyses were performed on all variables, using the Chi-square test, Fisher’s exact test, or Mann-Whitney U-test. Logistic regression analyses were conducted to identify the factors associated with better information sharing, adjusting the years of home-visiting nursing experience as the control variable. Results Of 762 anonymous self-administered questionnaires were mailed, data from 482 participants who consented to this study and had no missing answer were analyzed. Of the total, 77.2% shared the patients’ information. Having a friendly adviser (OR = 2.51, 95% CI = 1.14–5.55, p = 0.023), attending some conferences (OR = 2.32, 95% CI = 1.12–4.82, p = 0.024), joining workshops (OR = 1.89, 95% CI = 1.15–3.10, p = 0.012), and years of home-visiting nursing experience (OR = 1.27, 95% CI = 1.03–1.57, p = 0.025) were significantly associated with sufficient sharing of the information. Nurses sufficiently sharing the information were well satisfied with their job (OR = 5.38, 95% CI =3.19–9.09, p < 0.001) and highly preferred a career in home-visiting nursing care (OR = 5.62, 95% CI =3.41–9.27, p < 0.001). Conclusions The results suggested that having opportunities to discuss face-to-face such as at conferences and workshops as well as promoting good relationships among colleagues in the workplace will contribute to better information sharing among home-visiting nurses. Home-visiting nurses with less years of experience need to be supported in order to share the information sufficiently. Additionally, sufficient information sharing was also associated with job satisfaction and preference for home-visiting nursing care, which might lead to job retention for home-visiting nurses. Electronic supplementary material The online version of this article (10.1186/s12913-019-3924-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Akiyo Nonogaki
- Department of Nursing, Graduate School of Medicine, Nagoya University, Institutional address: 1-1-20, Daiko-minami, Higashi-ku, Nagoya, Aichi, 461-8673, Japan.
| | - Tomoko Nishida
- Department of Nursing, Sugiyama Jogakuen University, Institutional address: 17-3 Hoshigaoka-Motomachi, Chikusa-ku, Nagoya, Aichi, 464-8662, Japan
| | - Kazunari Kobayashi
- Department of Nursing, Graduate School of Medicine, Nagoya University, Institutional address: 1-1-20, Daiko-minami, Higashi-ku, Nagoya, Aichi, 461-8673, Japan.,Nursing course, School of Medicine, Gifu University, Institutional address: 1-1, Yanagido, Gifu, Gifu, 501-1194, Japan
| | - Kayoko Nozaki
- Home-visit nursing station Takayama, Institutional address: 588-1 Fuyutomachi, Takayama, Gifu, 506-0001, Japan
| | - Haruka Tamura
- Department of Nursing, Graduate School of Medicine, Nagoya University, Institutional address: 1-1-20, Daiko-minami, Higashi-ku, Nagoya, Aichi, 461-8673, Japan
| | - Hisataka Sakakibara
- Department of Nursing, Graduate School of Medicine, Nagoya University, Institutional address: 1-1-20, Daiko-minami, Higashi-ku, Nagoya, Aichi, 461-8673, Japan
| |
Collapse
|
8
|
Strandell-Laine C, Saarikoski M, Löyttyniemi E, Meretoja R, Salminen L, Leino-Kilpi H. Effectiveness of mobile cooperation intervention on students’ clinical learning outcomes: A randomized controlled trial. J Adv Nurs 2018; 74:1319-1331. [DOI: 10.1111/jan.13542] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2018] [Indexed: 12/21/2022]
Affiliation(s)
| | - Mikko Saarikoski
- Department of Nursing Science; University of Turku; Turku Finland
| | | | - Riitta Meretoja
- Department of Nursing Science; University of Turku; Turku Finland
- Group Administration; Helsinki University Hospital; Helsinki Finland
| | - Leena Salminen
- Department of Nursing Science; University of Turku; Turku Finland
| | - Helena Leino-Kilpi
- Department of Nursing Science; University of Turku; Turku Finland
- Turku University Hospital; Turku Finland
| |
Collapse
|
9
|
Jun WH, Lee G. The mediating role of spirituality on professional values and self-efficacy: a study of senior nursing students. J Adv Nurs 2016; 72:3060-3067. [DOI: 10.1111/jan.13069] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Won Hee Jun
- College of Nursing; Keimyung University; Daegu Korea
| | - Gyungjoo Lee
- College of Nursing; The Catholic University of Korea; Seoul Korea
| |
Collapse
|
10
|
Stone R, Wilhelm J, Bishop CE, Bryant NS, Hermer L, Squillace MR. Predictors of Intent to Leave the Job Among Home Health Workers: Analysis of the National Home Health Aide Survey. THE GERONTOLOGIST 2016; 57:890-899. [DOI: 10.1093/geront/gnw075] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 03/22/2016] [Indexed: 11/12/2022] Open
|