Home Care Nurses' Experience of Job Stress and Considerations for the Work Environment

Abstract

Home care nurses report increased stress in their jobs due to work environment characteristics that impact professional practice. Stressors and characteristics of the professional practice environment that moderate nurses' experience of job stress were examined in this embedded multiple case study. Real life experiences within a complex environment were drawn from interviews and observations with 29 participants across two home care agencies from one eastern U.S. state. Findings suggest that role overload, role conflict, and lack of control can be moderated in agencies where there are meaningful opportunities for shared decision making and the nurse-patient relationship is supported.

Municipal Eldercare: Leadership Differences in Nursing Homes and Home Help Services

“…The residents are located in the same area, although their needs vary, and leaders get direct feedback from subordinates about the leaders' desirable competencies ("results of leadership"). This interpretation is supported by the work of, 9 and by 10 who reported significantly higher performance from subordinates with a direct rather than indirect leadership. Leaders' self-assessments in nursing homes might also be more influenced by close interactions with subordinates, than leaders in do in home help services.…”

“…These fundamental environmental differences are supposed impact opportunities to engage in management and leadership: we assume that nursing home staff members have better opportunities to interact with leaders and colleagues, whereas home help staff members have limited opportunities to interact with leaders and colleagues. 9,10 Some previous studies on leadership in eldercare have focused on leadership at a general level. Others have focused on leadership in either nursing homes or home help services but not both.…”

Home Health Agency Work Environments and Hospitalizations

“…Robust linear regression models were used to estimate the relationship between the work environment and the agency outcomes. Covariates were state (California, New Jersey, or Pennsylvania), average level of nurse burnout, and the interaction between nurse burnout and the home health agency work environment 7. Separate regression models were estimated to assess the effects of each work environment subscale on the outcomes (see SDC, Supplemental Digital Content 1, http://links.lww.com/MLR/A766).…”

“…In home care, as in hospitals, effective and efficient nursing care requires adequate resources, managerial support, and collegial relations with doctors, and other members of the interdisciplinary care team 7,21–25. Elements of a good work environment include the conditions necessary to provide good patient care and retain qualified employees.…”

“…Because salary and benefits for nursing and therapy staff account for the majority of home health operating expenses, reduced Medicare payments may result in deterioration of the work environment in home health agencies, including increased workloads, strained relationships among coworkers, and pressure to ration care (eg, shorten number/length of visits) 6,7. One possible consequence is difficulty avoiding hospital and long-term care admissions.…”