Job demand and job resource factors explaining stress and job satisfaction among home care nurses – a mixed-methods sequential explanatory study

Abstract

Background Increasing home care has been seen as a way to respond to the growing care needs of the aging population. To secure a sufficient number of nurses to provide home care, it is essential to identify and take into account the factors related to their well-being and job satisfaction. This study examined associations of both objective and subjective job demands and resources with stress and job satisfaction among nurses working in home care. Methods This study used a mixed-methods sequential explanatory design. First, quantitative data was collected with a survey, followed by a qualitative survey with open-ended questions. Linear regression analyses and qualitative content analysis with an inductive approach were used to analyze the quantitative and qualitative data, respectively. Joint display in a form of a table was used to integrate the results. Results Of the objectively measured job demands and resources, higher proportion of direct care time and higher number of interruptions were associated with higher stress in the fully adjusted models. Of the subjective measures, higher time pressure, role conflicts and disruptions were associated with higher stress. Higher time pressure, role conflicts, and disruptions in the workday were associated with lower job satisfaction, whereas higher care continuity and having more autonomy were associated with higher job satisfaction. The results of the qualitative study, in which the nurses described their experiences of their working week, partly explained and confirmed the results of the quantitative study but were also contradictory in some respects. Conclusions Many demands, both subjectively experienced and objectively measured in terms of work organization, may undermine home care nurses’ well-being and enjoyment at work. A severe nursing shortage combined with a growing number of clients is the reality of home care, significantly increasing the risk of burnout and turnover among employees. Strategies must be developed urgently to ensure sufficient personnel in home care. For example, investments should be made in opportunities for autonomous planning of work, and promotion of good cooperation and functionality of work teams.

The need for acute assessments in home healthcare - Swedish registered nurses’ experiences

“…This is in line with the results from the current study, the RNs experienced the most difficult challenge in not having access to physicians in the same way as in inpatient care and primary care. In addition to a lack of support, it appears in Kaihlanen et al ( 2023 ) study that many demands, such as an increased number of seriously ill patients, affect home care RNs’ well-being and job satisfaction with increased risk of burnout at the same time as a serious nursing shortage (Kaihlanen et al, 2023 )., Our study shows that RNs often lack various aspects of support in their work and there is an urgent need to develop strategies to ensure sufficient personnel in home healthcare. An acute assessment at home carried out by an RN in home healthcare can be compared to a pre-hospital assessment carried out by RNs from the ambulance service.…”

Person-centred care and the work-related health and job satisfaction of health and social care professionals: protocol for a prospective longitudinal cohort study combined with qualitative studies (the PCC@Work project)

“…The work environment for health and social care professionals is characterised by demanding conditions, including high workloads, low control, ethical dilemmas, unclear roles, and demanding schedules which may lead to increased stress and job dissatisfaction [ 10 – 13 ]. Additionally, an unsatisfactory and stressful work setting, along with ethically challenging situations, often prompt health and social care professionals to seek alternative employment [ 10 , 12 , 14 , 15 ].…”

“…Notably, it is concerning that both newly graduated and experienced professionals show a significant likelihood of considering leaving their current positions [ 10 , 12 , 16 ]. The shortage of skilled professionals has detrimental effects on the workload, quality of care and patient safety [ 10 , 13 , 17 , 18 ]. This situation is untenable and requires immediate attention to ensure adequate staffing in the future of health and social care.…”

Effects of workday characteristics and job demands on recovery from work among Finnish home care nurses: a multi-source cross-sectional study

“…The lack of personnel, in addition to lower average functioning and growing number of clients in home care have caused an increase in job demands by increasing the number of client visits, but also through more intense and less flexible workdays (Kaihlanen et al 2023 ; Ruotsalainen et al 2020 ). The increase in the number of clients and visits has led to several nurses visiting one client (Väisänen et al 2022 ), which might compromise the continuity of care.…”