Carolyn J. Humphrey

Home care nursing orientation model. Justification and structure.

An orientation program for new nurses in a home care agency can be an effective tool that increases job satisfaction, alleviates a potentially high employee attrition rate, boosts morale, and thereby improves overall quality of patient care.

Home care nursing orientation model: content and strategies.

Orientation for the home healthcare nurse consists of specific content areas that are organized into a comprehensive program. The teaching strategies used to deliver the content are just as important as the information included in the orientation program.

Be careful out there.

Recently, a member of the ILA-USMX Joint Safety Committee came upon the photo above at a Facebook webpage devoted to “Longshore Safety.” The worker who posted the photo also posted a few other photos of the same piece of equipment, with a commentary that essentially complained of the general unsafe condition of that particular industrial truck. We couldn’t agree more, and have already approached the owner of that equipment to register our strong protest about the cluttered area at the operator’s foot pedals, oily surfaces on the machine’s access way and the absence of gauges that were installed by the manufacturer but that no longer exist.

Are there financial benefits of adding to the home health aide's role?

ince PPS, agencies have been reworking clinical models to reach the goal of more cost-effective home care. The rush to restructure began with IPS when many agencies hired LPNs because they were less expensive than RNs. There has been talk of moving some activities typically associated with skilled nurses to home health aides (HHA). Discussions on list servs and review of state nursing practice acts are being conducted to determine if activities such as blood collection, dressing changes, etc., could be done by an HHA on a visit rather than sending a nurse. The assumption is that this would save money and resources. Managers, administrators, and clinicians are examining how lower-paid personnel can assume activities that are presently carried out by more specialized and highlypaid professionals. Another expected outcome is that RNs would be free to assume the role of case manager and coordinator, ultimately saving resources. I’m reminded of the axiom, “Those who fail to learn from the past are destined to repeat it.” In this case, I would suggest we need only look at other facilities to learn a great deal. Our hospital colleagues were very busy when DRGs were being implemented in restructuring and “redesigning” their clinical departments. First, nurses were to assume all tasks (including serving meal trays and emptying waste baskets) under the guise of total patient-centered care. The next step, often called “Cross Training” was to transfer responsibilities away from the nurse to the unlicensed assisted personnel. The goal of these changes was to reduce labor expenses with a neutral or improved effect on quality. So, what’s been the result? An informative article in the November, 2000 issue of the Journal of Nursing Administration provides a review of the literature of the past decade which suggests that there have been few long-term studies that either support or contradict this assumption (McClung, 2000). The authors provide an excellent overview on the various literature that gives factual, sometimes only antidotal, accounts of one institution’s experience. Another article (McGillis Hall, 1997) sums up my sentiments about this topic. In discussing nursing staff mix models, the author expressed concern that nurses are often seen as a cost rather than a cost-effective means of delivering care, and that the focus on task delegation returns nursing to an older care model. We in home care and hospice must find newer models of care. We need to avoid replicating strategies that do not work. Such acts waste time, energy, and resources and are potentially hazardous to our patients. The home environment is a much different place than the confines of an institutional setting. Home care requires more oversight, assessment expertise, and clinical decision-making skills provided in an environment that is less structured with little, if any, back-up support for the care provider.