Linda Samia

Predictors of Home Healthcare Nurse Retention

PURPOSE To examine the level of job satisfaction and test a theoretical model of the direct and indirect effects of job satisfaction, and individual nurse and agency characteristics, on intent to stay and retention for home healthcare nurses. DESIGN A descriptive correlation study of home healthcare nurses in six New England states. METHODS Home healthcare nurse job satisfaction self-report data was collected with the HHNJS survey questionnaire & Retention Survey Questionnaire. FINDINGS Based on a structural equation model, job tenure and job satisfaction were the strongest predictors of nurse retention. CONCLUSIONS Understanding the variables associated with home healthcare nurse retention can help agencies retain nurses in a time of severe nurse shortages and increased patient demand. CLINICAL RELEVANCE Predicted nursing shortages and increasing demand have made the retention of experienced, qualified nursing staff essential to assure access to high-quality home healthcare services in the future.

What home healthcare nurses are saying about their jobs.

A troubling bit of evidence recently reported by Sochalski (2004a) is that among all groups of nurses, those working in home care are among the most dissatisfied with their jobs. This is a change from the past, when nurses working in home healthcare were believed to be the most highly satisfied group of nurses (Simmons et al., 2001). The source of nurses’ dissatisfaction has been attributed to the changing work environment in home care (Anthony & Milone-Nuzzo, 2005;Ellenbecker & Byleckie, 2005b) brought about by recent federal and state regulations. Requirements for the Outcome Assessment and Information Set (OASIS) and a capitated reimbursement system with incentives to limit the amount of contact nurses have with patients have increased nurses’ work demands (Anthony & Milone-Nuzzo; Smith-Stoner, 2004b). The changes made in organizational structures and policies to adapt to the changes in regulation and inadequate staffing have increased nurses’ workloads, job stress, and job dissatisfaction (Smith-Stoner, 2002, 2004;Sochalski, 2004b).