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Study Provides First Evidence for American Nurses Credentialing Center Pathway to Excellence Program in Home Care

In a new study, researchers at the University of Pennsylvania School of Nursing’s Center for Health Outcomes and Policy Research (CHOPR), and the Rutgers University School of Nursing examined the factors influencing the likelihood of missed nursing care in the home care setting. Their findings indicate that home care nurses with poor work environments are more likely to miss required care.

“This study provides the best evidence to date that better home care agency work environments and patient care can be expected from home care agencies that achieve Pathway to Excellence designation,” said Olga F. Jarrín, PhD, RN, assistant professor at Rutgers University School of Nursing and a senior fellow at CHOPR. “There has been a lot of research on the topic of hospital work environments, but very little on home care. Given that the homebound elderly and community dwelling disabled are a particularly vulnerable population, our question was, to what extent is the work environment in home care agencies related to the quality of care nurses provide to patients in their homes?”

Jarrín was first author on the paper, available online ahead of print in the journal Nursing Outlook, the official journal of the American Academy of Nursing and the Council for the Advancement of Nursing Science. She collaborated with CHOPR Director Linda H. Aiken, PhD, FAAN, FRCN, the Claire M. Fagin Leadership Professor in Nursing and the senior author on the paper, and Youjeong Kang, PhD, MPH, CCRN, now a postdoctoral fellow at the University of Washington School of Nursing.

To address their questions, the researchers relied on survey data collected from nearly 3,500 home care registered nurses in over 800 home care agencies between 2006 and 2007. Among other questions, nurses were asked whether they had omitted any required or necessary care activities due to a lack of time.

The quality of the home care agency work environment was determined from survey responses regarding nurses’ autonomy, the health and safety of the work environment, opportunities for professional development, quality of nursing management, and other standards of workplace excellence outlined in the American Nurses Credentialing Center Pathway to Excellence Program.

The Pathway to Excellence Program recognizes health care organizations that create positive work environments where nurses can excel in their practice and patient care.

“The pursuit of Pathway credentialing holds promise for recognizing nursing excellence in home care organizations and as a blueprint for moving more home care organizations into the highest levels of patient care excellence,” says Aiken.

As has been found in other settings, nurses working in agencies with poor work environments were more likely to report not having enough time to complete necessary patient teaching, counseling, and care coordination.

Categorizing home care agencies into poor, mixed, and better work environments, Jarrín and colleagues found that, nurses in in better work environments were less than half as likely to report missing necessary care coordination, counseling, or education of patients and their caregivers compared to nurses working in agencies with poor work environments.

Home care nurses were impacted as well. Specifically, nurses in the best work environments were less than one-third as likely to experience burnout, job dissatisfaction, or intend to leave their jobs compared with nurses working in the worst work environments.

“Having enough time to provide patient education and counseling helps nurses feel they are making a difference in the community and reduces burnout,” Jarrín said.

She noted that not only would ensuring that nurses have supportive work environments and manageable workloads improve care quality, but it could also improve retention for home care agencies.

Such attention to quality care is particularly significant in home care nursing, where a lack of good nursing care can lead to avoidable hospitalizations and institutionalizations.

The work was supported by grants from the American Nurses Foundation/Margretta Madden Styles Credentialing Research Grant, the National Institute of Nursing Research (NR007104 and NR014855), the Agency for Health Care Research and Quality (HS022406), the Robert Wood Johnson Foundation (053071), the John A. Hartford Foundation, and the Rita and Alex Hillman Foundation.