A new study used standards outlined in the American Nurses Credentialing Center (ANCC) Pathway to Excellence® Program to investigate how positive practice environments affect nursing workforce outcomes and patient care quality in home care.
The study, conducted by researchers from the University of Pennsylvania School of Nursing’s Center for Health Outcomes and Policy Research (CHOPR) and Rutgers University School of Nursing, was available online ahead of print in the journal Nursing Outlook.
Authors Olga F. Jarrín, PhD, RN; Youjeong Kang, PhD, MPH, CCRN; and Linda H. Aiken, PhD, FAAN, FRCN, relied on survey data collected from nearly 3,500 home care RNs in more than 800 home care agencies between 2006 and 2007. The survey asked questions 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 ANCC Pathway to Excellence Program. The researchers categorized home care agencies into poor, mixed, and better work environments.
“There has been a lot of research on the topic of hospital work environments, but very little on home care,” said Jarrín, an assistant professor at Rutgers University School of Nursing and a senior fellow at CHOPR. “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?”
Nurses in better work environments were less than half as likely to report missing necessary care coordination, counseling, or education of patients and their caregivers. RNs in better work environments were also less likely to report burnout, job dissatisfaction, and intentions to leave their jobs compared to nurses working in agencies with poor work environments.
“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 Jarrín, a Pennsylvania State Nurses Association member.
In addition to improving quality of care, Jarrín noted that supportive work environments and manageable workloads also may improve retention rates at home care agencies.
“The results of Dr. Jarrín’s study are consistent with those found in acute care settings about the benefits of empowering and supportive work environments,” said Christine Pabico, MSN, RN, NE-BC, director of the ANCC Pathway to Excellence program. “It also supports the applicability and value of using the Pathway to Excellence framework in transforming organizational cultures in the home health settings.”
“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,” said Aiken, who is the Claire M. Fagin Leadership Professor in Nursing at the University of Pennsylvania School of Nursing, and a Pennsylvania State Nurses Association member.
The work was supported by grants from the American Nurses Foundation/Margretta Madden Styles Credentialing Research Grant, the National Institute of Nursing Research, the Agency for Health Care Research and Quality, the Robert Wood Johnson Foundation, the John A. Hartford Foundation, and the Rita and Alex Hillman Foundation.