Work stress/strain, low job satisfaction, and intent to leave home health care nursing among Home Health Care Registered Nurses (HHC RNs)

Abstract

Background: The U.S. shortage of Home Health Care (HHC) Registered Nurses (RNs) is growing and the demand for HHC RNs is estimated to increase 109% by 2020. Factors associated with this shortage of HHC nurses include job stress/strain and low job satisfaction. Predictors of intent to leave their present HHC nursing position are not clear. To date, no published studies have been found that apply the effort-reward imbalance (ERI) model to HHC RNs. Purpose: The purpose of this study was to measure the level of job stress/strain associated with a low job satisfaction and intent to leave reported by HHC RNs practicing in the state of Maryland. Methods: This is a secondary analysis of the data collected from 794 HHC RNs participating in a 2006 study exploring hazard exposures in homecare. A mixedmethods analysis was conducted including quantitative and qualitative analysis. Results: Of the 206 HHC RNs that provided a narrative, 27.2% (n=56) reported an intent to leave or had already left their HHC positions. The six most frequent categories reported in the HHC RNs narratives included; negative organizationaltraits, work stress, love homecare, overwhelming paperwork, inadequate financial compensation, nurse attrition/intent to leave. Logistic regression analysis demonstrated reward as a significant predictor of good job satisfaction for all groups. Overcommitment and effort were significant predictors of low job satisfaction. Elevated ERI scores were reported for respondents with (77.2%) and without (35.0%) narratives indicating the respondents with narratives reported a higher incidence of elevated ERI scores compared to those without narratives. Conclusions: Many HHC RNs noted improvement is needed in their work environment. Job strain/stress is evident among HHC RNs and aspects of effort, reward, and overcommitment were found to be associated with low job satisfaction but no association with intent to leave.