Role Orientation in Novice Home Healthcare Nurses

Abstract

The focus of healthcare delivery continues to shift from hospital-based nursing practice to care in the community, which includes home health care. Many basic nursing education programs provide home healthcare clinical experiences for students. However, this may not be enough to assist nurses in achieving home health nursing competency. Most nurses recruited into home health care worked exclusively in hospitals. Many nurses are employed in a practice environment for which they lack the necessary education and skills. As the practice environment for the nurse changes, so does the role of the nurse. Nurses are having difficulty adjusting to changing roles and responsibilities. This cross-sectional research study was conducted to evaluate the extent that new home healthcare nurses understand their role. This study reveals that nurses employed in home health care for 24 months or less continue to have only a moderate degree of understanding of their new role. These data suggest that educators critically evaluate the effectiveness of orientation programs for novice home healthcare nurses.

Workplace Variables and Their Relationship to Quality Client Outcomes in Home Health

“…The results related to the workplace variable OS suggest that nurses who have high levels of interaction with supervisors (VP) and with peers (HP), as well as guidance from many rules and procedures (FO) may be the typical picture of OS in the home health setting. These results are similar to those found in previous studies of clinic and home health nurses , 1998. In this study, OS results suggest that clients are more satisfied when nurses follow procedures to guide practice (FO) and when supervisors seek the nurses' input for decision making and consult with nurses concerning job-related tasks (VP).…”

“…Nurses who have a clear understanding of their role will be more likely to perceive a positive working relationship that ultimately can lead to better nurses' perceptions of client outcomes and client satisfaction. Additionally, retaining nurses in the agency may lead to these high levels of role clarity (Murray, 1998; Azzarello, 2003).…”

“…In previous research in acute care settings, role conflict and role ambiguity varied across types of nursing units (Sowell & Alexander, 1989;Kroposki et al, 1999). In home health settings, researchers found that nurses employed longer have a better understanding of their role and possess ''knowledge structures'' that are predictive of care pattern recognition suggesting greater role clarity (Murray, 1998;Azzarello, 2003).…”

Transition from Academia to Home Health Practice

“…Murray (1998a) describes these phases as (a) separation from the old role, (b) transition period, and (c) assumption of the new role (p. 2). In this transition, nurses may experience surprise for several reasons: if their expectations regarding their new job are not fulfilled early, if they do not have the necessary skills, if there are unexpected requirements of the new job, or if assumptions brought from the previous job fail (Murray, 1998b). This surprise may engender a sense of being disconnected, reality shock, disorientation, depression, anxiety, frustration, or stress.…”

“…Variations in the nurses' responses are caused by the amount of preparation for the change, their emotional and physical health, their knowledge of their new role, support from peers and administration, and their perceptions of the expectations accompanying the new role (Kelly & Mathews, 2001). One study (Murray, 1998b) indicates that even after 2 years, new home care nurses still express only a moderate degree of understanding of their new role.…”