While home healthcare nurses value some of the same attributes as nurses in the magnet hospital studies (Flynn & Deatrick, 2003), it is not known if home healthcare nurses experience a practice environment that is reflective of the attributes they value. For this study, professional values and Donabedian’s SPO framework are used to describe how exercise of autonomous practice is translated into the practice model and impacts RN satisfaction. The purpose of this study is to describe how satisfied home healthcare nurses are with their ability to exercise autonomous practice: control over practice decisions and control over practice setting decisions. A convenience sample of staff RNs (N=146) from Medicare certified home healthcare agencies in Ohio (n=15) were surveyed. The Participation in Decision Activities Questionnaire (PDAQ) and the Nurse Work Index-Revised (NWI-R) measured exercise of autonomous practice and the Global Appraisal of the Practice Environment measured exercise of autonomous practice and satisfaction. Participants had an average age of 46 with 18.5 years of home care experience and almost 9 years of home healthcare experience. The importance of participation in practice decisions (mean=82.60, SD=17.23) to satisfaction was found to be slightly more important than importance of participation in decisions related to the practice setting (mean 77.41, SD=18.34). Using results from the NWI-R, regression analysis showed that 34% of satisfaction could be contributed to control over practice setting decisions and 24% to control over practice decisions. Findings suggest that the home care practice environment may not reflect the value of autonomy recognized by RNs as important to job satisfaction. It will take the collective wisdom of administration, nurses, and researchers to develop professional practice models that will reflect nursing values while providing cost-effective, quality care.
Session #1204 - Home Care
The 29th Annual MNRS Research Conference (April 1-4, 2005)