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Better Outpatient Work Environments Have Better Patient Outcomes

 |  By Alexandra Wilson Pecci  
   September 23, 2014

Home health agencies that provide supportive work environments for nursing staff have the best patient outcomes, a new study finds.

It's not only nurses who work in inpatient settings that suffer from unsupportive work environments. A new study from University of Pennsylvania School of Nursing shows that the same is true for nurses working in home health agencies.


Olga Jarrín PhD, RN

Moreover, research shows, those unsupportive work environments can result in worse patient outcomes.

The study, which claims to be the largest of its kind, shows that home health agencies that provide supportive work environments have the best patient outcomes.

"Agencies with better work environments had lower hospitalization rates, and higher community discharge rates than agencies with poor environments," the study's lead author, Olga Jarrín, PhD, RN, of Penn Nursing's Center for Health Outcomes and Policy Research, told me via email. "This effect was more pronounced in agencies where nurses reported higher levels of emotional exhaustion."

Stress and emotional exhaustion often plague home health nurses when they feel that something is preventing them from providing the best care. Sometimes factors outside their control, like patients' social and economic challenges or a lack of community resources, get in the way of patient care.

But other times "it is because a home health agency does not have the resources to support optimal nursing care," Jarrín says. "Where emotional exhaustion is caused or compounded by factors within the home health agency, outcomes are worst."

Allowing nurses to focus on patient care, rather than non-care responsibilities like administrative duties, is a major lesson from the study. In fact, she says documentation of care, driving, and making phone calls take up the majority of a home health nurses' time.

So who should do these activities instead? Jarrín says that the use of a scribe and/or driver "might dramatically increase the efficiency, safety, and satisfaction of home health nurses." For instance, she points out that interruptions from phone calls during patient care and while nurses are driving is very common.

And although home health nurses are often expected to do their documentation in patients homes, Jarrín says that "many nurses spend hours completing their charting after seeing patients, creating the potential for less accurate documentation, and long days for nurses."

But the study's overarching message is that nurses need supportive work environments to do their jobs to the best of their ability and training. Such environments provide enough time and staff to provide quality care; involve nurses in organizational decision making; provide opportunities for education and advancement; foster good working relationships between nurses and physicians; ensure continuity of patient care assignments; and offer good management and leadership, says Jarrín.

Her description of a supportive work environment should sound familiar to readers of this column because they're factors that are important for nursing and its leadership no matter the setting. Likewise, the critical lessons that Jarrín says nurse leaders can learn from this study are the same:

  • Involve direct-care nurses in identifying areas of care delivery that could be improved, and work together to make the changes
  • Ensure workloads are manageable
  • Ensure issues with documentation systems are addressed
  • Ensure nurses have access to knowledge and information needed to provide great care, such as: medication teaching and safety information, timely access to lab results, evidence-based assessment and decision-support tools, and expert/advanced practice nurses who can be consulted when needed regarding chronic disease management, wound care, and pain management, or end of life care
  • Learn about and consider the organization's readiness and progress towards being recognized as a place where nurses thrive and are supported in providing the best patient care possible

"The work environment, especially good nursing management and leadership, and the foundations of nursing care… are strongly associated [with] the national priority area of reducing preventable hospital admissions." Jarrín says.

Alexandra Wilson Pecci is an editor for HealthLeaders.

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