Feedback Needed on Measuring Workload in Home Health Nursing

caliotter3 · May 14, 2014

You have no questions directed to the home health nurse who does extended care, if that is germane to your inquiry. Typically only one patient to care for during a routine shift that is usually eight hours long, but may be as short as four hours or as long as 16 hours.

OJ_RN · May 14, 2014

Excellent point. We are interested in all Home Health Nurses, including those providing extended care or private duty. Is there a specific question about extended care nursing that you think would be important to include? Would it be helpful to ask directly if they provide extended care or private duty nursing? (We can figure this out if home health nurses answer #12 that they routinely only care for one patient). Also, just want to mention that this set of questions about workload and staffing is part of a larger survey that includes other topics related to nursing care and patient safety.

Home Health Columnist / Guide · May 15, 2014

Replace # 10, regarding employment status to tie into compensation

Do you provide Home Health:

__ Shift Care/Extended Care

__ Intermittent Skilled Visits

Are you employed in Home Health:

_ Full time exempt (salaried) employee

_ Part Time exempt (salaried) employee

_ Per diem paid by case

_ Full time hourly employee

_ Part Time hourly employee

_ Per diem hourly employee

Add: In the past year, has your employer changed how they are paying employees?

See thread: Agency is going to hourly vs pay per visit

Add to # 14 How often do you consult or case conference with:

Clinical Manager --------------- Daily / Weekly / Monthly / Rarely / Never

Do you want to add question regarding size of agency (# staff employed) or agency location: Urban, Suburban, Rural

Home Health Columnist / Guide · May 15, 2014

Another question to consider is on-call status

OJ_RN · May 15, 2014

Thank you for the great suggestions NRSKarenRN! In another area of the survey we ask if nurses are working full-time, part-time, per-diem, benefits and retirement. I will definitely incorporate some of your other suggestions (exempt/salaried, per case/visit, addition to #14). I like the idea of asking about on-call status, and your suggestion to ask about changes to agency payment model in past year - and will try to find a way to ask about overtime that is not routinely documented (if paid hourly).

I was hopeful that questions 8 and 9 might capture agency size (of licensed nursing staff working in a single branch, division or pod). I am very curious how others would answer those questions without additional cueing, as 8 & 9 are questions for ALL nurses on the 2014 survey, but were not asked of Home Health Nurses in 2006. We will also have agency location (asked in another section).

Home Health Columnist / Guide · May 16, 2014

8. Counting yourself, how many of each of the following provided direct patient care in your practice setting/unit the most recent shift/day you worked?
____ RNs
____ APNs Advanced Practice Nurses
____ LPNs/LVNs
____ Unlicensed Assistive Personnel
9. On your most recent shift/day, counting yourself, how many of the following were in your practice setting/ unit?
____ Patients
____ Permanent RNs
____ Float RNs
____ Supplemental Agency RNs

These questions really don't help capture home care staffing.

My employer has main administrative office + 4 satellite branch offices in Philly area...over 550+employees.

So if you ask about " your practice setting/ unit", would only be getting field staff informing you about one branch's staffing ~ 100 employees + think were medium size when agency actually is LARGE.

OJ_RN · May 16, 2014

Hi Karen, I so appreciate your feedback. Questions 8 & 9 have been used to get a sense of staffing and skill mix in a patient care unit, and the results are later aggregated to the organization level. In the example you gave, of a large agency with a main office and 4 branches, as long as we had at least one nurse returning a survey from each branch, we would have a picture of the organization as a whole. We do study organizations, however because one focus is on patient outcomes, we aggregate the data to Medicare ID numbers when possible, and a large agency that has multiple branches might also report under multiple Medicare ID numbers.

I am concerned nurses don't necessarily know how many registered nurses work outside their own branch or care team. There are also many home health agencies where nurses do not regularly return to a physical office or have much interaction in person with their coworkers. We will eventually be able to link survey data with information on agency reported patient census, number of visits and staffing - the accuracy of which has been hard to establish in the past. Thank you for helping to keep this conversation going, and I hope others will join in, as there are so many different ways home health agencies are organized.

OJ_RN · May 27, 2014

Last call for feedback on the wording of home health workload questions before we start pilot testing the survey.