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Discussion

Feedback Needed on Measuring Workload in Home Health Nursing

Dear home health nursing colleagues,

We would love your input on the wording of some questions about staffing and workload that will be included in a large survey of 300,000+ nurses later this year. The survey will be sent to RNs working in all practice settings; however we especially want to make sure that the questions are relevant and easy to answer for HOME HEALTH NURSES. Additionally, there are some items that will be asked ONLY of HOME HEALTH NURSES.

We invite you to read through the questions and answer them if you wish. We are especially interested in understanding which questions are difficult to answer, which you would be inclined to skip, or don't seem relevant. If you have any suggestions for other questions that we should ask related to home health nurse staffing and workload, please let us know that too.

Thank you in advance for taking a few minutes to help us out. The relationship between nurse staffing in hospitals and patient outcomes has been established; and this project may provide evidence of the same for home health care.

Sincerely,

Olga Jarrín, RN, PhD

Center for Health Outcomes and Policy Research

University of Pennsylvania, School of Nursing

This set of questions asks you about your nursing activities during the MOST RECENT SHIFT or the MOST RECENT DAY you worked at your primary job. [QUESTIONS FOR ALL NURSES]

1. Which best describes your last shift: Day / Evening / Night

2. How many hours were you scheduled? _____

How many hours did you work? ______

3. Was your last shift on a weekend or major holiday? Yes / No

4. Do you manage a panel/caseload of patients? Yes / No

If yes, how many patients? _____

5. How many different individuals did you care for during your last shift? ___

6. What was the maximum number of patients in your care at one time: ___

7. On the most recent shift/day you worked, how many patients....

Were assigned to you?___

Did you admit?___

Did you discharge?___

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

[QUESTIONS FOR HOME HEALTH NURSES ONLY]

10. How are you compensated for your work?

Per-visit / Hourly / Salary / Other_______

11. On a typical day, how many miles do you drive for work? ____

12. On a typical day, how many routine home visits do you make? ____

13. How many routine visits are counted for an admission or start-of-care visit?

N/A / 1.5 / 2 / 2.5 / 3 / Other_________

14. How often do you consult or case conference with:

Physicians/APNs/PAs -------- Daily / Weekly / Monthly / Rarely / Never

Physical therapists ----------- Daily / Weekly / Monthly / Rarely / Never

Occupational therapists ----- Daily / Weekly / Monthly / Rarely / Never

Speech therapists ----------- Daily / Weekly / Monthly / Rarely / Never

Social workers --------------- Daily / Weekly / Monthly / Rarely / Never

Pharmacists ------------------ Daily / Weekly / Monthly / Rarely / Never

Family caregivers ------------ Daily / Weekly / Monthly / Rarely / Never

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    • Featured Replies

    • Expert

    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.

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    • Author

    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.

  • Quote
    • Expert

    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

  • Quote
    • Expert

    Another question to consider is on-call status

  • Quote
    • Author

    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).

  • Quote
    • Expert
    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.

  • Quote
    • Author

    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.

  • Quote
    • Author

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

  • Quote

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