OJ_RN

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

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.

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).

In the non-profit VNAs where I have worked (in Connecticut) it was typically expected that you would work Monday-Friday and every 3rd or 4th weekend, that would entitle us to one extra weekday off. Otherwise we used vacation or paid time off if we needed a weekday day off. It was not a matter of just scheduling your own patients on other days, as at least one new admission visit was frequently assigned each day to all RNs. Flexibility to schedule patients around an errand or appointment was usually possible, but there were many days when charting extended for hours in the evening (especially when I was paid a salary vs. hourly wage). Definitely ask about the option of working 4 longer days, and how the agency handles issues that come up with the patients on your caseload on your days off.

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.

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