Departments of Psychiatry and Health Care Management, Perelman School of Medicine and the Wharton School, University of Pennsylvania, Philadelphia, PA, USA.
Departments of Medical Ethics and Health Policy and Health Care Management, Perelman School of Medicine and the Wharton School, University of Pennsylvania, Philadelphia, PA, USA.
J Am Med Dir Assoc. 2023 Nov;24(11):1773-1778.e2. doi: 10.1016/j.jamda.2023.07.023. Epub 2023 Aug 24.
Nurse turnover can compromise the quality and continuity of home health care. Scope of practice laws, which determine the tasks nurses are allowed to perform and delegate, are an important element of autonomy and vary across states. In this study, we used human resource records from a multistate home health organization to examine the relationship between nurse turnover and whether nurses can delegate tasks to unlicensed aides.
A retrospective, cross-sectional analysis.
The study sample included 1820 licensed practical nurses and 3309 registered nurses, who spanned 30 states. The study period was 2016 through 2018.
We used weighted least squares to study the relationship between nurse turnover for registered and licensed practical nurses and task delegation across state-years. We measured task delegation continuously (0-16 tasks) and as a binary variable (14 or more tasks, which indicated the state was in the top half of the distribution).
Across state-years, the turnover rate was 30.8% for licensed practical nurses and 36.8% for registered nurses. Although there was no significant relationship between task delegation and turnover among registered nurses, we found that states in which nurses could delegate the most tasks had lower turnover rates among licensed practical nurses.
The ability to delegate tasks to unlicensed aides was correlated with lower turnover rates among licensed practical nurses, but not among registered nurses. This suggests that the ability to delegate tasks is more likely to affect the workload of licensed practical nurses. This also points to a potential and unexplored element of expanding the scope of practice for nurses: reduced turnover. Given the added work-related hazards associated with home health care, including working in isolation, a lack of social recognition, and inadequate reimbursement, states should consider whether changes in their policy environment could benefit nurses working in home health.
护士离职可能会影响家庭保健的质量和连续性。执业范围法是确定护士被允许执行和委托的任务的重要因素，其在各州之间存在差异。在这项研究中，我们使用多州家庭保健组织的人力资源记录，来检验护士离职与护士是否可以将任务委托给无执照助手之间的关系。
回顾性、横断面分析。
研究样本包括来自 30 个州的 1820 名执业护士和 3309 名注册护士。研究期间为 2016 年至 2018 年。
我们使用加权最小二乘法来研究注册护士和执业护士的离职率与各州各年的任务委托之间的关系。我们连续（0-16 项任务）和作为二项变量（14 项或更多任务，这表明该州处于分布的上半部分）来衡量任务委托。
在各州各年中，执业护士的离职率为 30.8%，注册护士的离职率为 36.8%。尽管在注册护士中，任务委托与离职之间没有显著关系，但我们发现，护士可以委托最多任务的州，其执业护士的离职率较低。
将任务委托给无执照助手的能力与执业护士较低的离职率相关，但与注册护士无关。这表明，委托任务的能力更有可能影响执业护士的工作量。这也指出了扩大护士执业范围的一个潜在且未被探索的要素：降低离职率。鉴于家庭保健工作相关的额外风险，包括孤立工作、缺乏社会认可和补偿不足，各州应考虑其政策环境的变化是否会使家庭保健工作的护士受益。
