Productivity Measurement for Home Health Care Registered Nurses

The purpose of this study is to develop a productivity measurement applicable to home health registered nurses (RNs) by identifying and quantifying the knowledge and ability variables that define productive nurse practice. A preliminary set of knowledge and ability variables was identified based on content analysis of interviews with local nurse managers and round I of a three round Delphi procedure, using a purposive sample of nurse managers from nationally preeminent agencies. A randomized national sample of 337 nurse managers was then surveyed to determine the relative value and rank of the knowledge and ability variables. These variables were refined during Delphi round II and III. Based on the three Delphi rounds, the interviews and the responses to the national survey, a profile was developed, using factor analysis, consisting of 35 important knowledge and ability variables. These variables clustered into seven constructs: Practice Management, Knowledge/Skill Maintenance, Written Documentation, Home Health Care Knowledge, Communication, Nursing Process, and Client/Family Management. Within these seven constructs, the following individual variables were considered most important: skill in health assessment and hands on technical skill, documentation, independent decision making, communication, organizational ability, and a foundation in teaching/learning principles and home care rules and regulations. Qualitatively identified associations among variables were statistically supported. Nonparametric tests, including the Kruskal-Wallis and Mann-Whitney U test, were used to identify differences in the importance of specific knowledge and ability variables among governmental, hospital based, proprietary, and VNA agencies, and between hospice and non-hospice agencies. No significant differences were found among agency types. However, among agencies considered preeminent, intellectual skills appeared to be of greater importance to productive practice than direct care skills. Results of this study suggest a profile of productivity dimensions which provides (1) a theoretical basis for understanding the knowledge and ability variables associated with RN productivity in the home health setting, (2) a description of nurse inputs in a home health services productivity model, and (3) a reality based measurement tool that has utility in understanding and managing RN productivity in home health care