Organizational Climate and Nurse Work Outcomes in Home Healthcare

Researchers have identified associations between negative evaluations of organizational-climate indicators, attributes of the work environment, and worsening nurse work outcomes in acute care. Little is known about the relationships between organizational climate and nurse work outcomes in home healthcare (HHC). It is important to identify HHC organizational attributes that contribute to poor nurse work outcomes, particularly the loss of nurses and occupational safety injuries. This dissertation study is a secondary analysis of existing data from a large study, which used a cross-sectional survey design to evaluate occupational injuries in the HHC nurse population. The purpose of this study was to examine the relationships between organizational-climate indicators (i.e., management practices, professional-practice environment, and manageable workload) and two categories of HHC nurse work outcomes: (a) nurse response outcomes including job satisfaction, burnout, work-to-family stress, intent to leave the agency, and intent to exit the setting, and (b) occupational-safety outcomes including percutaneous injuries (needlesticks, other cuts, and human bites) and musculoskeletal injuries (back, upper extremity, and lower extremity). Bivariate and multivariate regression analyses were used. This research was designed to extend the limited HHC research and bridge the knowledge gaps by providing evidence of important relationships between organizational climate with nurse response outcomes. Relationships were found between higher levels of the organizational-climate indicators of interest and better HHC nurse response outcomes. In adjusted analyses, higher manageable workload was found to have the most relationships (seven) with nurse response outcomes, followed by a strong professional-practice environment (six) and strong management practices (two). Thus, organizational leaders are better informed as to important levers for evidence- based organizational development and change to improve nurse response outcomes. No associations were found between the organizational-climate indicators of interest and the occupational-safety outcomes, in bivariate analyses. Future HHC researchers can further evaluate relationships between the work environment and nurse occupational injuries in larger samples and may consider adding patient-safety outcomes.