The work environment and job-related stress among home healthcare nurses

The purpose of this study was to describe the relationship of the home healthcare work environment and job-related stress experienced by nurses. The study was guided by a theoretical model derived from an integration of job stress theory, the Neal Theory of Autonomy (Neal, 2000a), and theory of the professional nursing practice environment. It was theorized that there was some variability in stressors among home healthcare agencies, and that the adverse effects of stressors and job-related stress would be moderated in agencies where characteristics of the professional nursing practice environment were present.;An embedded multiple case study design, based on Yin's Case Study Method (2003), was used to contrast the work environments of two home healthcare agencies from one New England state. Data were collected through 29 semi-structured interviews, 13 formal field observations and several informal observations. Data were analyzed using pattern matching and grounded theory methodology. The case study was bounded in time from November 2005 to January 2006.;Findings suggest variability in stressors experienced by nurses in two home care agencies and work environment characteristics of a professional nursing practice environment were a factor in moderating the effects of stressors. Nurse autonomy was restricted with delayed adaptation to new roles and role change was a stressor experienced by nurse case managers from one agency and nurse specialists from both agencies.;Common themes were identified: nurses from both agencies experienced role conflict; nurses lacked control over their practice and the work environment in one agency and lost this control in the second agency with organizational change. Nurses from both agencies sought specific mechanisms to share in decision-making. There was a trend for nurses in both agencies to seek part-time and flexible hours of work in response to the stressors of the case manager role, role change, and personal demands. Work environment factors of leadership, organizational support of management and peers, and access to resources, were moderating factors.;Findings from this case study can be generalized to the guiding framework suggesting that characteristics of a professional nursing practice environment moderate the effects of nurse stressors.