Autonomy of nursing staff and the attractiveness of working in home care

Abstract

In many Western European countries, the need for home care is rising. As this is often not accompanied by sufficient growth in the supply of home-care nursing staff, a number of countries are facing current and expected future shortages of home-care nursing staff. Therefore, it is pivotal to gain insight into working conditions that are related to the attractiveness of working in home care. This knowledge can help in retaining current nursing staff in home care and in recruiting new staff. The central idea studied in this thesis is that autonomy is important for the attractiveness of working in home care. Reasoning from some important contributions to the sociology of professions, it is assumed that home-care nursing staff value autonomy as it contributes to their professionalism. Three dimensions of autonomy were distinguished: autonomy over patient care; work autonomy; and organisational autonomy. This thesis also discusses whether the assumed positive association between autonomy and attractiveness of working in home care applies to nursing staff regardless of their level of education. The research findings described in this thesis show that autonomy is positively related to the attractiveness of working in home care. Home-care nursing staff who perceive more autonomy are more engaged in their work and less likely to consider leaving the healthcare sector. Nurses see the three dimensions of autonomy as attractive aspects of their work. In addition, home-care nursing staff who feel they have more autonomy over patient care are more satisfied with their job. Concerning the positive relationship between autonomy and the attractiveness of working in home care, no major overall differences were found between nursing staff with a higher educational level and nursing staff with a lower level of educational attainment. The study outcomes can help policymakers, home-care organisations, employers' organisations in home care and professional associations to develop strategies for tackling staff shortages in home care. It is recommended that the autonomy of nursing staff in home care is promoted in home-care policy and practice. This thesis also offers indications as to how nursing staff’s autonomy can be enhanced. For instance, it was found that working in a self-directed team, which probably contributes to nursing staff’s organisational autonomy, is positively related to job satisfaction, partly because nursing staff in self-directed teams feel they have more autonomy over patient care. Furthermore, delivering and organising people-centred and integrated home care is also likely to enhance nursing staff’s autonomy. This thesis revealed that nurses value the different aspects of people-centred, integrated home care. The downside of autonomy may be a higher risk of professional misconduct going unnoticed. If home-care nursing staff’s autonomy is enhanced, self-regulation by the professional community becomes more important. This thesis explores whether home-care nursing staff know how to deal with suspicions of misconduct by colleagues. It was shown that there is still some room for improvement here as a substantial number of nursing staff find it difficult to raise suspicions of professional misconduct within their organisation.