Carol Hall Ellenbecker

AIM: A national survey was conducted to examine the relationship between individual students’ experiences and nursing PhD program characteristics and program outcomes. BACKGROUND: In light of the shortage of doctorally prepared nurse scientists and a growth in nursing PhD programs, an examination of the PhD nursing education experience in relation to educational outcomes is timely. METHOD: Data were collected from graduates of a 50 percent random sample of nursing PhD programs in the United States. RESULTS: Graduates who had worked as research assistants, attended classroom-based programs, and worked as a nurse no more than 12 hours per week during their PhD education were more likely to have successful publication records and receive external research grant funding than graduates who did not have these experiences. CONCLUSION: On the basis of traditionally accepted measures of research productivity, our results indicate that nursing PhD programs have limited success in producing nurse researchers.

Nurse leaders and health-care experts agree that nurses have a responsibility to address the health problems facing the nation by participating in health policy development. However, nurses have not fully realized their potential when it comes to engaging in health policy advocacy and leadership. Nurse leaders, professional nursing organizations, accrediting bodies, and the Institute of Medicine have all identified the need to educate nurses in heath policy. Valuable recommendations for content and learning activities in health policy have been made. We argue that nursing education in health policy and the many recommendations offered have been broad and overly ambitious. This article presents a proposal for a staged approach to educating nurses. This approach would tailor content to the role of the nurse at each level of nursing education. The focus of health policy content would progress from the organizational level to local, state, and finally national level health policies. The goal of this approach is to better prepare all levels of nursing students to participate in shaping effective health policies.

The primary roles of nurse scientists in conducting health policy research are to increase knowledge in the discipline and provide evidence for informing and advancing health policies with the goal of improving the health outcomes of society. Health policy research informs, characterizes, explains, or tests hypotheses by employing a variety of research designs. Health policy research focuses on improving the access to care, the quality and cost of care, and the efficiency with which care is delivered. In this article, we explain how nurses might envision their research in a policy process framework, describe research designs that nurse researchers might use to inform and advance health policies, and provide examples of research conducted by nurse researchers to explicate key concepts in the policy process framework. Health policies are well informed and advanced when nurse researchers have a good understanding of the political process. The policy process framework provides a context for improving the focus and design of research and better explicating the connection between research evidence and policy. Nurses should focus their research on addressing problems of importance that are on the healthcare agenda, work with interdisciplinary teams of researchers, synthesize, and widely disseminate results.

Ellenbecker c.h. & cushman m. (2011) Home healthcare nurse retention and patient outcome model: discussion and model development. Journal of Advanced Nursing68(6), 1881–1893. Aim.  This paper discusses additions to an empirically tested model of home healthcare nurse retention. An argument is made that the variables of shared decision‐making and organizational commitment be added to the model based on the authors’ previous research and additional evidence from the literature.Background.  Previous research testing the home healthcare nurse retention model established empirical relationships between nurse, agency, and area characteristics to nurse job satisfaction, intent to stay, and retention. Unexplained model variance prompted a new literature search to augment understanding of nurse retention and patient and agency outcomes.Data sources.  Data come from the authors’ previous research, and a literature search from 1990 to 2011 on the topics organizational commitment, shared decision‐making, nurse retention, patient outcomes and agency performance.Discussion.  The literature provides a rationale for the additional variables of shared decision‐making and affective and continuous organizational commitment, linking these variables to nurse job satisfaction, nurse intent to stay, nurse retention and patient outcomes and agency performance.Implications for nursing.  The new variables in the model suggest that all agencies, even those not struggling to retain nurses, should develop interventions to enhance nurse job satisfaction to assure quality patient outcomes.Conclusion.  The new nurse retention and patient outcome model increases our understanding of nurse retention. An understanding of the relationship among these variables will guide future research and the development of interventions to create and maintain nursing work environments that contribute to nurse affective agency commitment, nurse retention and quality of patient outcomes.

Nurse shortages coupled with the need for national healthcare reform present a challenge. We are not preparing enough nurses nor are we preparing nurses with the right skills to fully participate in a reformed healthcare system. Historical forces in nursing education have resulted in multiple levels of entry into nursing practice and an inadequate nursing workforce. Today’s environment of expanding knowledge, the call for interdisciplinary healthcare delivery teams, and evidence of the relationship between nurse education and improved patient outcomes strongly indicate the need for nurses prepared at the baccalaureate level. Requiring a baccalaureate degree for entry into nursing practice, and as the initial degree of nursing education would prepare nurses earlier for graduate education and the much needed roles of educator, researcher and advanced practice nurse. The nursing profession should take the lead in advocating for educational policies that would adequately prepare the nurse workforce of the future.

Purpose: To examine the level of job satisfaction and test a theoretical model of the direct and indirect effects of job satisfaction, and individual nurse and agency characteristics, on intent to stay and retention for home healthcare nurses. Design: A descriptive correlation study of home healthcare nurses in six New England states. Methods: Home healthcare nurse job satisfaction self‐report data was collected with the HHNJS survey questionnaire & Retention Survey Questionnaire. Findings: Based on a structural equation model, job tenure and job satisfaction were the strongest predictors of nurse retention. Conclusions: Understanding the variables associated with home healthcare nurse retention can help agencies retain nurses in a time of severe nurse shortages and increased patient demand. Clinical Relevance: Predicted nursing shortages and increasing demand have made the retention of experienced, qualified nursing staff essential to assure access to high‐quality home healthcare services in the future.

Since the 2001 NAHC nursing shortage survey, no national study has explored changes in staffing vacancies, turnover rates, or the extent of the nurse shortage in home care. This article sets out the latest data.

Faced with a nursing shortage and anticipated increase in demand, home care agencies are implementing retention strategies with little knowledge of their effectiveness. The purpose of this study is to describe the strategies implemented and their effect on nurse job satisfaction and intention to leave. Data were collected from a random sample of 123 New England agencies during in-person interviews. Most agencies reported implementing multiple recruitment and retention strategies. Regression results suggest that the effects of employer retention strategy on nurses' intent to stay are the indirect result of its effects on job satisfaction. The only retention intervention that made a statistically significant difference in job satisfaction was shared governance, and no retention strategy directly affected nurses' intention to stay in their jobs.

A troubling bit of evidence recently reported by Sochalski (2004a) is that among all groups of nurses, those working in home care are among the most dissatisfied with their jobs. This is a change from the past, when nurses working in home healthcare were believed to be the most highly satisfied group of nurses (Simmons et al., 2001). The source of nurses’ dissatisfaction has been attributed to the changing work environment in home care (Anthony & Milone-Nuzzo, 2005;Ellenbecker & Byleckie, 2005b) brought about by recent federal and state regulations. Requirements for the Outcome Assessment and Information Set (OASIS) and a capitated reimbursement system with incentives to limit the amount of contact nurses have with patients have increased nurses’ work demands (Anthony & Milone-Nuzzo; Smith-Stoner, 2004b). The changes made in organizational structures and policies to adapt to the changes in regulation and inadequate staffing have increased nurses’ workloads, job stress, and job dissatisfaction (Smith-Stoner, 2002, 2004;Sochalski, 2004b).

The purpose of this study was to explore the factors that contribute to variability in home healthcare nurses’ job satisfaction. Nurses completed the 30-item Home Healthcare Nurses Job Satisfaction Scale specifically designed to measure job satisfaction of home healthcare nurses. Results suggest that the greatest amount of variability in satisfaction for home healthcare nurses are salary and benefits, stress and workload, and organizational factors, that is, factors over which organizations and management have the most control.