Abstract
Nurses are among the largest providers of home care services thus optimisation of this workforce can positively influence client outcomes. This scoping review maps existing Canadian literature on factors influencing the optimisation of home care nurses (HCNs). Arskey and O'Malley's five stages for scoping literature reviews were followed. Populations of interest included Registered Nurses, Registered/Licensed Practical Nurses, Registered Nursing Assistants, Advanced Practice Nurses, Nurse Practitioners and Clinical Nurse Specialists. Interventions included any nurse(s), organisational and system interventions focused on optimising home care nursing. Papers were included if published between January 1, 2002 up to May 15, 2015. The review included 127 papers, including 94 studies, 16 descriptive papers, 6 position papers, 4 discussion papers, 3 policy papers, 2 literature reviews and 2 other. Optimisation factors were categorised under seven domains: Continuity of Care/Care; Staffing Mix and Staffing Levels; Professional Development; Quality Practice Environments; Intra‐professional and Inter‐professional and Inter‐sectoral Collaboration; Enhancing Scope of Practice: and, Appropriate Use of Technology. Fragmentation and underfunding of the home care sector and resultant service cuts negatively impact optimisation. Given the fiscal climate, optimising the existing workforce is essential to support effective and efficient care delivery models. Many factors are inter‐related and have synergistic impacts (e.g., recruitment and retention, compensation and benefits, professional development supports, staffing mix and levels, workload management and the use of technology). Quality practice environments facilitate optimal practice by maximixing human resources and supporting workforce stability. Role clarity and leadership supports foster more effective interprofessional team functioning that leverages expertise and enhances patient outcomes. Results inform employers, policy makers and relevant associations regarding barriers and enablers that influence the optimisation of home care nursing in nursing, intra‐ and inter‐professional and inter‐organisational contexts.
Highlights
The Canadian Academy of Health Sciences (Nelson et al, 2000) and Fraser Institute (Barua, Hasan, & Timmermans, 2017) noted that the Canadian healthcare system is underperforming considering the financial investments that have been made; determining optimal scopes of practice for healthcare providers will be essential to inform system transformation
The research question was defined in collaboration with nursing leaders in home and community care and other sectors on the Home Care Nursing Optimization Workgroup Advisory Sub‐Committee of the Ontario Ministry of Health and Long‐term Care
This scoping review explored Canadian literature published over a 13‐year span and identified 32 factors categorised under 7 domains, which were identified for their potential relevance to the optimisation of home care nurses (HCNs)
Summary
The Canadian Academy of Health Sciences (Nelson et al, 2000) and Fraser Institute (Barua, Hasan, & Timmermans, 2017) noted that the Canadian healthcare system is underperforming considering the financial investments that have been made; determining optimal scopes of practice for healthcare providers will be essential to inform system transformation. Nelson et al, assert that creativity and innovation in relation to scope of practice are required to improve Canada's healthcare system. Nurses are among the largest p roviders of home care services; optimisation of this workforce can support optimal client outcomes while ensuring effective and appropriate use of human resources. This paper addresses a gap in synthesised literature and explores factors influencing optimisation of home care nurses (HCNs) in Canada, which will inform health system employers and policy makers struggling with similar challenges
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