Care continuity, team autonomy and resource planning systems in relation to perceived time pressure among Finnish home care nurses: a cross-sectional multi-source study

Abstract

Background: Due to a growing number of older people, nurses working in Finnish home care have been subject to increasing efficiency requirements leading to e.g., growing job demands, and turnover. Previous research has indicated that factors such as care continuity and self-organizing teams are beneficial to staff wellbeing and care quality, however, the research incorporating workday characteristics remains scarce. The aims of this study were to examine (1) how individual level work characteristics and job demands are associated with time pressure among home care nurses, and (2) how time pressure varies between work organization factors at the organizational level. Methods: A cross-sectional wellbeing survey for home care nurses in 16 teams, across Finland (n = 416). Further, items from a managers’ survey and RAI data sources were merged with the survey data. Linear regression analysis was used to analyze time pressure and individual level variables. T-tests and ANOVA were used to analyze the differences in time pressure among organizational level variables. Results: Lower proportion of breaktime, lower care continuity, working alone, and if something disrupted the course of a workday were associated with higher perceived time pressure. Of the organizational level factors, teams with higher autonomy and an Enterprise Resource Planning (ERP) system that took teams into account when planning client visits perceived lower time pressure. Conclusions: Flexibility is needed in home care nurses’ workdays. If an ERP system is used, it should ensure care continuity and allow for changes if disruptions during the workday occur. Due to the independent nature of home care work, collegial support is needed to cope with difficult situations. Furthermore, home care teams should have more autonomy over their work, which might lead to higher job satisfaction and retention among staff.