The Relationship Between Scope of Practice Laws for Task Delegation and Nurse Turnover in Home Health.

TitleThe Relationship Between Scope of Practice Laws for Task Delegation and Nurse Turnover in Home Health.
Publication TypeJournal Article
Year of Publication2023
AuthorsCandon, M, Bergman, A, Rose, A, Song, H, David, G, Spetz, J
JournalJ Am Med Dir Assoc
Volume24
Issue11
Pagination1773-1778.e2
Date Published2023 Nov
ISSN1538-9375
KeywordsCross-Sectional Studies, Home Care Services, Humans, Retrospective Studies, Scope of Practice, Workload
Abstract

OBJECTIVE: Nurse turnover can compromise the quality and continuity of home health care. Scope of practice laws, which determine the tasks nurses are allowed to perform and delegate, are an important element of autonomy and vary across states. In this study, we used human resource records from a multistate home health organization to examine the relationship between nurse turnover and whether nurses can delegate tasks to unlicensed aides.

DESIGN: A retrospective, cross-sectional analysis.

SETTING AND PARTICIPANTS: The study sample included 1820 licensed practical nurses and 3309 registered nurses, who spanned 30 states. The study period was 2016 through 2018.

METHODS: We used weighted least squares to study the relationship between nurse turnover for registered and licensed practical nurses and task delegation across state-years. We measured task delegation continuously (0-16 tasks) and as a binary variable (14 or more tasks, which indicated the state was in the top half of the distribution).

RESULTS: Across state-years, the turnover rate was 30.8% for licensed practical nurses and 36.8% for registered nurses. Although there was no significant relationship between task delegation and turnover among registered nurses, we found that states in which nurses could delegate the most tasks had lower turnover rates among licensed practical nurses.

CONCLUSION AND IMPLICATIONS: The ability to delegate tasks to unlicensed aides was correlated with lower turnover rates among licensed practical nurses, but not among registered nurses. This suggests that the ability to delegate tasks is more likely to affect the workload of licensed practical nurses. This also points to a potential and unexplored element of expanding the scope of practice for nurses: reduced turnover. Given the added work-related hazards associated with home health care, including working in isolation, a lack of social recognition, and inadequate reimbursement, states should consider whether changes in their policy environment could benefit nurses working in home health.

DOI10.1016/j.jamda.2023.07.023
Alternate JournalJ Am Med Dir Assoc
PubMed ID37634547
PubMed Central IDPMC10735229
Grant ListP30 AG012836 / AG / NIA NIH HHS / United States