TABLE 2.
Themes within provider responses to “What barriers do you experience staffing nursing hours?” (sample of quotes below, total N = 54)
| Theme 1: Insufficient availability of home health nurses with desired skills/experience. |
| 1 A: There is a general shortage in the nursing workforce and it unevenly impacts certain geographical areas |
| “Lack of RN and LPN availability. Difficulty retaining consistent staff. High staffing turnover.” |
| “The demand for home nursing far exceeds the supply of home care nurses.” |
| “Lack of nurses in the field in the biggest barrier.” |
| “Severe shortage of home nursing available.” |
| “Availability of nurses in the areas where families live” |
| “Not enough nurses in our area to staff cases.” |
| “[I practice] in a very rural state where there are pockets of areas with no home health nursing available. Some families have had to move.” |
| 1B: Home nurses lack core qualifications and skills e.g., trach/vent and medical complexity experience |
| “Nurses with poor skills/competencies which results in a lot of turnover.” |
| “first job for many nurses/lack clinical competencies” |
| “lack of trach/vent trained nurses” |
| “Very little training required by the homecare agencies to nurses. Some in a home with a vented patient on their own and have never taken care of a vent.” |
| “home health companies do not have qualified nurses to take care/cover of these medically complex children.” |
| 1 C: Inadequate supply of home nurses with pediatric experience |
| “We do not have adequate supply of home nurses with experience taking care of children with complex health care needs.” |
| “Not enough [pediatrics]-experienced nurses available.” |
| Theme 2: Nurses are not interested in home care sector due to core job characteristics. |
| 2 A: Low pay for nurses secondary to low wages |
| “Availability of nursing likely due to poor reimbursement rates from Medicaid” |
| “low reimbursement rates (nurses gravitate to higher paying hospital-based jobs)” |
| “rate that nurses receive for home care has not changed in 20 years until a month ago.” |
| 2B: Difficulty with staffing shifts based on time of day |
| “Overnight shifts and weekends are the toughest to staff.” |
| “Availability of day vs. night nursing” |
| Theme 3: Insurance approval is a barrier to providing home nursing to families. |
| “Insurance does not have the shift nursing benefit coverage.” |
| “Private insurance does not approve 24/7 [home nursing]; can often negotiate for 14 days worth.” |
| “not enough hours approved” |
| Theme 4: Barriers to home nursing due to location and condition of family home |
| 4 A: General location of home is a barrier to home nursing |
| “Location of patient’s home” |
| “Neighborhood where family lives.” |
| “zip code of parental home” |
| 4B: Patient being in rural and/or remote area is a barrier to home nursing |
| “rural areas and decreased nursing availability” |
| “Patient living in larger communities have better access to nursing than many of our patients living in remote, rural areas.” |
| “Not enough pedi experienced nurses available. Also live in a very rural state where there are pockets of areas with no home health nursing available. Some families have had to move.” |
| 4 C: Poor home conditions/safety issues deter home nurses |
| “poor home conditions” |
| “unfavorable housing settings, real/perceived risk to nursing staff related to housing, neighborhood, poverty, family conflict, substance use/abuse in family, moral distress for nursing when family’s care standards differ from nursing staff’s” |
| “family, home environment” |
| “family lives in unsafe area so nurses do not want to go to that location to work” |
| Theme 5: Family relationship with home nurse or agency is a barrier to home health care |
| 5 A: Dissatisfaction with nurse or agency |
| “Experienced parents who don’t like specific nurses/companies for home care” |
| “Family not happy with nurse interviewed. |
| Language/cultural differences” |
| 5B: Family relationship with nurses is a barrier to staffing |
| “The demand for home nursing far exceeds the supply of home care nurses. Barriers include but not limited to: compensation offered to RN’s, area that pt lives, family dynamics, medical complexity/amount of tasks needing to be performed on shift.” |
| “1. Shortage in home nursing nurses; 2. Family interaction/personality barriers; 3. Case complexity; 4. Funding for private duty nursing” |
| “parents do NOT want nurse in home-- feel like it’s a stranger in home” |
| Theme 6: Family factors which create barriers to staffing hours. |
| 6B: Lack of family knowledge about home nursing is a barrier to staffing nursing hours |
| “Family unaware of how to obtain nursing hours |
| Family unaware of independent nurses” |
| 6 C: Other family social factors impacting home nursing receipt |
| “lack of trach/vent trained nurses, unfavorable housing settings... family conflict, substance use/abuse in family, moral distress for nursing when family’s care standards differ from nursing staff’s” |
| “social complexity” |
| “social home considerations” |
| 6D: Language/cultural barriers |
| “language barriers” |
| “Language/cultural differences” |