title: Home healthcare nurse retention and patient outcome model: discussion and model development.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors: College of Nursing and Health Sciences University of Massachusetts Boston Massachusetts, USA. carol.ellenbecker@umb.edu
authors: Carol Hall
authors: CH
authors: Ellenbecker
authors: Margaret
authors: M
authors: Cushman
mesh_terms: D003657:Decision Making; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D033182:Intention; D007588:Job Satisfaction; D008962:Models, Theoretical; D015401:Nursing Administration Research; D009732:Nursing Care / Q000592:standards; D009740:Nursing Staff / Q000458:organization & administration* / Q000523:psychology; D010558:Personnel Loyalty; D010563:Personnel Turnover; D012196:Review Literature as Topic; D013315:Stress, Psychological; D000078329:Workforce