title: Autonomous home-care nursing staff are more engaged in their work and less likely to consider leaving the healthcare sector: a questionnaire survey.
abstract: BACKGROUND
  The need for home care is rising in many Western European countries, due to the ageing population and governmental policies to substitute institutional care with home care. At the same time, a general shortage of qualified home-care staff exists or is expected in many countries. It is important to retain existing nursing staff in the healthcare sector to ensure a stable home-care workforce for the future. However, to date there has been little research about the job factors in home care that affect whether staff are considering leaving the healthcare sector.
  
  
  OBJECTIVE
  The main purpose of the study was to examine how home-care nursing staff's self-perceived autonomy relates to whether they have considered leaving the healthcare sector and to assess the possible mediating effect of work engagement.
  
  
  METHODS
  The questionnaire-based, cross-sectional study involved 262 registered nurses and certified nursing assistants employed in Dutch home-care organisations (mean age of 51; 97% female). The respondents were members of the Dutch Nursing Staff Panel, a nationwide group of nursing staff members in various healthcare settings (67% response rate).
  
  
  METHODS
  The questionnaire included validated scales concerning self-perceived autonomy and work engagement and a measure for considering pursuing an occupation outside the healthcare sector. Logistic regression and mediation analyses were conducted to test associations between self-perceived autonomy, work engagement and considering leaving the healthcare sector.
  
  
  RESULTS
  Nursing staff members in home care who perceive more autonomy are more engaged in their work and less likely to have considered leaving the healthcare sector. The positive association between self-perceived autonomy and considering leaving, found among nursing staff members regardless of their level of education, is mediated by work engagement.
  
  
  CONCLUSIONS
  In developing strategies for retaining nursing staff in home care, employers and policy makers should target their efforts at enhancing nursing staff's autonomy, thereby improving their work engagement.
authors.affiliation: Netherlands Institute for Health Services Research (NIVEL), P.O. Box 1568, 3500 BN Utrecht, The Netherlands. Electronic address: e.maurits@nivel.nl.
authors.forename: Erica E M
authors.initials: EE
authors.lastname: Maurits
authors.affiliation: Netherlands Institute for Health Services Research (NIVEL), P.O. Box 1568, 3500 BN Utrecht, The Netherlands.
authors.forename: Anke J E
authors.initials: AJ
authors.lastname: de Veer
authors.affiliation: Netherlands Institute for Health Services Research (NIVEL), P.O. Box 1568, 3500 BN Utrecht, The Netherlands.
authors.forename: Lucas S
authors.initials: LS
authors.lastname: van der Hoek
authors.affiliation: Netherlands Institute for Health Services Research (NIVEL), P.O. Box 1568, 3500 BN Utrecht, The Netherlands; Department of Public and Occupational Health, EMGO Institute for Health and Care Research (EMGO+), VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
authors.forename: Anneke L
authors.initials: AL
authors.lastname: Francke
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D006699:Home Care Services; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009740:Nursing Staff / Q000523:psychology*; D010563:Personnel Turnover / Q000706:statistics & numerical data*; D017009:Professional Autonomy; D011795:Surveys and Questionnaires; D000078329:Workforce
keywords: Autonomy; Home-care services; Nursing staff; Turnover; Work engagement; Work environment