Home care nursing competencies: Expected entry-level proficiency levels of new baccalaureate nursing graduates

This study was designed to examine the similarities and differences of home care nursing supervisors and nursing professors regarding their perceptions of the proficiency levels for competencies new baccalaureate nursing graduates need for entry level practice in home care nursing. ^ Nursing programs (associate, hospital diploma, and baccalaureate degree) have primarily prepared graduates for employment in hospitals. A distinguishing feature of baccalaureate programs has been added preparation in community health. Home care is a subspecialty of community health along with school, occupational, and public health, all of which focus primarily on health promotion and chronic illness in non-hospital settings. In 1993 certification in home care nursing was started by the American Nurses Association. ^ With recent changes in health care delivery, there has been an increased focus on community health nursing, especially home care. Between 1988 and 1992 the nurses employed in home care services doubled (AACN, 1999) while hospitals downsized. ^ In recent reports, the Pew Health Professions Commission called for higher education and the health care industry to respond collaboratively to prepare health care providers for practice in non-hospital settings. Although several studies have focused on nursing educators\u27 and administrators\u27 perceptions of entry level nursing competencies in other practice settings, none have focused exclusively on home care. ^ The subjects in this study were 72 home care clinical nursing supervisors and 21 community health nursing professors. All were employed in the State of Connecticut. A survey instrument, designed for this study, examined the proficiency level of 155 home care competencies new baccalaureate nursing graduates would need for an entry level position. The competencies were placed into four construct clusters: direct patient care, case management and coordination, supervision and leadership, and technical procedures. ^ Separate variance t-tests and one-way analysis of variance tests were used to compare responses of supervisors and professors. There was no significant difference between the groups for all four competency constructs, however significant differences were found for 34 of the individual competencies. ^ The findings of this study have implications for curriculum design in nursing programs and recruitment, orientation, and performance evaluation in the work setting. Areas for further research are identified.