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  1. Murray, Teri A. PhD, RN, C


The focus of healthcare delivery continues to shift from hospital-based nursing practice to care in the community, which includes home health care. Many basic nursing education programs provide home healthcare clinical experiences for students. However, this may not be enough to assist nurses in achieving home health nursing competency. Most nurses recruited into home health care worked exclusively in hospitals. Many nurses are employed in a practice environment for which they lack the necessary education and skills. As the practice environment for the nurse changes, so does the role of the nurse. Nurses are having difficulty adjusting to changing roles and responsibilities. This cross-sectional research study was conducted to evaluate the extent that new home healthcare nurses understand their role. This study reveals that nurses employed in home health care for 24 months or less continue to have only a moderate degree of understanding of their new role. These data suggest that educators critically evaluate the effectiveness of orientation programs for novice home healthcare nurses.


There is a growing concern that current organizational entry practices do not adequately ease the transition of new members into work organizations. These trends persist despite attention by institutions to provide orientation programs for new employees. As the practice setting for nurses changes, so does the role. Each role change involves a socialization process to the new role and setting. This role change can be applied to nurses who change from hospital-based practice to home healthcare nursing. A comprehensive program of orientation, skill acquisition and refinement, and continuing education is needed to ease the transition for nurses who change from a hospital-based practice to home care nursing.


The socialization process of the new home healthcare nurse involves role-related learning and learning of the organizational culture. The home healthcare agency orientation should be the process in which the new employee learns appreciate values, abilities, expected behaviors, and essential knowledge for assuming the new role and participating as a home healthcare staff member (Van Maanen & Schein, 1979). Three features often experienced by nurses entering new settings are change, contrast, and surprise. Change is described as the difference between the old and the new setting; contrast is the notable differences between the former setting and the current setting; and surprise represents the difference between anticipations and subsequent experiences in the new setting (Louis, 1980). Surprises may occur in varying forms: when expectations about the new job are not fulfilled early in the experience, when personal capability to perform job activities is absent, when unanticipated aspects of the job are encountered, and when assumptions brought from previous settings as operating guides fail.


Expectations exist in the professional practice of nursing that are specific to the setting in which the delivery of nursing care occurs. Nurses take on and internalize those expectations in each specific setting (Ebaugh, 1988). Role transition is the term used to refer to the process of changing from one set of expected positional behaviors in a social system to another (Allen & Vliert, 1984). This definition suggests significant changes in tasks, behaviors, norms, and values for a particular role holder. This is often the case when a nurse moves from one practice setting to another. The role transition process discussed in this study focuses on nurses who have changed from hospital-based practice settings to home healthcare settings. Role transitions can create role stress as the person attempts to meet new situational demands to adapt to new realities in work life (Nicholson, 1984). The unique aspects of home healthcare nursing as a specialty may not be addressed readily when nurses move from the hospital setting to home health care. An orientation to the role and responsibilities of the home healthcare nurse is essential. Nurses entering home health care may experience reality shock when their assumptions differ from those that prevail in the hospital setting. There are substantial differences in the task and skill requirements of work for the two settings. Although nurses employed in both settings provide nursing care, their daily routines are quite different in terms of the roles and the responsibilities they perform.