1. Greenberg, E. Liza MPH, RN

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VNAA's voice has long advocated for safe, high-quality care for the patients and caregivers served by home healthcare, palliative care, and hospice. VNAA's free online tool, the Blueprint for Excellence features evidence-based and best practice recommendations for delivering quality home care through the paired tactics of creating structural systems that support delivery of high-quality care and adopting condition-specific interventions to improve outcomes.


In late 2019, VNAA launched two new modules of the Blueprint for Excellence: Home Healthcare Worker Safety and Registered Nurse Orientation Pathway. They expand the Blueprint's focus to those essential individuals providing care in the home. With the demand for home care expected to increase in the coming decade, agencies need to develop robust programs to train workers effectively, reduce risk, increase employee satisfaction (a key element of the Quadruple Aim), and improve retention.


The Blueprint module on Home Healthcare Worker Safety identifies resources and best practices to assist home healthcare and hospice organizations improve safety of their team members. The National Institute for Occupational Safety and Health reports that the nation's 4 million home healthcare workers typically work alone and without many of the safety protections typically available in institutional settings. Risks to home care workers include those common to all healthcare settings: infection, repetitive motion injury, and falls. Other risks are unique to home care or may present with very different implications including physical/verbal abuse, risks of injury from guns, pets or crime, automobile injuries, and environmental hazards including pests.


VNAA's best practice recommendations include proactively using data to understand and mitigate risk; developing policies and procedures for reporting and preventing risk to protect both patients and staff (and communicates the agency's commitment to staff safety); developing protocols to educate and partner with patients to reduce risks; regular training for staff including using scenarios or role playing on de-escalating risky situations; and identifying community resources to support patients.


VNAA's Registered Nurse Orientation Pathway module offers best practice tools to guide orientation of registered nurses new to home care and hospice practice. It responds to recommendations generated through a series of leadership forums convened by VNAA in 2019 to discuss challenges recruiting and retaining registered nurses in home care. Orientation of home care nursing staff was identified as a critical strategy for effective recruitment and retention of both experienced nurses and new graduates. Effective orientation programs correlate to greater satisfaction in practice and to nurse retention. Also, the caliber of an agency's orientation plan may influence nurse candidates.


The VNAA Registered Nurse Orientation Pathway module offers a four-part customizable tool to guide orientation. Checklists embedded in the tool address four critical domains: experiences for new nurses (the who, what, and where of the agency), skills needed for competent care delivery in the home, standards of care, and a guide to collaborative leadership coaching for new nurses. VNAA's expert work group created the tool by adapting orientation programs used by high-performing home care organizations to improve nurse satisfaction with home care and to reduce turnover. The Blueprint for Excellence can be reached via the ElevatingHome and VNAA websites.