607 - Home health nurses’ perspectives on gaps and opportunities for recruiting into the workforce to care for children with invasive mechanical ventilation (IMV)

Poster Number: 607
Publication Number: 607.404

Sarah A. Sobotka, University of Chicago, Chicago, IL, United States; Sarah Laudon, Chicago Medical School at Rosalind Franklin University of Medicine & Science, Chicago, IL, United States; Emma Lynch, University of Chicago, Chicago, IL, United States; Kim Whitmore, Marquette University College of Nursing, Milwaukee, WI, United States

Background: Children with medical complexity (CMC) with invasive mechanical ventilation (IMV) often require private duty home health nursing care to live in their homes. However, there are ubiquitous shortages of skilled home nursing professionals. Home health is an especially vulnerable nursing sector because of less competitive wages and lack of exposure to the field during nursing education.

Objective: Our team sought to (1) review existing literature on the home health nursing workforce and nursing education and (2) understand home health nurses’ perspective on gaps and opportunities for recruiting into the workforce to care for children with IMV.

Design/Methods: Semi-structured interviews were conducted with home health nurses for children with IMV, recruited though a state-wide agency, using convenience and snowball sampling.  All interviews were coded independently by two reviewers; the interview guides served as initial codebooks and were iteratively modified as themes emerged. Themes relating to nursing and employment backgrounds, perceived gaps in education and training, and IMV experiences were identified.

Results: Fifteen interviews lasting an average of 79 (45-132 minutes) were analyzed. Participants were primarily female (93%) with a mean age of 42.3 years.  The majority worked full-time (60%) and had an average of 14 years of experience (range: 1-36). Seven were Registered Nurses, 4 had a Bachelors of Science in Nursing, 3 were Licensed Practical Nurses, and 1 had a Master of Nursing.  During nursing education, participants described a lack of exposure to private duty home health nursing; many entered the field serendipitously. Nurses often entered the field because of a passion for care of CMC or to continue care for specific children they met in the hospital. Challenges to employment included lack of: adequate training, competitive wages, and benefits. Home health nurses remained in the field because of the rewarding work with patients and families. Many valued flexibility, slower pace, and one-on-one patient interactions. Nurses described that home care for children with IMV requires high clinical competence which was achieved through experience.Conclusion(s): Home health nurses for IMV describe lack of formal recruitment, adequate training, and employment benefits. However, the opportunity to work longitudinally and individually with patients was rewarding. Creative solutions must be explored with nursing perspectives to recruit and sustain this essential workforce, including exposure during education, improved training and benefits, and consideration of alternative employment structures.