Quitting Home Care: A Narrative Inquiry of Registered Nurses Experiences in Navigating the Changes to Home Care Over Time

As populations are aging, there is an increasing demand on the acute care system. As a result, more care is transitioning to the community. Home care is a sector in health care that is well-positioned to support this transition and is expanding rapidly to do so. During the growth of the home care sector, rapid and ongoing changes are occurring that risk affecting frontline nurses who are the implementors of the changes. In this study, I engaged three nurses who left home care jobs due to burn out, lack of job satisfaction, and unrealistic expectations from their employer over time. For the methodology, I used Clandinin and Connelly’s (2000) narrative inquiry approach. My research puzzle explored how changes within the home care sector shaped the experiences of home care nurses, potentially influencing their decision to leave, and how their experiences of leaving home care impacted their lives. Their decision to leave home care was heavily influenced by the rapid and ongoing changes, which were negatively affecting them. The participants and I co-constructed stories about their experiences in feeling a lack of support from the employer, how they felt themselves negatively change, and how they could not see the extent of the negative effect until they had left the position in home care. The three participants worked in the south zone of Alberta, in an Alberta Health Services home care setting. I engaged in a minimum of four audio-taped conversations with each participant, lasting approximately 60 minutes per meeting. Using participants’ stories provided a snapshot of their time in home care. The participants spoke of how they felt the vision of home care was lost in the process of home care’s rapid growth and how this loss of vision affected their confidence in their nursing role. The participants also spoke about needing to reevaluate the role and expectation of a case manager as the program evolved. Furthermore, with the rapid growth of the program, the participants felt there was a lack of time to effectively build relationships with their clients and provide safe care. Lastly, the participants felt the team dynamics change as the pressures and expectations increased. Through these changes, they described how symptoms of trauma arose. The participants described situations that threatened their personal safety from both inside the organization and from the clients they provided care to. They explained feelings of powerlessness to be able to change their work experience, eventually resulting in moral distress. Lastly, as time went on in their home care journeys, the participants explained how chronic stress developed and how that impacted their physical and emotional health. Eventually, their experiences of trauma trickled into their personal lives. At one point, each participant identified their intent to leave nursing altogether from their experiences. Once they left home care, each participant spoke about their healing journey and what they had learned since leaving such as the ability to set boundaries for a healthy work life balance. Recommendations for health care organizations, nurses, frontline managers, education, and future research are presented in the final chapter, based on the participants' journeys and experiences.

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