Abstract
As reform activities continue to restructure health care, traditional roles of nurses are being reshaped and redefined. Many nurses displaced by organizational downsizing are seeking employment "outside of the hospital walls," including home care practice. Novice home care nurses may lack confidence in their ability to care for clients in the home. The purpose of this study was to examine the extent to which perceived self-efficacy is associated with job satisfaction in nurses who have recently changed from hospital-based practice to home care. Self-efficacy correlated significantly with job satisfaction. Nurses with high perceptions of self-efficacy fended to be more satisfied with their jobs. Using the theoretical framework of self-efficacy, educators can structure orientation programs to enhance the new nurse's perception of self-efficacy and, thereby, increase job satisfaction.
As the pendulum of healthcare reformation continues to swing away from hospital-based care, the need for nurses in community-based settings such as home care will increase. Nurses enter home care with varied clinical and educational backgrounds. Previous employment may not have provided them with the experience required to function in the home setting. Independent clinical judgment is critical in the home care setting because immediate assistance and supervision are not readily available. The roles and responsibilities of home care nurses differ greatly from those nurses practicing in acute care. Home care nurses must be competent in a variety of areas, possess technical proficiency, adapt equipment for use in the home setting, and exercise judgment that ensures safe clinical care. Novice home care nurses often have difficulty adjusting to changes in role expectations and performance. The transition from a hospital-based practice to home care can be difficult. Nurses who change practice settings often have unclear expectations. These nurses often lack the necessary confidence in their ability to care for clients in the home. This lack of confidence can contribute to job dissatisfaction, decreased productivity, and poor client care. Identifying the nurse's perception of self-efficacy when entering home care may assist in role development and contribute to job satisfaction.
The purpose of this study was to examine the extent to which perceived self-efficacy was associated with job satisfaction in nurses who recently changed from hospital-based practice to home care.
It was hypothesized that the degree of self-efficacy perceived by nurses who have recently changed from hospital-based practice to home care nursing is definitely correlated with job satisfaction. Self-efficacy was defined as the belief in one's capabilities to organize and execute the courses of action required to manage prospective situations (Bandura, 1995). Efficacy beliefs can be developed by four main forms of influence: mastery experiences; vicarious experiences; social persuasion; and physiological and emotional states (Bandura, 1995). Self-efficacy was measured in terms of the nurses' expectations that they could successfully perform the behaviors and activities required to produce the outcome which, in this case, was mastery of role and organizational requirements following transition from a hospital-based practice to home health care. Job satisfaction was defined as the combination of psychological, physiological, and environmental circumstances that cause a person to have a composite satisfaction with the job as a whole (Hoppock, 1935). Job satisfaction was measured as an overall composite score of these circumstances. Home care nursing was defined as the provision of nursing to acute and chronically ill clients of all ages in the home while integrating community health nursing principles that focus on the environmental, psychosocial, economic, cultural, and personal health factors affecting an individual's and family's health status (Humphrey & Milone-Nuzzo, 1991). Nurses who recently changed from hospital-based practice to home healthcare nursing were considered to be those who have 24 months or fewer in the home healthcare setting and at least 6 months of hospital experience prior to the home healthcare experience.