PREPARING TO CHANGE FROM ACUTE TO COMMUNITY-BASED CARE - LEARNING NEEDS OF HOSPITAL-BASED NURSES

Objective: Increasingly, professional nurses will be required to funct ion in practice settings other than acute care,vet little is known abo ut how nurses perceive the skill sets required to practice in these no nacute care settings. This study explores nurses? perceptions and need s concerning the transition from acute to home care and community-base d healthcare facilities, Background: Because the healthcare reform env ironment of the 1990s mandates changes II the ways hospitals and hospi tal nurses care for patients, many nurses in acute care settings antic ipate that their roles will include or perhaps shift completely to pra ctice in the home and other community-based settings. How professional nurses perceive the skills required to practice in these nonacute car e settings may well influence their willingness to accept work redesig n initiatives and voluntary employment transitions that involve workin g outside the hospital setting. Methods: Based on focus groups and the literature, a three-part 56-item questionnaire was developed as the s tudy instrument to assess skill needs and concerns related to function ing in the acute, home, and community-based settings. A coral of 879 n urses representing various specialties in healthcare institutions in t he Philadelphia and five-county surrounding areas participated. Result s: Test retest for the study instrument was 0.87 for a 2-week period, and alpha coefficients ranged from 0.90 to 0.94, Multivariate analyses revealed that proficiency on certain skill items in the acute care se tting predicted feelings of proficiency in home and community based se ttings. Based on regression and discriminant function analyses, top pr edictors and differentiators of proficiency in the nonacute care setti ngs were wound care and dressing, knowledge of community resources, di abetic education, patient and family advocacy, communication with thir d-party payers, and neonatal care. Conclusions: Some nurses, such as t hose working in critical care, perceive themselves as being able to fu nction proficiently in a wide variety of care settings-acute, home, an d community based. Furthermore, certain acute care skills were identif ied as top differentiators of proficiency in nonhospital settings, thu s providing direction for nursing administrators and academic institut ions. In addition, the tool developed for the study can serve as a sel f-assessment for individual nurses.