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20 Volume 39 | Number 1 www.homehealthcarenow.org

Jose Abelardo Garza, DHA, MBA, and Donna Taliaferro, PhD, RN, COI

Job Satisfaction Among
Home Healthcare Nurses

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Understanding the experiences of home healthcare nurses and exploring the factors

that influence job satisfaction is important in reducing costly staff turnover. The purpose

of the qualitative case study was to describe experiences related to job satisfaction

among home healthcare nurses. Herzberg’s Two Factor theory was used to frame the

study. Twelve home healthcare nurses from an agency in South Texas volunteered to

participate in in-depth interviews. Four themes emerged from the data: 1) patients

contribute to job satisfaction, 2) autonomy promotes job satisfaction, 3) occupational

stressors negatively influenced job satisfaction, and 4) leadership impacts job satisfac-

tion. Home healthcare leadership should take safety concerns seriously and explore in-

novative ways to promote communication between field nurses and physicians. Further

research is needed with a larger and more diverse sample of home healthcare nurses in

order to be able to generalize findings.

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

January/February 2021 Home Healthcare Now 21

strategy to increase job satisfaction (Baljoon et
al., 2018; Mohammed et al., 2017).

Method and Sample
After institutional review and facility approval, a
purposeful sample of RNs were recruited from a
for-profit home healthcare agency in South Texas.
Inclusion criteria included: a) working at least part-
time as an RN, b) an associate degree in nursing or
higher, and c) at least 1 year of experience as a
home healthcare nurse. Potential participants
were contacted by email. The study was explained
and interviews were scheduled with interested
participants.

Data Collection
The in-depth interviews were conducted in a pri-
vate office within the home healthcare agency and
lasted 30 to 60 minutes. Participants were assured
of confidentiality. A textual instrument (Supplemen-
tal Digital Content http://links.lww.com/HHN/A139)
was used to guide the in-depth interviews, which
were audio-recorded and transcribed verbatim. The
interview guide questions were divided in three
broad categories—defining job satisfaction, work-
ing conditions, and organizational factors. Audio
recordings and transcriptions were kept in a locked
office, and computerized data were password-
protected. Field notes were used to document ob-
servations during the interviews. Document re-
views of monthly turnover rate reports and exit
interview surveys were examined during data col-
lection as a method of data triangulation.

Data Analysis
This qualitative study used a thematic analysis
approach to describe experiences related to job
satisfaction among RNs working in home health-
care. A general inductive approach was used dur-
ing the analysis, which consisted of multiple
steps, as described by Vaismoradi et al. (2013).
First, interviews were transcribed verbatim. Sec-
ond, data collected were organized using De-
doose, a qualitative analysis tool. Third, tran-
scriptions and observational field notes were
organized into smaller components to give the
data meaning and formulate emerging themes.
Fourth, validating ensured that the information
collected was through ethical and accepted qual-
itative approaches. Triangulation strengthened
the study’s confirmability originating from multi-
ple sources of evidence. In addition, trustworthi-
ness was reached by continuously ensuring the

J
ob dissatisfaction is one of the main predic-
tors of burnout and turnover among regis-
tered nurses (RNs; Fatemi et al., 2019). The
consequences for high RN turnover are

costly, and the quality of care provided to the pa-
tients can be affected (Kieft et al., 2014; Nei et al.,
2015). Healthcare organizations spend between
$44,000 and $63,000 to replace an RN who resigns
(Yarbrough et al., 2017). Nurse job satisfaction has
received national recognition, particularly focusing
on hospital settings. The most common reasons
cited by nurses in hospitals for job dissatisfaction
are: heavy workload, pay, irregular schedules, lack
of opportunity for promotion, and leadership styles
of managers (Andrioti et al., 2017; Halcomb et al.,
2018; Lee & Jang, 2019).

Tourangeau et al. (2017) conducted a cross-
sectional survey to integrate nurse job satisfac-
tion factors and intent to remain employed in a
home healthcare setting. Surveys were mailed to
1,582 nurses who met the inclusion criteria of
being employed as a home healthcare RN, either
full-time or part-time, and more than 5 years away
from retirement. Forty-six percent of the surveys
were returned. The authors concluded that work
environment, supervisor relationship, and pay
were characteristics related to satisfaction and
intent to remain employed.

Baljoon et al. (2018) used Herzberg’s Two Factor
theory to present the conceptual analysis of work
motivation and the factors that affect a nurse’s job
performance. The study focused on intrinsic and
extrinsic motivation factors and the relationship
the factors had on job performance. Intrinsic fac-
tors such as self-interest and job pleasure were
established as motivational factors that affected
job performance. Rewards, job pay, fringe benefits,
and bonuses were identified as extrinsic factors
that affected job performance among nurses. The
theory was used to support the idea that motiva-
tion can affect a nurse’s job performance and level
of satisfaction in both negative and positive ways.

Little is known about job satisfaction of home
care nurses. The aim of this descriptive qualita-
tive study was to describe experiences related to
job satisfaction among RNs working in home
healthcare. Herzberg’s Two Factor theory was
used as the theoretical framework, which helped
provide a broader perspective on factors that in-
fluence nurse job satisfaction in home health-
care. The theory emphasizes the importance of
both preventing an unfavorable work environ-
ment and using encouragement as a motivating

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

22 Volume 39 | Number 1 www.homehealthcarenow.org

alignment of the study with the
research design and method,
bracketing, and authenticating
the data sources.

Results
The recruitment of participants
continued until data saturation
occurred at 12 participants. Age
was collected by decades, with
three participants were in their
20s, four in their 30s, two in their
40s, and three in their 50s. Only
one participant was male. Seven
participants held a bachelor’s de-
gree and five held an associate
degree. See Table 1 for additional
demographic information.

Major Themes
Four major themes emerged during analysis
of the data: (1) patients contribute to job satis-
faction, (2) autonomy promotes job satisfaction,
(3) occupational stressors negatively influenced
job satisfaction, and (4) leadership impacts job
satisfaction.

Theme 1: Patients contribute to job satisfac-
tion. All 12 of the participants stated that patients
and patient care contribute to job satisfaction and
were personally rewarding. Answers such as “I
enjoy helping people,” and “patients make the job
satisfying” were provided when describing their
relationship with their patients. For example, Par-
ticipant 3 stated the following:

The best part of my job is the patients. I
have always been passionate about nursing
and helping people. I find this type of work
so rewarding and motivational. I could be
having such a crappy day, and it only takes
one of my precious patients to cheer me up.
I love when I get to their house, and their
face lights up. Most of the time, these people
are lonely and do not have family, so when I
show up, I make their day.

Theme 2: Autonomy promotes job satis-
faction. Participants mentioned that a feeling of
autonomy in their daily work promoted job satis-
faction because they were able to make their own
decisions about patient care, and have the flexibil-
ity they loved. Participants felt that making their
own decisions made them feel confident and

trusted. This statement by Participant 1 is repre-
sentative of this theme:

I think there are many elements that would in-
fluence job satisfaction. For example, one
would be the time or length of work experience,
for example, do you have years of experience
or days of experience. That would definitely
affect the confidence or autonomy in the care
you provide, which I think highly influences
your level of job satisfaction. I make the deci-
sions and my supervisor supports me, which
gives me the confidence and trust that I need.

Flexibility was often mentioned as one of the ele-
ments that positively influenced job satisfaction.
The participants said they enjoyed the flexibility
because they were able to schedule their patients
around other commitments. Four of the nurses spe-
cifically mentioned flexibility as it relates to their
families—they were able to drop their children off
at school and pick them up at the end of the day.
The other three nurses said they enjoyed the flexi-
bility because they were able to work on their own
time and finish early or late. This statement by
Participant 2 reflects the importance of flexibility:

I would say that the best parts are that I am
on my own most of the time. I’m not having
to be in the office all day, so I’m not restricted
to one single area. Also, the scheduling flexi-
bility, most of the time, it’s pretty good, like I
said, if I have a doctor’s appointment or

Table 1. Study Participants Demographics

Participant Age Group Gender Race
Years of

Experience
Level of

Education
FT/
PT

Participant 1 30s Female Hispanic 6 BSN PT

Participant 2 20s Female White 7 BSN PT

Participant 3 50s Female White 2 ½ ADN FT

Participant 4 30s Female Hispanic 6 ADN PT

Participant 5 20s Female Black 5 BSN FT

Participant 6 40s Male White 1 ½ BSN FT

Participant 7 50s Female White 10 ADN FT

Participant 8 40s Female Asian 2 ADN PT

Participant 9 20s Female White 10 ADN FT

Participant 10 30s Female Hispanic 5 BSN PT

Participant 11 50s Female White 12 BSN FT

Participant 12 30s Female Black 2 BSN FT

Note. BSN = Bachelor of Science in Nursing, ADN = Associate’s Degree in Nursing,
FT = full-time position, PT = part-time position.

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

January/February 2021 Home Healthcare Now 23

their job satisfaction. Participant 10 related that a
“simple thank you” makes her feel good:

What I mean by that is that a simple thank
you for a job well done or thank you for mak-
ing that extra home visit when a nurse can-
cels or when you pick up a patient. Any of
that, I mean, it is part of your job. Yes, that is
our job, and we do our job but a simple rec-
ognition, just a simple thank you just makes
you feel good. It makes you feel like you’re
appreciated for what you do. It’s not just an
actual job. Yes, you’re getting paid to do it,
but management is actually recognizing the
job that you do. That goes a long way.

Nurses who expressed a lack of leadership sup-
port described this in terms such as “unhappy,”
“negative,” and “overwhelmed” related to job sat-
isfaction, whereas nurses who felt supported by
leadership used terms such as “happy,” “positive,”
and “teamwork” related to job satisfaction.

Discussion
The purpose of this study was to describe experi-
ences that affect job satisfaction of RNs working in
home healthcare. The participants expressed sat-
isfaction with their jobs, especially when describ-
ing positive patient encounters. They described
building relationships and connections with the
patients as a vital aspect of their satisfaction with
their jobs. Wälivaara et al. (2013) also concluded
that good relationships with patients influence job
satisfaction. Furthermore, the professional rela-
tionship the home healthcare nurses build with
the patients influences the nurse’s experience and
the quality of care delivered (Wälivaara et al.).
Morrow (2017) discussed how relationship build-
ing and the journey of patient recovery is one of
the most rewarding aspects of home healthcare.

Outcomes from the study revealed that the
participants felt autonomy was a vital factor that
led to job satisfaction. Autonomy was described
as integral to performing job duties as a home
healthcare nurse. Irani et al. (2018) also found that
the home healthcare nurses in their study valued
the autonomy and flexibility they felt when creat-
ing their schedules. Han et al. (2015) concluded
that the nurses in their study who were dissatis-
fied at work had lower levels of autonomy.

The participants in our study pointed to occu-
pational stressors they face while providing care
to patients in their homes. Findings from a re-

something in the morning I can go to that and
then go see my patients the rest of the day.

Theme 3: Occupational stressors negatively
influenced job satisfaction. The third theme that
emerged was related to the occupational stress-
ors that home healthcare nurses encounter on a
day-to-day basis. These occupational stressors
were considered elements that the participants
associated negatively in relation to job satisfac-
tion. All participants mentioned documentation
as one of the occupational stressors that nega-
tively influenced their job satisfaction. They de-
scribed the documentation process as “tedious,”
“repetitive,” and “time-consuming.” Eight out of
12 nurses described the challenges they face with
insufficient staffing. Participant 12 expressed her
concern with the high turnover rate:

Some of the worst parts are the high turnover
rate of the employees. A lot of the nurses
don’t stay very long in home health. I have
been there for about four years, and I have
trained several other nurses. They may stay
a month or five months, and then they leave.
It is not a very steady thing for most people,
and I am not sure why. But when our census
is high, and we have a lot of turnover at the
same time, it gets very challenging. The
nurses who are left have to pick up the slack
for those who left and see extra patients.

The participants voiced their concerns regarding
the work environment while in the field. They de-
scribed the connection between the patient’s socio-
economic status and the work environment, noting
that some patients reside in areas where the nurse
feels safe and protected, whereas other patients re-
side in what they described as “high crime” areas.
Some of the participants recalled unsafe encounters
with pets, family members, and unsanitary homes.
The participants voiced much frustration with is-
sues related to trying to reach the patient’s physi-
cian, with some concluding that the best way to
contact a physician is through a third party, such as
the secretary or medical assistant. Nurses described
communication with some physicians as “difficult,”
“obnoxious,” and “an act of God” when successful.

Theme 4: Leadership impacts job satisfaction.
The fourth theme that emerged from data analysis
was the impact leadership has on job satisfaction.
Eleven out of the 12 participants indicated that
recognition by leadership positively influenced

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

24 Volume 39 | Number 1 www.homehealthcarenow.org

The authors declare no conflicts of interest.

Address of correspondence: Jose A. Garza, DHA, MBA, 2001 Hol-

combe Blvd., Unit 604, Houston, TX 77030 (eandsfam@sbcglobal.net).

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

DOI:10.1097/NHH.0000000000000921

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search study by Irani et al. (2018) concluded that
high productivity and staffing factors influenced
home healthcare nurses. Weerdt and Baratta
(2015) examined working conditions for home
healthcare workers with similar findings—the
home healthcare nurses described unsanitary
homes and unfavorable working conditions, which
affected their job satisfaction. Additionally, previ-
ous studies have found that the relationship with
physicians is essential, and healthy collegial rela-
tionships were associated with higher job satisfac-
tion levels (Scruth et al., 2018; Wargo-Sugleris et
al., 2018; Yarbrough et al., 2017).

Finally, the nurses described the impact of lead-
ership and recognition by leadership on job satis-
faction. Baljoon et al. (2018) conducted a study to
understand nurses’ work motivation and the fac-
tors that influence motivation. They concluded that
a supportive leadership environment increased the
nurses’ motivation in the workplace. Additionally,
the authors stated that recognition and apprecia-
tion were high motivators for the nurses.

Limitations
The small sample of 12 participants from a single
home healthcare agency in South Texas limits gen-
eralizability, although the findings can be used as
a resource for future studies of nurse job satisfac-
tion in home healthcare. Additionally, only one
participant was male, so future research would
benefit from a more diverse sample.

Conclusion
A sense of autonomy over work, flexibility in
scheduling, and positive feedback from leadership
were found to positively influence nurse satisfac-
tion with home care. On the other hand, documen-
tation mandates, safety concerns in the field, and
difficulty communicating with physicians were
factors associated with dissatisfaction. Although
the sample size of this study was small, findings
can be used to further study job satisfaction and
turnover among home healthcare nurses. Home
healthcare leadership should take safety concerns
seriously and explore innovative ways to promote
communication between field nurses and physi-
cians. Further research is needed with a larger and
more diverse sample of home healthcare nurses in
order to be able to generalize findings.

Jose Abelardo Garza, DHA, MBA, Houston, Texas.

Donna Taliaferro, PhD, RN, COI, is Lead Faculty Area Chair,
Methodologist, University of Phoenix, Phoenix, Arizona.

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.