'I Feel the Pressure of Racing the Clock': An Institutional Ethnography Examining Home Care Nursing in Canada

Home care nursing is an essential component of health care in Canada, yet little is known about the work of home care nurses.

As a part of a larger Canadian study on home care, this institutional ethnography (IE) focused on home care nurses in one health authority in Western Canada. The purpose of this research was to explore the work of home care nurses and to trace how this is organised and coordinated from the standpoint of the nurses.

IE is a methodology that focuses on day-to-day work from an established standpoint to uncover what is coordinating the work at a systems level. In this research, the standpoint of nurses was explored through interviews, observations and collected texts. Data were collected from March 2020 to December 2021.

Nurses work in home care includes the determination, coordination and provision of care, documentation, supporting care givers, communication and referrals. The role is complex and uniquely autonomous. Texts that are used to collect information about home care nursing focus on task completion resulting in a representation of nursing practice that misses significant components including the organisation, relational and ethical work. Analysis shows that nurses' work, coordinated through electronic health documentation systems and texts, is influenced by dominant safety, efficiency and measurement discourses.

Home care nurses' time is increasingly spent managing their referrals, documentation and schedules eclipsing time spent on direct client care.

Understanding the invisible but dominant forces organising, and at times disorganising, the everyday work of nurses is a vital first step in creating change for home care nursing.

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Globally there is an increasing need for home care nursing to be delivered effectively; this research provides insights relevant to home care systems across jurisdictions.