E d u c a tio n,r e s e a r c h a n d d e v elo p m e n t
RNs in home nursing have an impor- tant educational mission, but the interviewed RNs mainly relied on experience-based pedagogical knowl- edge. A study from Norway31 identi- fied similar weaknesses in staff educa- tion in long-term care: unstructured and sometimes ad hoc with quality work fragmented rather than compre- hensive and systematic. Educational strategies in home nursing settings need to be developed further.
Academic requirements for work- ing in home nursing were not set by the municipalities. The only require- ment set was a nursing degree. The interviewed RNs’ formal education presented diverse specialty compe- tencies and experiences, not always adapted to work in home nursing. The nurses stressed the importance of experience-based knowledge,32 but did not connect the experience of working with ongoing foot ulcers to preventive work.
The results of the present study give the impression that the munici- palities’ goal is to make the RNs dele- gate their entire work to HCAs and instead cover up for the lack of physi- cians, yet retaining the ethical and legal responsibility for the nursing process of the patients. This situation has also been described by Nilsson et al. from other Swedish municipali- ties.33 Aiken et al. showed that the quality of the care environment and nurses’ work had an impact on patient mortality, and it has been suggested that, if RNs’ staffing, education and care environments are improved, this will contribute to the best patient outcomes.