Improve retention rates by making safety a priority

Job satisfaction correlated to safety issues

[Editor's note: This is the second of a two-part article that discusses the safety of home health employees. Last month, we looked at the types of workplace hazards home health employees face in patients' homes. This month, we look at how improving employee safety can affect recruitment and retention of employees and specific actions to take when an employee reports an unsafe situation.]

Why should a home health manager pay close attention to employee safety? Not only are there legal and ethical reasons to do so, there is also the fact that employees who feel safe in their work environment are more likely to remain in their job.

"As home health nurses grow older, it becomes more important to make sure that they are satisfied with their jobs and stay with the agency, because it is difficult to replace their experience and knowledge," points out Robyn R.M. Gershon, MHS, DrPH, associate dean of research resources and professor at the Mailman School of Public Health at Columbia University in New York City. High turnover at a home health agency is not only expensive, but it also can create more dissatisfaction among employees, as other staff members are asked to cover more patients, she says.

One study shows a negative correlation between threatened verbal or physical abuse, environmental exposures to cigarette smoke or unhealthy homes, and household job-related risks to both job satisfaction and retention, Gershon says.1 Other issues that home health employees identify as issues in the job, such as transportation and travel, or the type of work that is done, do not present a significant correlation to retention. "It is clear that violence — or the potential for violence — are issues that affect the employee's plan to stay with the agency," says Gershon. If a home health agency can develop safety policies that are specific to home health and ensure that all employees understand that the agency takes their safety seriously, the opportunity to retain employees increases, she says.

Be sure your policies address the process to report a safety issue, the actions that are taken after a safety incident or report, and the options for resolving the safety issue, says Gershon. Safety policies should address a range of issues, including infection control and personal security, she adds.

Just developing policies is not enough to reassure employees, suggests Norma R. Anderson, RN, MSN, CNL, DNP(c), nurse educator, University of San Francisco School of Nursing and author of "Safe in the City," a study of workplace danger in home health.2 "Safety policies and protocols needs to be reinforced through yearly safety training classes and daily reminders that safety is important," she says. "A continuous focus on employee safety makes employees feel valued."


1. Sherman MF, Gershon RRM, Samar SM, et al. "Safety Factors Predictive of Job Satisfaction and Job Retention Among Home Healthcare Aides" JOEM. 2008; 50:1430-1441.

2. Anderson, NR. "Safe in the City" Home Healthcare Nurse. 2008; 26: 534-540.


For more information about employee safety, contact:

• Norma R. Anderson, RN, MSN, CNL, DNP(c), Nurse Educator, University of San Francisco School of Nursing, 2130 Fulton Street, San Francisco, CA 94117-1080. Fax: (415) 422-5618. Email:

• Robyn R.M. Gershon, MHS, DrPH, Associate Dean of Research Resources, Professor, Mailman School of Public Health, Columbia University, 722 West 168th Street, Room 938, New York, NY 10032. Telephone: (212) 305-1186. Fax: (212) 305-8284. E-mail: