Reducing nurse practitioner turnover in home-based primary care:a Department of Veterans Affairs quality improvement project

Objective: To identify factors in the Department of Veteran Affairs (VA) Home Based Primary Care (HBPC) program that may contribute to nurse practitioner (NP) retention and decrease provider gaps and access to primary care disparities for veterans. Background: For a Texas VA Medical Center, high and rapid HBPC NP turnover was identified and a program evaluation was conducted to explore factors associated with turnover. Methods: To determine factors with potential to decrease NP turnover, a program evaluation was conducted using the Anticipated Turnover Scale (ATS) and the Misener NP Job Satisfaction Scale (MNPJSS), administered to currently employed, non-supervisory NPs, who had been in HBPC for more than six months. Results: ATS responses reflected 57.1% of the participants intended to stay; however, mean responses to individual questions represented the group was equally divided on intent to leave. Of the 43 MNPJSS questions, 24 were answered as dissatisfied and 19 were answered as satisfied by the group. Conclusions: Recommendations resulting from this program evaluation may help retain NPs in HBPC, reduce organizational costs, and support optimal veteran outcomes.