Challenges for work design

Home care nurses routinely work alone - often under severe time pressure - and have to adapt frequently to changing domestic environments that are often unsuitable for the provision of nursing care. Not only physical activities such as lifting and moving patients, but also the demands associated with mobility and intense interactions with clients' relatives are important stressors of providing home care.

Specific work situation

With the aim of objectively assessing the work situation of home care workers, the Federal Institute for Occupational Safety and Health (Bundesanstalt für Arbeitsschutz und Arbeitsmedizin, BAuA) uses investigative approaches such as activity observation. Instead of questionnaire surveys, nursing staff is accompanied and observed at work. In a recent study, fifty-two work shifts were analysed this way. The results show that roughly a quarter of nurses' working time is spent on mobility i.e. travelling between work locations which often happens under severe time pressure. Employees' "actual" work usually takes place in the care recipients' homes, which are not ergonomically optimised. In addition, the analysis shows that work-related contact during leisure time and sexual as well as physical violence are widespread stressors in the home care sector. Presenteeism is also a common phenomenon among home care workers: Due to a high sense of responsibility towards those in need of care many of them go to work even when they are ill.

These stressful situations clearly distinguish outpatient care from other forms of nursing services. Practical work design measures must therefore take these specific circumstances in account.

Design approaches

"Although mobility is only one aspect of everyday working life in outpatient care, it is an important starting point for improvements. Some of the measures described can help to ensure that employees do not get under time pressure in the first place. Other measures promote concentration and appropriate behaviour in road traffic so that unexpected situations can be dealt with effectively." aus baua: Aktuell 2/2025, S. 5. (German)

Good working conditions for home care staff cannot solely be created in the homes of those in need of care. To relieve home care nurses' stress, travelling must be taken into consideration as an integral part of their work.

Approaches for optimising work-related stress in outpatient care include for example:

• realistic scheduling based on route plans with built-in time buffers
• driver safety training and ergonomic fittings
• legal concessions to simplify parking for home care staff
• suitable protective clothing and equipment for home care nurses travelling by bicycle and on foot