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Nurses play a vital role in the delivery of Hospital in the Home (HITH) services, making up the bulk of professionals in this expanding healthcare model.
But, while acute nursing practices may have shifted from traditional bricks and mortar hospitals, into patient homes, the design of this work is yet to evolve.
This has caused strain on HITH nursing practices, as they strive to provide acute hospital-level care using resources that are not aligned with the complexities of home-care.
Rajni Nair of Queensland Health – a speaker at this year’s Hospital in the Home Conference – has been studying this concept, as part of her PhD. She says the lack of evolution in HITH nursing design frameworks matters on two counts.
“Work design is about shaping jobs and work environments, so that people can perform well and thrive in their workplaces,” she said.
“In healthcare, generally, we still base most of our decisions on data, which is based on bricks and mortar parameters, and this may not translate to virtual and hybrid care contexts.”
Work design is also crucial for employee wellbeing, Rajni said, with poorly designed work leading to employee strain, turnover, and workforce instability. It can also lower engagement and morale, impacting organisational performance.
Conversely, when work design aligns with demands with resources, it fosters employee resilience and performance.
“If the demands of the role are not tailored to the setting, they could be unrealistic, leading to burnout,” Rajni said. “For example, if nurses in bricks and mortar hospitals are expected to keep tabs on x number of patients simultaneously, HITH nurses are required to undertake additional and innovative mechanisms to achieve the same outcome.”
In healthcare, burnout is already a significant concern, with around 40% of professionals reporting it in 2024.
A systemic issue
To help remedy this issue, Rajni’s scoping review looked at existing literature on HITH work designs within the nursing population and mapped out evidence against them. In doing so, she found little data that could be used to design these roles in the future.
“I categorised information according to physical, emotional, cognitive and organisational demands and mapped it across the available resources. I then looked at how work demand and resources affect work outcomes – and found very little supporting evidence,” she said.
Data aside, Rajni says the topic of work design is not widely discussed in healthcare contexts.
“It’s not an overly familiar concept in healthcare industry, In the health industry, there is so much interpersonal complexity, we’re working with consumers, we’re working with a wider healthcare system. So, this work design concept hasn’t yet become prevalent – and the lack of evidence is certainly not helping on this front.”
A growing need
Rajni says the industry is pressed to build more evidence in HITH nursing work design frameworks, given the current challenges around recruitment and attrition in the broader healthcare sector. At present, there is an 85,000 shortfall in nursing professionals, nationwide and by 2030 this figure will reach 123,000.
“We’re getting to a stage where workforce sustainability is a big challenge for healthcare, so we need to be able to make evidence-based decisions by leveraging off theoretical frameworks on work designs.
“This will put us in better stead to assist organisations with the development and expansion of new models, like HITH. And it will also support employee wellbeing and reduce burnout.”
Cross-sector comparisons
While Rajni’s lays the groundwork for improvement in nursing, she said her study framework could be applied in other sectors.
“It could be used to map out the resources for Allied Health or other professional streams, to help identify gaps in the evidence base around role design,” she said.
Sharing more on her research design and findings, Rajni will present at the upcoming Hospital in the Home Conference – one of three to be held at Connect Virtual Care on 31st March to 1st April 2026.
One pass for Connect Virtual Care gives you access to three concurrent events:
– AI in Health Regulation, Policy and Standards
– National Telehealth
– Hospital in the Home
Learn more and register your tickets here.
About Rajni Nair
Rajni Nair is a PhD Candidate and Adjunct Senior Fellow, UQ, working as Acting Clinical Senate Manager and Networks for the Health Improvement Unit at Clinical Excellence Queensland.
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