Learning Objective #1: describe how the case study methodology is used in a multiple embedded case study to explore variability in home healthcare nurses' perception of stressors.

Learning Objective #2: identify characteristics of the professional nursing practice environment that moderate levels of job-related stress experienced by home healthcare nurses.

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Nurses’ job-related stress adversely affects the quality of patient care, how nurses feel about their jobs, and whether they will remain in their jobs. The purpose of this study was to identify: 1) stressors home healthcare nurses describe as specific to their practice and work environments, and 2) characteristics of the work environment that moderate levels of job-related stress experienced by home healthcare nurses. The theoretical model tested was an integration of empirical research findings related to job stress and job stress theory, the professional nursing practice environment, and components of Neal’s Theory of Home Health Nursing Practice. A case study design is the most effective in describing the work environment and nurses’ job-related stress since the boundaries of the context of the environment and characteristics of the individual, which contribute to the interaction, are complex and multivariate. The researcher used a multiple case study design for purposes of cross-unit comparison and replication to explore the variability in job-related stress of home healthcare nurses explained, in part, by the specific context of two home healthcare work environments. Findings suggest variability in nurses’ perceptions of stressors when compared across settings. Role overload and role conflict are two key stressors for nurses. The adverse effects of stressors and job-related stress are moderated in agencies where there is responsive management and administration, and adequate resources are available to support the nurse in the case management role. Job-related stress is moderated in environments where nurses have control over decision-making activities affecting case management functions. Study results can be generalized to the analytic theory guiding the study. Results cannot be generalized to a target population of home care agencies. Findings suggest that specific characteristics of the professional nursing practice environment may make a difference in the job-related stress experienced by home healthcare nurses.