The management of nurses in internet-based home care in tertiary general hospitals in China: a mixed methods study

China is currently implementing an “Internet-Based Home Care” program, wherein medical institutions utilize institution-registered nurses to provide door-to-door nursing services to discharged patients or those with limited mobility through an “online application and offline service” model. Tertiary general hospitals play a leading role in this program, and effective nurse management is crucial for its success. However, the overall development status of Internet-based home care in these hospitals remains unclear. This study aimed to investigate the current status and challenges of nurse management in Internet-based home care within Chinese tertiary general hospitals and to propose evidence-informed recommendations. We employed an explanatory sequential mixed-methods design. From March to December 2022, we first conducted a national cross-sectional survey of 117 tertiary general hospitals. Findings from this quantitative phase informed the development of a focus group interview guide. Subsequently, a focus group was conducted with eight experienced home care nurses to qualitatively explore the underlying reasons and contextual factors behind the survey results. The survey revealed that the coverage rate of Internet-based home care in Chinese tertiary general hospitals was 64.1%. Among hospitals offering the service, 51.3% had fewer than 5% of their nurses participating, and 85% provided the service fewer than 50 times monthly. Although 97.33% of hospitals offered pre-job training and assessment, no uniform standards existed. Legal and medical safety risks persisted, and benefit distribution mechanisms among stakeholders were underdeveloped. The qualitative findings provided depth to these challenges, revealing that nurses’ positive attitudes were tempered by concerns about work-life balance and safety. Their concrete proposals centered on developing collaborative service models (e.g., with community providers), implementing standardized training and assessment, establishing fair incentive mechanisms, and enhancing safety protocols through technology and policy support. This study provides a systematic analysis of nurse involvement in internet-based home care in Chinese tertiary hospitals. Based on the integration of quantitative and qualitative data, the study calls for strategic human resource policies, standardized training, robust safety measures, and supportive policies to guide the sustainable development of Internet-based home care in China.