As I write, the 2012 election battle is heating up-known candidates, long-time candidates, and some newer names are emerging-but I sometimes worry when people say to me, "what does the candidate I choose (or not choose) have to do with me? If I just keep my head down and keep working it will all work out." Sadly, this ostrich view of the world does not work, especially if you are employed in any aspect of healthcare or use any healthcare services-which is all of us! We must embrace advocacy for the things in which we believe and support, which are values directly tied to the patient for whom care is being provided at home.

My enthusiasm for the political world started early: I was lucky enough to win a Soroptomist writing award while in high school about "Why 18-21 olds should be allowed to vote." There were two winners from each state and the "prize" was to be able to go to Washington, DC, and work with one of your state's two senators-in my case, Connecticut. This meant there were 100 "winners" (two from each state) who were housed in what was then the Congressional Hotel on Capitol Hill. We got to view government at work firsthand, an education and experience that stayed with me and propels me to tell you to get as involved as you can. Nothing gets done without the "want to" get things done, and that enthusiasm for your job or your beliefs is the fire that makes all the difference. There are so many government initiatives and other ways you can get involved; this is a just snapshot:

I was in an audience last summer when Susan Hassmiller, the study's director, gave a great presentation about the IOM report and its findings. There are key messages that will resonate across the entire healthcare industry. Because nursing represents the largest group of the healthcare professions (more than 3 million), the implications in sheer numbers are significant. In this issue of Home Healthcare Nurse, Elizabeth Madigan provides some important findings about the report and its implication for home healthcare nurses. In addition, Kathy Duckett provides her perspectives about what the report may mean for us.

Home HealthcareNurse welcomes your letters to the editor on this important topic and your response to Elizabeth Madigan's and Kathleen Duckett's articles about the IOM report entitled "The Future of Nursing and the Future of Home Care Nursing: Two Views on the Future."

This March 2012 issue of Home Healthcare Nurse offers three Continuing Education (CEs) articles: (1) "Adults With Sickle Cell Disease: An Interdisciplinary Approach to Home Care and Self-Care Management With a Case Study," an interdisciplinary article authored by Lishia Lee and colleagues; (2) "An Interdisciplinary Wound Team in Home Health: The Role of the Physical Therapist in Wound Care" by Michelle Abeln and Anna Pitassi; and (3) "The Management of Respiratory Insufficiency in Patients With ALS at or Near the End of Life" by Andrea Torres.

Infection control continues to be an important component of quality care, and the article "Hand Hygiene Practices of Home Visiting Community Nurses: Perceptions, Compliance, Techniques, and Contextual Factors of Practice Using the World Health Organization's 'Five Moments for Hand Hygiene,'" by Ohood Felembam, addresses the World Health Organization's innovative practice method related to hand hygiene using an observational study.

As we examined some of the IOM report's findings, it is particularly timely that we have one article related to nurse practitioners and their scope of practice. "The Effect of Nurse Practitioner Practice in Home Care on Emergency Department Visits for Homebound Older Adult Patients: An Exploratory Pilot Study" highlights one model from Canada and explores the scope and differences with the U.S. model.

This issue also has two articles to highlight the importance of therapy in home care and hospice. Andy Carter skillfully writes about an important and difficult topic in the VNAA's Voice column, titled "Reimbursement for Therapy in Medicare Home Health: Balancing Patient Need and Program Integrity." Finally, Tracey Collins, a physical therapist, writes about her important experiences with hospice patients at home in "Reflections of a Hospice Physical Therapist."

The variety of information and articles in this issue reflects the diversity in home care, hospice at home, and other community-based programs.

Prescription to Help: A Ten-Point Plan!

1. Retain your best team members: nurses, therapists, and aides. Clinical competence will be more important than ever! (The demographics are likely to increase demand for nurses and aides.)

2. Be supportive of education and team members expanding their "framework" or knowledge and support them to practice at the full extent of their education and training.

3. Recognize home care as one piece of the continuum-one very important piece.

4. Be able to articulate at the table with hospital managers and other components of the continuum about what home care and other home-based programs can offer to them, including improved safety, quality, outcomes, and cost impact.

5. Strive to be in the first group of home care industry leaders and clients who meet the learning curve of the new emerging system.

6. Learn and integrate the new "glossary" into your thinking and planning across your organization (think accountable care organizations, home-based primary care, evidence-based practice, PCMHs, etc.).

7. Read the literature so you have peer-reviewed data to bring to a discussion and information to support evidence-based practice and changes and apply evidence-based management.

8. Be active and advocate for what you believe!

9. Encourage and mentor others to come along as how we "have known" home care changes significantly.

10. Take a leap and consider running for an office!

Sincerely,

Tina Marrelli, Editor

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