1. Harris, Marilyn D. MSN, RN, NEA-BC, FAAN

Article Content

The authority for the practice of nursing is based on a social contract that acknowledges the professional rights and responsibilities of nursing and includes mechanisms for public accountability. Nursing's Social Policy Statement: The Essence of the Profession (American Nurses Association [ANA], 2010b, p. 92) states "Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human responses, and advocacy in the care of individuals, families, communities, and population."


Nursing: Scope & Standards of Practice (ANA, 2010c) outlines the expectations of the professional role of the registered nurse. This 2010 scope statement and these updated standards of nursing practice guide, define, and direct professional nursing practice in all settings. This 2010 publication is to be used in conjunction with Nursing's Social Policy Statement: The Essence of the Profession (ANA, 2010b) and the Guide to the Code of Ethics for Nurses: Interpretation and Application (ANA, 2010a). These three professional resources provide a complete and definitive description for better understanding by specialty nursing organizations, policy makers, and the public of nursing practice and nursing's accountability to the public in the United States.


The ANA has actively engaged in scope of practice and standards development initiatives since the late 1960s (ANA, 2010c, p. 96). Specialty standards are based on the ANA's Nursing: Scope & Standards of Practice (2010) that provides the template for the practice of professional nurses as well as a reference for consumers, payers, legal counsel, and policy makers. The ANA published the first Scope and Standards of Home Health Nursing Practice in 1986. This publication was revised in 1992, 1999, and 2007. It is time for another revision. The 2007 document is being updated to reflect the current and future scope and standards of practice.


In the summer of 2011, the ANA issued a call for home healthcare registered nurses to volunteer to update the 2007 scope and standards. Professionals responded and have been working on the document in small groups and through frequent conference calls since March 2013. The goal is to complete the revisions later in 2013 to facilitate public comment and the ANA review processes prior to publication.


I am writing to you to share this important information for several reasons:


* To inform all home care professionals of the current review process,


* To invite every home healthcare nurse, regardless of your role or title, to share thoughts and comments on the scope of practice and standards for this specialty, and


* To invite readers to access the ANA Web site at on a periodic basis to determine when the revised scope and standards are available for public comment, and encourage you to share your input.



The following topics are being addressed by the work group:


What is our title?


* Home care nurse?


* Home healthcare nurse?


* Another title?


* What is your rationale/justification for your choice?


* Does our title really matter?



Who are we?


* Generalists?


* Specialists?



What education/certification do we need to prepare for this specialty?


* Diploma/associate/undergraduate/graduate degree?


* Do we need a degree plus some defined time period before working in this specialty?


* What professional certifications do we have/need?


* Certification for home healthcare nursing is no longer available through the American Nurses Credentialing Center. This certification ended because too few applicants wished to sit for the examination. The examination's reliability, validity, and psychometric soundness could no longer be ensured.


* What other certification options are available?



Where does the patient live? Where do we practice?


* Home?


* Assisted living?


* Homeless shelter?


* Adult day care?


* Other?



When do we work?


* 24/7?


* Intermittent care?



What care do we provide and to whom?


* Direct care?


* Coordination of care?


* Use of technology/telehealth?


* Health promotion?


* Pediatric/adult care?


* Acute/chronic care?


* Skilled/custodial care?


* Private-duty care?


* Other?



What are our roles?


* To empower patients and families?


* To provide help along the continuum of care?


* To be knowledgeable about reimbursement/insurance challenges?


* Delegation/supervision?


* Autonomy?


* Relationship to coworkers/team?


* Other?



Issues and trends


* What will the care we provide look like in 5 years?


* What education will be needed?


* What is the interaction with other specialties?


* Ethical considerations?


* Cultural competencies?


* Nursing shortage/retention?


* Legislative/regulatory issues?


* Accreditation/certification of the agency?


* Pay for Performance-Outcome and Assessment Information Set (OASIS)?


* Productivity versus patient outcomes?


* Outcome-Based Quality Improvement (OBQI)?



Research in home care


* What topics or questions are of concern to you?



Myriad challenges are faced every day. The updated document will delineate the scope and standards of our practice. It will guide, define, and direct professional nursing practice in the home care setting for at least the next 5 years until the next revision. Now is the time to envision the future of our specialty. Now is the time to be an active participant in improving our specialty and the care provided for our patients. Now is the time to participate in this important professional nursing responsibility!


I value your participation and look forward to hearing from you about the survey. Please send your comments to me as soon as you read this article. They are due by May 1, 2013. Thank you!



American Nurses Association. (2007). Home Health Nursing: Scope & Standards of Practice (2nd ed.). Silver Spring, MD: Author.


American Nurses Association. (2010a). Guide to the Code of Ethics for Nurses: Interpretation and Application. Silver Spring, MD: Author. [Context Link]


American Nurses Association. (2010b). Nursing's Social Policy Statement: The Essence of the Profession. Silver Spring, MD: Author.


American Nurses Association. (2010c). Nursing: Scope & Standards of Practice (2nd ed.). Silver Spring, MD: Author.


In This Issue

This issue of Home Healthcare Nurse offers the second part of a two-part series on constipation titled "Evidence About the Pharmacological Management of Constipation: Implications for Palliative Care" by Deborah Fritz and Matthew Pitlick. Margaret Lyons and Lawrence Carey provide an evidence-based summary of heart failure intravenous inotropic medications in their article, "Parenteral Inotropic Therapy in the Home: An Update for Home Care and Hospice." In the commentary in this issue, titled "A Personal Perspective on Death and Dying," a home healthcare nurse, Patricia Mingle, offers her own, personal experience with hospice. Andrea Zaldivar and Nancy Bohnarczyk offer a Research Briefs column about "New Approaches to Delivering Primary and Preventive Care to the Older Population." The VNAA column in this issue, "Rural Healthcare and the Challenges of Home Health and Hospice" by Margaret Franckhauser, discusses the unique challenges presented to agencies who serve rural communities. In the Hospice and Palliative Care column, titled "Evidence-Based Practice in Hospice: Is Qualitative More Appropriate Than Quantitative?," Brian Jones discusses the application of evidence to practice in hospice care.


Home Healthcare Nurse always welcomes your input! Please e-mail Tina Marrelli at with any ideas or questions about writing for HHN.


The Future of Healthcare Is at Home

The International Home Care Nurses Organization (IHCNO) Inaugural Conference, "The Future of Healthcare is at Home," will be held June 25-28, 2013 at Case Western Reserve University, Cleveland, Ohio. The conference is cosponsored by the Francis Payne Bolton School of Nursing at Case Western Reserve University.


Registration is now open at


Early registration is available prior to May 1st.


For more information, go to or e-mail


For information about IHCNO, see the following editorials:


* "The International Home Care Nurses Organization (IHCNO) Goes Global" by Mary Narayan,


* "Chronic Care Management and Quality, the International Council of Nurses (ICN) Meeting in Malta, and an International Home Care Nurses Organization (IHCNO) Poster!" by Tina M. Marrelli,


* "National Home Care and Hospice Month, Holiday Readings, and an IHCNO Update," by Tina M. Marrelli,


* "Update About the International Home Care Nurses Organization-A Functional Home Care Nurse-Focused 'Meeting Place'" by Tina M. Marrelli,


* "The Interdisciplinary Team, a Free Resource and a Survey to Complete about the International Home Care Nurses Organization (IHCNO)" by Tina M. Marrelli,



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