N. Pauline Myers was a Perry County Public Health Nurse in Hazard, KY. In 1930 she shared the following thoughts in an article published in The Public Health Nurse and reprinted on the previous pages:
"When I was a very young nurse, the first tenet of my professional creed was, `thou shalt not get into a rut.' New places, new patients, new duties, and new routines were, I thought, essential to me. I felt that I needed the stimulation of strangeness to keep my enthusiasm to the pitch where I could do my best work" (p. 320).
A rut has been defined as a narrow track worn or cut in the ground. Many times we think we are becoming mired in a rut. However, there are benefits of having someone go before us who extends the rut and makes it smoother and easier to travel the road.
During my 48-year nursing career I experienced some wonderful ruts. One such rut was to spend 92% of my professional career in community/ home care/hospice nursing. Another is my association with Home Healthcare Nurse (HHN) as an author, reviewer, and editorial board member for 90% of the journal's existence.
HHN has kept pace with, and sometimes been ahead of, current events in home care (without the help of a crystal ball)! This accomplishment is a tribute to the motivated, attentive editors who have tracked trends, attended conferences, and cultivated authors who share pertinent information and experiences for each issue of the journal. On numerous occasions, the timing of an article coincided with the announcement of a new directive from the federal government or fiscal intermediary. This is an extraordinary accomplishment considering HHN 's editor assembles each issue months in advance of publication.
It would have been easy for home care nurses and administrators to become mired in unlimited ruts during the past 20 years. In the 1980s, Medicare denials presented challenges for patients, staff, and organizations. Implementation of the 485 Plan of Treatment form challenged staff and physicians. Since the 1990s the challenges have related to managed care, implementation of the Interim Payment System (IPS), Outcome-Based Quality Improvement (OBQI), Outcome and Assessment Information Set (OASIS), Prospective Payment System (PPS), Home Health Resource Groups (HHRGs), and more.
Ms. Myers closed her article with the following insight:
"Grown older and wiser, I see in my own smooth rut unimagined beauties....So I say to each nurse in this work, make yourself a rut and stick to it. You'll find you are always having to extend the rut, that everyday brings something of new interest, some tragedy, some joy that you must touch. You will find that eventually your rut will widen out and smooth down until you are traveling a long and golden highway straight into the hearts of your people." (p. 321).
Home care and hospice nurses, from their earliest history, as portrayed in this issue by Karen Buehler-Wilkerson, have traveled a long and golden highway straight into the hearts of their patients and families. Each of us, employed or retired, have many opportunities to extend the rut and smooth the way for the many nurses who will follow us in the 21st Century by reading and sharing the information found in HHN.
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