1. Magowan, Cathy MSN, RN

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Historically, the public image of nurses has been that of an "angel" who cares about and takes care of people who are ill or injured, by fluffing pillows, giving backrubs, and handing out pills. However, nursing has evolved into a profession whose members are educated, competent, and utilize critical thinking skills and evidence-based practice to solve problems in order to provide the best possible care to the patient (Rhodes et al., 2011). Nursing is a profession with several specialty areas, including, but not limited to, pediatrics, forensics, diabetes, medical-surgical, critical care, emergency, and home healthcare. Each of these specialty areas requires in-depth nursing knowledge and experience. Home health nursing is no exception-it is a specialty area of its own. The American Nurse Association recently revised the Scope and Standards of Practice for Home Care Nurses, which outlines the unique knowledge, skills, and competencies of home health nursing. It also defines the specialized way the nursing process is applied in home nursing, and identifies 12 key areas of nursing practice and responsibilities.


Certification is not typically a requirement of any given nursing position, but should be available for nurses within their chosen specialty. Unfortunately there is no certification for home care nurses. According to the Bureau of Labor 2014 Statistics, 14% of the almost 2.7 million nurses in the United States are home healthcare nurses (Occupational Employment Statistics, 2014). This is a significant number of nurses who do not have the opportunity to become certified in their chosen specialty.


The practice of home health nursing is going to grow in the coming years, with the aging of the U.S. population and more emphasis being placed on shorter lengths of hospital stay, potentially leaving sicker people to fend for themselves at home. A home healthcare nurse needs to not only understand a myriad of disease processes, but also be able to teach the patient and family members how to manage those disease processes. It is feasible that in one day, a home healthcare nurse could care for a patient suffering from an acute infection, another patient trying to manage a chronic disease such as diabetes or congestive heart failure, and a postoperative patient, followed by a patient with an open wound from any number of causes. The home healthcare nurse needs to be able to help the patient recover from, or manage their disease process, as well as assess the home environment, recognize potential barriers to the patients' recovery, and implement a comprehensive plan of care that addresses all of the patients' needs as well as needs of their family members. The nurse must also be aware of the care provided by other disciplines such as physical or occupational therapy and social work, and for supervision of the care provided by home health aides.


Just as accreditation of an agency is important, certification of the home healthcare nurse is important. A nurse will probably have several reasons for becoming certified, whether it is just to test his or her own knowledge base and prove the test can be passed (if that is the method used for certification), or to demonstrate to supervisors and patients that he or she is knowledgeable in the most recent evidence-based practice recommendations (Shepherd, 2011).


Many times, patients or their families will select a primary care physician based on whether or not that physician is board certified. They could potentially choose a home care agency based on whether or not the nurses employed there are certified in their specialty. There are many benefits of certification, for the employer, patient, and nurse. Table 1 provides a summary of the benefits.

Table 1 - Click to enlarge in new windowTable 1. Benefits of Certification

For the employer, nurse, and patient, a big benefit of certification is improved patient outcomes. The employer's costs decrease when nurses feel validated and appreciated so they don't seek employment elsewhere. Nurses feel empowered, and patients are assured that they are receiving the best care possible, leading to what we all want-better health outcomes.


Just as certification validates the home care nurse's level of expertise and can help to advance the profession of nursing, it stands to reason that lack of certification can have the opposite effect. The specialized care provided by home care nurses will not be recognized. Lack of identified role models can lead to lower quality of care. There is no career ladder, turnover can increase, and patient outcomes can suffer.


Standards of practice in nursing can positively affect direct patient care through assessment, nursing diagnosis, and establishing and implementing a plan of care. But, the American Nurses Association has also identified many other standards, including but not limited to ethical, educational, and professional practice evaluation. Florence Nightingale recognized the need for nurses to continually seek out new knowledge and new evidence (Witt, 2011). So, whether a nurse wants to earn certification for his or her own personal reasons, or because they work for an employer who encourages and supports their employees in their pursuit of advancing education, certification for home healthcare nurses needs to be made available. Let's make it a reality!


New NIH Brochure Highlights the Value of Palliative Care for Children Living With Serious Illnesses

The National Institute of Nursing Research releases the publication as part of their PalliativeCare: Conversations Matter campaign. A new brochure from the National Institute of Nursing Research (NINR), a component of the National Institutes of Health, provides information about pediatric palliative care-a type of care that can reduce a child's pain, help manage other distressing symptoms, and provide important emotional support to the child and family throughout the course of an illness. The brochure answers questions that parents and families may have about pediatric palliative care. Many patients and their families have never heard of palliative care or do not understand what it is. This is especially true when talking about palliative care for children and teens.

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

NINR's brochure, Palliative Care for Children: Support for the Whole Family When Your Child Is Living with a Serious Illness, explains in easy-to-understand language what palliative care is, who it benefits, and how it works. Dealing with the diagnosis of a serious illness in a child is extremely difficult for the entire family. It is important that children and their families get the support and care that they need. To order or download a free copy of the brochure and learn more about the Palliative Care: Conversations Matter campaign, visit or call 301-496-0207. NINR is currently working to translate the brochure into Spanish.




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