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One of our nurses said this to me recently as she proudly expanded her chest and smiled ear to ear. Our home health agency is a premier site for McKesson HBOC and we had just hosted a site visit with a group from a home health agency four times the size of ours.


During the in-depth inquisition as their representatives rode along with our staff, great ideas were shared between members of both agencies and our nurse eagerly composed a page of ideas and concepts she had learned. But in the end she was the proud one, proud of the agency, proud of her colleagues, and most of all proud and enthusiastic about being a part of it all.


It made me stop and think about how I felt about our agency and about home health nursing in general. I have always loved home care as I feel it is one of the few nursing specialties that allow a nurse to truly practice the art of nursing. Sure, you have to know anatomy, physiology, pharmacology, and disease processes, but you also have to have social service skills, pediatric and geriatric concepts, and even at times, a little veterinary science.


Home care is about seeing and caring for so much more than a single patient while knowing you can never lose sight of the reason you're there. You have to care for the patient's home, family, environment (however deplorable it may seem to you), and often, the family pet. You quickly learn that the contents of a patient's refrigerator can tell you much about the patient, as can patient and room odors. Home care is a lot like scouting; you leave environments better than you found them!


When our clinician discharges a patient, the person knows the basics about his or her diseases, which medications can cause which reactions, and the importance of a proper diet in regard to staying healthy. Often the patient will know the names of the nurse's children, and how the nurse spends her time when not on the job. Home health is holistic, not only for the patient but the nurse as well.


However, we also must remember that home care is not without its challenges. Never have nurses had their notes scrutinized as they are in home health. Speaking of notes, documentation now takes as much time as patient care. However, as home care nurses have always done, we've adapted to the obtrusive regulatory requirements, all in the name of our patients.


Home care is not for everyone. Keen eyes are needed to see beyond the obvious, sturdy hand coordination is required to meet documentation requirements, and a firm fanny for driving is a must! You also need to convert your car into a traveling office, eat-in diner, and medical supply center.


But it can be done!


The rewards outweigh the challenges. The autonomy of practice has often been mentioned as one of the key reasons nurses stay in home care. Daytime hours (although there are on-call shifts) and scheduling flexibility are also considered incentives. Mostly, however, it's the difference we see. We can admit a patient to home care scared and unsure if he or she will ever be independent again and yet, by discharge a self-assured patient or family member has emerged, one who knows he or she can continue living a productive life.


Why am I proud? Because we have nurses that make a difference. We provide quality and compassionate home care to meet the needs of our community. We stand tall against other agencies, large or small. I also know that there are thousands of us providing the same services across the globe every day.


As the nurse said, "I'm so proud of us!"