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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 (American Nurses Association [ANA], 2003, p. vi) 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 and Standards of Practice (ANA, 2004) outlines the expectations of the professional role within which all registered nurses must practice. This scope statement and these updated standards of nursing practice guide, define, and direct professional nursing practice in all settings. This 2004 publication is to be used in conjunction with Nursing's Social Policy Statement (ANA, 2003) and the Code of Ethics for Nurses with Interpretive Statements (ANA, 2001). These three 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 (ANA, 2004, p. vi).


The ANA has actively engaged in scope of practice and standards development initiatives since the late 1960s (ANA, 2004, p. vi). Specialty standards are based on the ANA's Nursing: Scope and Standards of Practice, which provides the template for the practice of professional nurses as well as consumers, payers, and policy makers (ANA, 1999). The ANA published the first Scope and Standards of Home Health Nursing Practice in 1986. This publication was revised in 1992 and 1999. It is again time for a revision. The 1999 document is being updated to reflect the current and future scope and standards of practice.


In the summer of 2005, the ANA issued a call for home care professionals to volunteer to update the 1999 scope and standards. Twenty professionals responded and have been working on the document in small groups and through monthly conference calls since September 2005. The goal is to complete the revisions by spring 2006 in order to facilitate public comment and the ANA review processes so that the updated document is published and available for the October 2006 National Association for Home Care (NAHC) Annual Meeting in Baltimore, Maryland.


Information about the current review process was shared at the Home Healthcare Nurses Association meeting at the NAHC Annual Meeting in October 2005 in Seattle, Washington. 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 health nurse, regardless of your role or title, to share thoughts and comments on the scope of practice and standards for this specialty;


* To invite readers to access the ANA Web site at in the summer of 2006, when the revised scope and standards are available for public comment, and encourage you to share your input.



The following topics were presented and are being addressed by the workgroup:


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 health 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)/Outcome-Based Quality Improvement (OBQI)?


* Productivity versus patient outcomes?


Current and future research in home care


* What topics are of concern to you?


We face myriad challenges every day. The 2006 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. Please send your comments to me by April 1, 2006.




American Nurses Association. (1999). Scope and standards of home health nursing practice. Washington, DC: Author. [Context Link]


American Nurses Association. (2001). Code of ethics for nurses with interpretive statements. Washington, DC: Author. [Context Link]


American Nurses Association. (2003). Nursing's social policy statement. (2nd ed.). Washington, DC: Author. [Context Link]


American Nurses Association. (2004). Nursing: scope and standards of practice. Washington, DC: Author. [Context Link]