For the first time since the implementation of PPS, a Home Care Nursing Forum was held at the National Association for Home Care's Annual Meeting held in Orlando, FL, this past October. Recent regulatory, financial, and federal oversight activities have forced agencies to devote resources for operational issues. Obviously many home care nurses felt it was time to put home care nursing back on the agenda.
Even though the forum was scheduled very late in a day full of educational sessions and touring the exhibit hall, 120 nurses participated in a spontaneous discussion, idea sharing, and suggestions for future plans. Penn State University School of Nursing's Dr. Paula Milone Nuzzo was the moderator, and the respondent panel consisted of Jeanie Stoker, Director of AnMed Home Care in Anderson, SC, and the former president of the Home Healthcare Nurses Association; Karen Utterback, Vice President of Operations, South Mississippi HomeCare; and yours truly.
Purpose
The Forum's purpose was 1) to identify issues critical to professional home care nursing practice through a proactive constructive discussion and 2) to initiate a plan to advance home health nursing practice to its highest level.
Attendees identified the following nursing practice issues:
[black small square] How to meet the varied professional development/practice needs of a diverse nursing staff and advance them from novice to expert.
[black small square] Assure home health nursing's value by encouraging home health nursing certification.
[black small square] Overcome the isolation inherent in practice.
[black small square] Promote teamwork (nurse-nurse and nurse-interdisciplinary team).
[black small square] Identify ways to merge the productivity emphasis (valued by boards/financial officers) with patient outcomes (valued by nurses and OBQI).
[black small square] Reduce the documentation burden and constant regulatory changes that frustrate and overwhelm clinicians resulting in neglected professional development and continuing education.
[black small square] Clarify HHNA's current status within NAHC.
All these factors strongly influence the recruitment and retention of home health nurses.
Suggested Strategies
[black small square] Create a nursing taskforce that can evaluate agency data relative to productivity and teach clinicians how to use this data in practice.
[black small square] Encourage agencies to partner with local colleges to create Nurse Extern programs, teach a course, or serve on an advisory board.
[black small square] Create nurse internship programs (e.g., programs of 6-months duration) to bring new home care nurses to comfortable level of competence.
[black small square] Encourage the American Nurses Credentialing Center (ANCC) to maintain home health nursing certification and to eliminate the criteria that requires a BSN.
[black small square] Publish material about successful preceptor and clinical ladder programs, so other agencies can build programs on these models.
Future Planning
The group reached concensus that the following items should be set as priorities and addressed as soon as possible. Several participants volunteered to serve on committees and task forces.
1. Create a nursing taskforce to appraise agency data to determine:
* if quality nursing time focused on outcomes (vs. productivity) yields better patient and financial outcomes than the present productivity model;
* how to decrease documentation time (required by regulatory bodies vs. clinical/legal needs) increases the availability of nurses enabling improved patient outcomes.
2. Determine the current status and role of the HHNA and how NAHC can help HHNA members meet their nursing practice concerns.
3. Advocate with the ANCC to:
* maintain credentialing for home health nursing generalists and specialists, and
* eliminate the BSN requirement for home health nurse certification.
4. Encourage clinicians and managers who have developed model programs that could address identified problems to publish them inHHN.
Become Involved
You too can become involved in these exciting activities! HHN will serve as the coordinator of the contact information of those interested in Forum activities. Simply e-mail [email protected] (preferred method), fax to (502) 339-0087, write to me at 3904 Therina Way, Louisville, KY 40241, or call (502) 339-9005 indicating your contact information, interest, and anything you'd like to share about home care practice issues, strategies, and how you'd like to help. We'll look forward to hearing from you!