APRNs, or Advanced practice registered nurses, are able to provide high quality health care that is affordable. This type of service is especially needed in regions in which the ability to see a physician is limited. The majority of such areas are characterized by rural spaces and underserved urban districts. Recently, APRNs with patients that required home health care services were unable to care for them for excessively long periods of time due to the need for a physician to verify their assessment. These delays are inconveniencing to the patient, but could also become dangerous and become a hazard to their health. Additionally, costs may continue to rise while the beneficiaries are likely to be kept in expensive and unaffordable institutional settings or discharged too early, without having the appropriate care. Currently, nurse professionals are experiencing issues in their ability to perform home health care due to the lack of available advocacy, especially in the case of clinical decisions. A recent advocacy effort, the Home Health Care Planning Improvement Act became a part of the Coronavirus Aid, Relief, and Economic Security Act (American Nurse Association, 2021). This would now allow nurse practitioners and nurse specialists to arrange home health services for their Medicare beneficiaries without the requirement of approval by a physician. This is an improvement in the movement towards installing further advocacy for nursing professionals in order to provide timely and affordable health care for patients that are unable to receive it outside their homes.
A recent study analyzed commonly occurring issues within the system of home care nursing. The data analysis was able to provide issues that fell into five distinct categories. They included difficult incidents, economic issues, professional barriers, social difficulties, and bureaucratic tension. These results were able to depict the ways in which home health nurses face a multitude of issues that are not present within hospital settings, and which can harm the ways in which they are able to provide adequate care (Chandrashekar et al., 2019). Each of the five categories have roots in the ways in which nurses have limited advocacy. It is essential to understand how these issues stifle many working nurses from not only offering better care but being unable to develop and contribute to nursing leadership.
To better understand the relationship between home health problems and nursing advocacy, it is essential to break the issues down into more specific components. Difficult incidents consist of job burnout and the increased stress factors of home health care, which are both proportional to the other four categories of home health issues (Fatemi et al., 2019). Economic problems are faced by both the patients and the attending nurses as many of the problems include disproportion between expenses and income, tight employment competition, and lack of special tariffs. Professional barriers include the lack of professional cohesion, limited human resources, and role ambiguity. Social difficulties mainly affect the nursing staff and include power status changes, lack of social security and services. The bureaucratic tension refers to ineffective supervising and extreme bureaucratic processes.
The importance of upcoming nurse leaders has become even more prevalent during the pandemic. During times of shortened resources and fewer hospital staff that can operate as supervisors, nurses that can step up and offer accurate clinical insight become vital (Centers for Medicare and Medicaid Services, 2018). In the sphere of home health, the nurses are quite self-reliant and are their own leaders. The advocacy for the improvement of home health nursing is essential to current nursing leadership, as well as those that will join their ranks. A home health nurse that has advocacy to create timely and appropriate medical decisions for their patients will be able to follow and lead others if they chose to work in a collaborative setting. Additionally, their leadership allows them to be more autonomous and save time for other physicians and nursing leaders. As such, this advocacy work aims to increase the available body of information that educates nurses on their political and patient advocacy as well as encouraging them to participate in policy concerning such topics.
A number of leadership strengths need to be implemented in order to begin educational programs concerning nurse advocacy as well as policy-alterations. It is essential that the decision-making is unbiased, considerate of all stakeholders, and future-oriented, in order to analyze the possible outcomes of any changes to policy. It is important to list and rank priorities, such as beginning with educational material on political and patient advocacy, followed by an analysis of the current issues as presented in the studies prior. It is also vital to be observant of potential risks and drawbacks of any changes made to the policy, but also to be critical of things that may currently be more harmful than beneficial. The team that will discuss this issue should include representatives of nursing leaders, registered nurses working at patient’s homes, and individuals familiar with the current home health policies on a governmental level.
There are a number of roles a leader must take in order to oversee successful policy implementation on any level. First, it is the leader’s role to successfully direct the group’s energy and workflow while clearly relaying the message and purpose of their movement to those within the group or outside it. Second, the leader is also a motivator that encourages the group to continue, especially in the time of adversity or during serious changes to the plan. Third, the leader must act in a way that is committed to the cause and make informed decisions based on extensive knowledge on the issue. A topic about advocacy is likely to cause discourse between groups that want to improve the ability of informed decision-making by home health nurses and those that find that certain working nurses may not be qualified to do so. It is important to keep this conversation civil and find a compromise which determines what is the necessary level of qualification. For instance, the groups should be able to discuss if certain educational requirements including accredited nursing programs with an associate degree or a Bachelor of Science in Nursing, as well as a passing grade on the NCLEX exam are satisfactory while nurse assistants without licensure may not be qualified (HealthStream, 2021).
It was not until 1953, during which the International Council of Nurses established the first ethical code for nursing which required advocacy as a core function of nursing (O’Connor, 2018). However, the recent Home Health Care Planning Improvement Act is a step towards the right direction and is a policy that has passed into legislation. It is the aim of this advocacy work to require this act and similar acts to be upheld even outside the timeframe of the pandemic. A recent study found that although nurses comprise the largest segment of all health care workers in the United States, their participation in health care policy advocacy has been quite low (Perry & Emory, 2017).
As such, it is vital for our advocacy group and those that support our aim to become more involved in committee and board activity. Certain motions towards improved education on advocacy have been made, such as partnerships among professional nursing groups, policy stakeholders, and academics (Lewinski & Simmons, 2018). This format of education is one that will be formulated and distributed by our advocacy group, to assist home health nurses and to encourage more nurses to contribute their influence on policy changes.
To better understand ways in which the current issues in home health care can be overcome, it is vital to understand the role of the nurse in a home health setting. The home health nursing branch of the profession is available to registered nurses, licensed practical nurses, and nurse assistants. Specific educational requirements include accredited nursing programs with an associate degree or a Bachelor of Science in Nursing, as well as a passing grade on the NCLEX exam. Meanwhile, LPNS need an accredited nursing program while nurse assistants are unlicensed but may obtain certification (HealthStream, 2021). The RNs, as the most qualified of home health nursing practitioners, is likely to require most advocacy in their ability to make important decisions concerning at-home patients.
References
American Nurse Association. (2021).Home Health. RNAction. Web.
Centers for Medicare and Medicaid Services. (2018). Medicare & Home Health Care. Web.
Chandrashekar, P., Moodley, S., & Jain, S. H. (2019). 5 Obstacles to Home-Based Health Care, and How to Overcome Them. Harvard Business Review. Web.
Fatemi, N. L., Moonaghi, H. K., & Heydari, A. (2019). Perceived Challenges Faced by Nurses in Home Health Care Setting: A Qualitative Study.Int J Community Based Nurs Midwifery, 7(2), 118-127. Web.
HealthStream. (2021). What Does a Home Health Care Nurse Do? HealthStream. Web.
Lewinski, A. A., & Simmons, L. A. (2018). Nurse Knowledge and Engagement in Health Policy Making: Findings From a Pilot Study.J Contin Educ Nurs., 49(9), 407-415. Web..
O’Connor, M. (2018). Advocacy Perspectives of Future Nurse Administrators.Nurse Admin Quarterly, 42(2), 136-142. Web.
Perry, C., & Emory, J. (2017). Advocacy Through Education.Policy, Politics, & Nursing Practice, 18(3), 158-165. Web.