A concept of nursing discharge.

The timing is opportune for this expansion of hospital nurses' practice into the home. First, more home health agencies are aligning themselves with hospitals, making cooperative arrangements easier. Second, in response to the nursing shortage crisis, institutions are developing share governance models that offer nurses more autonomy and control over their schedules, affording them the opportunities to accommodate home visits into their day. If these visits are reimbursable through a third party payer, the nurse and the home health agency could receive payment if the hospital nurse either had a direct contract with the agency or belonged to a temporary staffing agency (registry) from which the home health agency could request services. If, however, the hospital nurse is unable to follow the patient into the home, that nurse could make a referral to a home health agency. For example, the hospital nurse would communicate the patient's treatment plan to the home health agency, request any necessary ancillary services (e.g., physical therapy or home health aides), and provide any education and training necessary for the community health nurse to provide hands-on care to patients with complex or high-technology needs. The home health agency could also employ special high-technology nurses for these types of cases. The use of this alternative, however, reduces the continuity of care aspect of the nursing discharge concept. The concept of nursing discharge solves several problems. It facilitates continuity of care and provides a definition for home health care that identifies the need both to service acutely ill patients and facilitate basic community health concepts.(ABSTRACT TRUNCATED AT 250 WORDS)