Raising the Bar

Cherylann Gregory, RN, BSN
Published Online: Wednesday, May 18, 2011
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Nursing services in the home care setting provide direct care for patients, often through specialty pharmacies. What are the best models and practices. 


As a licensed health care service pool, Specialty Pharmacy Nursing Networks (SPNN) assumes the accountability of the nurse providing infusion therapy in the home care setting. Nurses who provide direct care and education in the home must adhere to specific state rules and regulations as well as other disciplines that include Medicare/Medicaid, American Nursing Standards, and the Nurse Practice Act. Each state defines who can provide direct care and teaching in the home care setting and under what service it can be provided.

Services are defined as a home health care agency (HHA), nurse registry, staffing agency, and independent contractor. States also specify if the entity providing the service needs to be licensed, accredited, or certified. These rules and regulations need to be taken into consideration prior to scheduling a nurse to provide direct services to a patient in the home setting.

SPNN’s nursing model is designed to meet the rules and regulations of each state. The company utilizes both per diem infusion nurses and licensed HHAs to provide direct care and teaching to a patient in all care settings, including the Medical Doctor’s Office, infusion suite, and the home.

Liability Coverage: Who Is at Risk?

As a high-risk infusion nursing service, SPNN carries high-risk professional and general liability and workers’ compensation coverage nationwide for all employees. Many specialty pharmacies (SPs) utilize independent nurse contractors for direct care in the home. What is the difference between an independent contractor and a per diem employee?

The general rule is that an individual is an independent contractor if the payer has the right to control or direct only the result of the work and not what will be done and how it will be done. This applies even if you are given freedom of action. As a per diem employee, the employer has the legal right to control the details of how the services are performed. In addition, an independent contractor is required to carry their own workers’ compensation insurance. Not many independent nurse contractors are even aware of this fact; SPs need to take note because it puts them at risk.

Standards of Practice

All SPNN infusion nurses are per diem employees who must meet and follow SPNN’s Standards of Practice (SOP). The SP is guaranteed that every patient treated through the company will receive the same level of care per SPNN’s SOPs. The per diem registered nurses are specially educated and skilled in the field of infusion therapy and SPs therapies. In fact, SPs are not always aware of the quality and credentials of the nurse administering care to their patients. All of our nurses are competency tested, background checked, and drug screened. They undergo annual education reviews to ensure ongoing compliance with all OSHA, JCAHO, and HIPAA standards. SPNN’s business operations also meet JCAHO certification benchmarks/standards and SPNN credentialed HHAs are also utilized to provide nursing services. These agencies must be accredited by JCAHO, ACHC, or CHAP or be equivalent to the standards.

HHA nurses with current infusion experience are educated to the specific therapy and competency tested by SPNN and all nurse and agency profiles are available on file.

Our goal is to lessen the burden of the SP and manufacturers—whose focus is pharmacy—by providing a customized nursing service that assists in the branding of a product/ service. The company’s performance indicators validate the success of our nursing model in initiating patients on therapy, monitoring adherence, and demonstrating the cost effectiveness of nursing services. SPT


About the Author

Cherylann Gregory, RN, BSN, is founder and president of the Specialty Pharmacy Nursing Network (SPNN). SPNN is one of the first specialty pharmacy nursing services to provide a nationwide network of qualified nurses to meet the needs of the specialty pharmacies and biotech manufacturers. The organization’s services include coordination of care, drug administration, first dosing, education, clinical outcome data collection and reporting, and on-call coverage for specialty therapies. Visit www.spnn.org for more information. Ms. Gregory will focus on key trends in subsequent columns. 



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