The dissertation analyzes the role of the Registered Nurse in Home Health Care. Home Health Care nurses are characterized by an ethos of care centered around more traditional nursing dicta of a sort that goes unrealized in hospitals. As a result, nurses in home health care are more satisfied, find they have more authority and responsibility and also practice nurse-dominated, patient-oriented care, rather than care ordered around the medical model, the mainstay of hospital treatment. However, though home care nurses experience autonomy on personal (micro) levels, their authority does not extend beyond; physicians still maintain legal authority over patient responsibility. The organization of nursing does not necessarily gain any professional impetus, nor, because of their isolation in home care, do nurses improve their collective strategies toward more power in health care more generally.

Observation and interviews were conducted with a total of 82 nurses, 40 primarily from two home health care agencies, one Medicare-certified and one Licensed, and 42 nurses from two hospitals, one large, teaching hospital and another smaller community hospital, both on Long Island. All data was supplemented by a mail questionnaire of 454 nurse respondents representative of all Long Island Registered Nurses.

In addition, patients were observed and interviewed. Home care patients, either recently discharged from hospital care or in the case of the chronically ill, who repeatedly encounter hospital care, receive different levels of care in different settings and therefore provide direct comparison of two different nursing experiences.