Most nurse practitioners function in primary care settings, such as employee or student health services, physician's offices, hospital clinics, and health maintenance organizations. A few are in joint practice with physicians or practice independently. Yet it seemed to me, after four years as a community health nurse, that the nurse practitioner role, with its emphasis on management of 'chronic illness, accountability, and primary care, could be -used with equal effectiveness within our home care agency. I discussed this idea with my employer, the Visiting Nurse Association of the District of Columbia, which agreed to sponsor me in a family nurse practitioner program and promised to employ me as a nurse practitioner once I became certified. So, after a 20-year hiatus, it was back to college for me. The next twelve months were the most diffi-