Medicare charting regulations????

  1. Ok, here is the situation. I have been a LPN in the same SNF for 10 years. I have been trained and I am skilled in med administration using the pyxis system, IV antibiotic administration, IV insertion, blood draws, EKG's, RXs, ect., ect.

    Last night was the very first time in 10 years that LPN's were excluded from a nursing meeting. My charge nurse, whom I have a great relationship with, informed me that one of the things that came up in the meeting was that the Administrator stated that beginning very soon, she wanted ONLY RNs to do the nurses notes. Her stated reason was "because of Medicare regs".

    First of all I can't possibly believe that there is any Medicare regs that state that it has to be an RN that does the nurses notes. Secondly, this is the biggest slap in the face that I can imagine. I've been doing 90% of the charting on my shift for almost 10 years now. I write at least as good a note or better than anyone else on the unit.

    I have dug around the net for Medicare regs but am coming up with nothing so far that is quite that specific.

    So, has anyone here ever heard of anything quite so freaking rediculous? Does anyone know of any such Medicare regulations?
    Can you lead me somewhere where I could acquire the info I need?

    Please help me out. I have already spent one sleepless night over this and I would like to be armed with as much information as possible before I have a meeting with the administrator about this issue.
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  2. 8 Comments

  3. by   sjoe
    If I understand you correctly, Jammer, you actually WANT the responsibility and time-sink of charting, when it could be passed off to RNs?

    What on earth does charting do for you that you find it so appealing? I'd think you'd be happy to get rid of that task.

    Some of the jobs I've had where charting was 90% of my work left me feeling as though I accomplished next to nothing.

    Or perhaps I am not understanding....

    But to answer your question, it sounds like so much management BS to me. I've heard nothing about this "rule." Apparently your management thinks the RNs have too much extra time on their hands and/or that LVNs suddenly have lost their charting skills for unexplained reasons.

    (I'd PM NRSKarenRN if you are in a hurry for an answer. She seems to be up to date on everything!)
    Last edit by sjoe on Dec 18, '02
  4. by   Jammer
    Yes, as a matter of fact, I do enjoy charting. As hard as it may be for some to understand, I find it personally rewarding to give an accurate account of a residents care but this is actually NOT the main point here. The main point would be that after a decade of doing this particular task well, to all the sudden be told that my credentials are no longer adequate to do the job is an EXTREME insult.

    Now,........ is there anyone that could actually answer my questions as apposed to questioning my likes or dislikes?
  5. by   NRSKarenRN
    Here is link to Medicare SNF Manual---glanced thru it but unable to find any indication of only RN's documenting. I would request to see this Medicare Regulation IN WRITING....never heard of it.

    HOWEVER, under your states practice act it may say that only RN's can perform assessments (we have that in PA). So maybe that is their problem: lack of RN documentation of assessments.

    Let me know if you find out anything.

    http://cms.hhs.gov/manuals/12_snf/sn201.asp
  6. by   emily_mom
    So let me get this right....RNs are supposed to be charting things that they didn't even do b/c they don't want the LPNs to do it? Somehow that just seems wrong.

    Kristy
  7. by   RN auditor
    Something definitely doesn't sound right here. I do Medicare auditing in a hospital setting and often times someone quotes a regulation or something that simply does not exist. I always ask to see the reference to the material that is being quoted. Also, if the RNs are the only ones to do the charting, they are also the only ones providing the care since they cannot document what another nurse is doing? Does this mean the RNs are going to be doing 100% of the phone calls to physicians offices, assessments, etc? Iwould definitely clarify it and I would get the directive from your supervisor in writing. Are the RNs also in an uproar over this?
  8. by   montroyal
    [QUOTE]Originally posted by Jammer
    [B]Ok, here is the situation. I have been a LPN in the same SNF for 10 years. I have been trained and I am skilled in med administration using the pyxis system, IV antibiotic administration, IV insertion, blood draws, EKG's, RXs, ect., ect.

    Last night was the very first time in 10 years that LPN's were excluded from a nursing meeting. My charge nurse, whom I have a great relationship with, informed me that one of the things that came up in the meeting was that the Administrator stated that beginning very soon, she wanted ONLY RNs to do the nurses notes. Her stated reason was "because of Medicare regs".

    First of all I can't possibly believe that there is any Medicare regs that state that it has to be an RN that does the nurses notes. Secondly, this is the biggest slap in the face that I can imagine. I've been doing 90% of the charting on my shift for almost 10 years now. I write at least as good a note or better than anyone else on the unit.

    I have dug around the net for Medicare regs but am coming up with nothing so far that is quite that specific.

    So, has anyone here ever heard of anything quite so freaking rediculous? Does anyone know of any such Medicare regulations?
    Can you lead me somewhere where I could acquire the info I need?

    Jammer, I inserted a copy of a reg which may help with what your looking for. I know it sounds petty, but the reg requires a registered professional nurse, not a liscenced one. This may be what they are refering to. Also, some BON require the initial daily assessments of patients to be done by a registered nurse and then subsequent ones can be performed by LPN's. Contact your BON to check.


    271.4 COVERAGE OF SERVICES 11-87



    Changes to such plans also may be made pursuant to oral orders given by the pathologist to another qualified speech pathologist, by the occupational therapist to another qualified occupational therapist, or by the physical therapist to another qualified physical therapist, or by the therapist or pathologist to a registered professional nurse on the staff of the provider. Such changes must be immediately recorded in the patient's records and signed by the individual receiving the orders. While the physician may change a plan of treatment established by the pathologist or therapist providing such services, the therapist or pathologist may not alter a plan of treatment established by a physician.
  9. by   Jammer
    Thanks everyone. The above really seems to be more about changing a particular plan as apposed to just nurses notes. I don't know. I've had a good nights sleep now and feel better but I'm sure it's not gonna be pretty when I confront the DON today!!!!!!

    Any yes, as far as intial admission assesments, that was already taken away from me. I had been the ONLY one doing them for about 5 years when this very same DON also took that duty away from me, stating that it had to be an RN. So, low and behold we do now have RN's (that have barely even looked at the residents), filling in the blanks on our assesment forms with some sort of clairvoyance................they are simply amazing!!!

    Anyway, I guess I'll find out more today. It might be that this is no longer the profession for me. I'm kind of getting sick of this crap anymore.
    Last edit by Jammer on Dec 19, '02
  10. by   cargal
    Be it RN or LPN, I would certainly want to document my interventions for all the reasons Jammer mentioned and to cover myself too, to prove that I gave proper care, etc. Challenge it. Period.

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