Home health nurses and documentation problems - please help me understand. - page 4

by nursetobeoneday 17,163 Views | 37 Comments

Hello everyone who works for home health! Please make me understand the following (based on my experience as an admin for a home health): -Sometimes is takes a month or even two months to get home health documentation... Read More


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    I share your frustration in this matter. But as a home health nursing manager, we do not allow paperwork over 48 hours. The reality is that the case cannot be opened if the case is not opened in the computer and staff following the first visit do not get paid until the initial visit paperwork is turned in. Makes for heavy pressure from peer staff.
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    We do everything by paper and have to hand in Oasis within 24 hours. I have a hard time documenting things when things have not changed. I do education every visit but for example a bad diabetic whose numbers are all over 200 and does not listen about diet. I keep educating on diabetic diet. But he is not going to change no matter what I say. Then do you close him?
  3. 1
    oooo, my favorite gripe topic- I have the other side of this story and Im really glad it is in my rear-view mirror. As the "extra" RN at my last agency I looked on in horror as the case management RN's were allowed to get [I]months[I] behind in their paperwork. I knew they were because I had to follow them. All their visits kept getting dumped on me so [I]they[I] could have paperwork days. More and more fell on me, the one who wouldnt allow myself to get behind on any paperwork. I worked overtime and my days off to make certain my work was done in 24 hours as a matter of personal professional standards- standards no one else was being held to. I begged management to stop this practice- I didnt want to work that many hours, OR have to do all the admits because the others were so far behind. What we needed was more staff, what I got was alot of flack for my "attitude".

    I was the one asked to leave. Looking back I should have RUN- NOT-WALKED from this place. Happy to say I finally found another agency where the management actually appears to care about and understand how difficult it is to complete all the proper documentation and they make an obvious effort to help the staff get it done and done right- its everybody's **** on the line and in everybody's best interest to work together to make it happen. Mandates coming down from management without the tools and willingness to help make it happen will only create an "us-vs-them" situation. There needs to be an atmosphere of "how can we all make this happen", not just a mandate that the staff has to make it happen.

    I haven't been with this agency for long, but I am surprised to find myself optimistic that maybe this place gets it. We shall see.
    RubyRN,CHPN likes this.
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    Thank you Hannahleah. I think you summed up my experience and frustration of not having the tools to do the job properly including and appropriate plan of care and a documentation history on the patient. Brings back memories of dreading the last week of the month (payroll was due on the first) and how many sick calls would come down the pipe from the same old clinicians who were behind in their paperwork and dreading the workload being asked of others because of their lack of compliance. I too have moved on to greener pastures where nursing and mngt. work toward creating an atmosphere of patient centered, professional, accountable and compliance concientous nursing. Best thing I ever did was moving on. Unfortunately, dear friend collegue fell in those nurses not getting work done on time. She is now at a different job with same difficulties of being behind in her paperwork. Called her today and asked if she wanted to join me for dinner and drink tomorrow night, said she was behind in her paperwork and didn't have time. Sad the impact is has on your personal life whe you slack.
  5. 0
    Hello allnurses!!!,

    Anyway, I've worked in home health in CA and TX and I know it doesn't work that way. The nurse that works home health usually doesn't get pain unless they submit their paperworks. We have deadlines for our documents. I used to dread paper documentation but we're blessed with agencies who are already transitioning or HAVE transitioned to computer documentation.

    There are some agencies that provide a guide for their nurses for documentation. The RN's are usually more bombarded with this requirement for specifics due to their role in Admissions and Recertifications. Poor documentation of a nurse will usually be corrected (supposedly) by a nurse supervisor because this covers the back of the home health agency itself. They are very serious with the right documentation because a lot of things can backfire on an agency if they don't have that - including NOT BEING PAID by medicare.

    I guess nurses should be very careful on working for an agency that allows delays in submission of documents because for me it suggests an agency that's unsafe to work for. It will eventually also show that they don't care about the nurses' licenses when they fail to give them ACCOUNTABILITY for prompt nursing documentation. I'm not saying home health nurses can ALWAYS submit a finished documentation in 24 hrs (it's not possible if you're seeing 10 patients/day like I did). I catch up on documentations over the weekend so if I do submit any late documents, it's only a week late. Besides, I don't see a paycheck coming if I don't make it to cutoff.

    As for the nurses who do delay documentation for a month (!?!), I bet their licenses are already on the way to being revoked. That's just too unprofessional in the first place! If they work this way all the time then an agency better let go of that nurse because they just bring trouble - to the agency, and worse to the patients we take care of.



  6. 0
    At my agency, the nurse's note sheet functions as the time sheet. One copy stays at the patient's home, the other 2 go back to the office. The work week runs Mon-Sun, and paperwork is due the following Monday by noon. You can fax or scan and e-mail it to the office, as long as the hard copy is mailed, with a postmark before the deadline. You can also put it in the office drop box.
  7. 0
    Quote from SunnyAndrsn
    I worked as a home care nurse for a medically fragile child for about a year. This child had RN care--no aides--for approximately 12 hours a day. There was a brand new nurse, straight out of school, and her only professional job was working for this child. Her documentation (lack there of) drove me crazy! I'd find out more about what was going on from the school (as we attended with him) than I would from the nurse. According to her, everything was always fine.

    As an example: "O2 sats stable this shift, except when the probe wasn't working right." Um, ????? No comments on changing the probe, contacting the company that provides the medical equipment, and no comment on how the client actually appeared during the time that the "probe wasn't working right." Left me with some fun CYA the next day.

    I discussed the situation with our agency, specifically citing her need for help with documentation and nothing was ever done :-(
    I am not sure how everyone else does things, but here it is up to the client to contact the DME to replace faulty equipment. The nurses do not do this, do not have access to the DME and it is fruitless to contact the agency and report it because nothing is done from that end. I know because I have tried. Some of the parents find it very frustrating to deal with an indifferent DME. The best they can do is to ask for a different company to supply equipment. Medicaid and Medicare patients do not have a lot of choices.
  8. 0
    Quote from nursetobeoneday

    I am really just looking for a way to get nurses to submit paperwork on time. What can I do or say to make that happen? It does not seem that paying extra money will do the trick since they do not care to get paid for a few months anyways ....
    I am amazed that there is someone out there working as a nurse for nothing because they don't care if they get paid. Are they running a charitable service? I find this very hard to believe. Unless it was someone who worked one night never to return, that is the only way I could imagine something like this happening.

    The turning in of paperwork in our agency is mandatory if the nurse wants to get paid. No paperwork - no pay. If the paperwork is not filled in correctly, one has to go back and fill it in correctly or no pay. Now, my agency has given me a courtesy call several times so that I will come back and fill in the paperwork properly. One time it was just that as a night shift nurse, I put the date in like this: 9/26-27/2010. It has to be the date you started working, 9/26/2010, even though that consists of one hour of your time.


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