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

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... Read More

  1. by   caliotter3
    I would take away the visits in terms of no more work, no more job. Then hire a replacement. The other nurses would not be inconvenienced for very long at all and probably would not know what happened unless informed in an inservice on "how to keep your job". JMO
  2. by   MindyTX
    Timely documentation works only if your agency's leadership enforces policy consistently. If you are fulltime at our agency and do not get documentation completed in 24 hours you are suspended without pay until documentation is in. If this happens 3 times you are terminated. If you are per diem and have late documentation, all visits are removed until documentation is complete and termination occurs after 3 occurneces.. If new employees are trained appropriately, the policy is emphasized and the preceptor is a role model for appropriate and timely documentation these issues do not exist.
    It is unfortunate and disappointing that nurses practice this way. I could not leave my shift at the hospital without completing all documentation. Why would a nurse think it is OK to do home health documentation 1 or 30 days later. It is unprofessional and puts the nurse, agency and pt. at risk.
  3. by   carwin
    To MindyTX, great policy. I can't believe the stuff I read in these posts. I get sick to the stomach.
  4. by   kids
    Quote from nursetobeoneday
    -sometimes is takes a month or even two months to get home health documentation from a field nurse
    totally unacceptable.
    your agency legally can't even bill for the visit until the complete and correct paperwork showing that the visit took place is done and turned in, to do so is fraud.

    Quote from nursetobeoneday
    -the documentation is missing critical info or poorly chosen interventions resulting in office staff having to redo lot of the paperwork
    stop that.
    office staff should never be re-doing paperwork. no additions, changes or corrections should ever be done by anyone but the nurse who signed the forms, i believe other people making any changes to the signed paperwork is fraud.
    your office staff is contributing to the problem by 'fixing' the paperwork, there is no reason for the nurse(s) to do it right the first time because someone does it for them. make the nurse come back into the office to correct/complete the paperwork. don't pay for the visit until it's done. a visit isn't complete until the paperwork is done correctly and completely and turned in.

    and don't give them any new cases. if they can't turn in their paperwork done correctly and completely, in a timely manner then they obviously don't have time to take on any new cases.

    Quote from nursetobeoneday
    i understand that home health nurses are swamped with paperwork. yet, it makes no sense to put off paperwork for a month or two when it will be even more time consuming to try to figure out what was done during home visit. it would appear that the most effective and fastest way to do this is during pt visit or right after while all info is still fresh. this would likely reduce many errors in documentation.
    part 'job' of doing a visit is doing the paperwork. if the paperwork isn't done the visit isn't done.
    are you sure she's actually doing the visits? does her late paperwork always seem to happen with the same clients(s), if it is i'd suspect the nurse(s) and client(s) are committing fraud.

    Quote from nursetobeoneday
    submitting late paperwork is very unprofessional, irresponsible, and potentially dangerous. i thought that nurses, in general, are very professional and responsible. am i wrong to assume such a thing?
    yes, it is unprofessional, irresponsible and potentially dangerous. nurses are human beings like anyone else. what you have on your hands is a problem nurse or nurses who have been allowed to make their own rules without consequence.

    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 ....
    don't pay them "extra" for doing their job, stop paying them for not doing their job.
    don't pay them for a visit if the paperwork isn't done correctly and completely and turned in. their paperwork is in effect their time card. if that doesn't jerk them in line...fire them for violating policy.

    Quote from nursetobeoneday
    finally, i was told this is how things are in home health and have always been so (chronically late paperwork & poor documentation). i refuse to believe that this is how it should be. there really must be an alternative because since when should we accept mediocrity and half done jobs?
    no, this is not how it is in home health, at least it hasn't ever been with any of the agencies i've worked for off and on for the last 15 years including a 3 year stint as the location director for a nation-wide chain of agencies. the alternative is setting deadlines, sticking to them and firing people who refuse to follow policy. they are turning in paperwork late because they are being allowed to.

    if your company/administration won't support you in cleaning things up bring up what i mentioned at the top:
    your agency legally can't even bill for the visit until the complete and correct paperwork showing that the visit took place is done and turned in, to do so is fraud.

    my agency has a 5pm friday deadline to be paid the following week. there is an exception made for visits that happen too late for the deadline, the paperwork for late friday visits and only late friday visits is due by 8am monday.

    it really sounds like you've fallen into a sloppy agency with sloppy nurses.
    if they won't follow the rules for paperwork what other rules are they ignoring? rules that could put the clients and the agency's license in jeopardy. i can tell you, it is your reputation and career they are putting on the line, if it all goes to hell and the agency gets investigated by the state or feds and is fined or closed down.
    no one, not the state, the feds or your future employers are going to care that the nurses wouldn't do what you told them to do, they are only going to see that you allowed them to break the rules.

    i would call the all the nurses (good and bad) in for a mandatory meeting to go over the expectations and review what constitutes correct and complete paperwork including the deadlines, have examples of complete & correct paperwork to give them copies of.
    lay out the consequences incorporating your agency's policy of progressive discipline for failing to do it all in a correct and timely manner.
    have an outline of the meeting with specifics printed out and attach any handouts and have each of them sign a copy. then follow through with applying the disciplinary process as needed, with their signature on the meeting minutes you've just established willful violation of policy/expectations. any nurses who don't show for the meeting have to read and sign the packet before being given their paycheck.
    my agency schedules (the rare) mandatory meeting a couple weeks in advance, on payday. our schedulers do not book any visits that would interfere with our being there and they give ample warning that paychecks will be not mailed prior to the employee meeting with the director.

    i hate to toss this out there but these days, if your current nurse(s) don't want to meet the expectations of the job, in many areas there are plenty of nurses who would be more than happy to do the job and do it right.

    start acknowledging and rewarding the nurses who are performing to expectations and drop the hammer on those who aren't.
    Last edit by kids on Aug 2, '10
  5. by   valeriejean2
    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.
  6. by   twokidsmom,rn
    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?
  7. by   HannahLeah
    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.
  8. by   RubyRN,CHPN
    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.
  9. by   cookziedough
    [FONT="Century Gothic"]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.

  10. by   Not_A_Hat_Person
    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.
  11. by   Luv2care0907
    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.
  12. by   Luv2care0907
    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.