medicare A nurse/documentation nurse

[TigerxLiLy]

Do any of your facilities have a nurse designated for Mon-Friday looking at skilled pAtients and documenting on them?

We have one. (Had a good nurse who knew each res. And did the job very well,but quit because she kept being pulled to floor or asked to do things that did not pertain to skilled patients- so hired a new one... My expectation levels are so high from previous nurse..this one is lacking)

This position does: all med a documentAtion Mon-Fri (observing (she's a lpn) medical status and adls) and is responsible for discharge meetings and coordinating the dc plans for the resident with the IDT team.

I make documentation cue sheets on residebt admission- hand the med a nurse the copy and also have unit book that has a copy of the cue sheet for weekend documentation. Med a nurse is instructed to update her copy during the week (order changes, new diagnosis) and then at end of week update the unit book's with her copies.

I think this nurse is not actually looking at our patients..

During RUG meetings she never has the answers to my adl questions or medical questions...

Found out today she hasn't been updating the cue sheets (she is New to position 4 weeks But not new to our facility- 4 yrs)--which should be easy to do if your documenting on the patient's right? Or am I being to harsh? And she knew she had to because I got her to verbalize what she was suppose to do with the cue sheets on week 2 appropriately.

Then on my cue sheet for one particular resident - I have "Dx pneumonia from hospital,observe respiratory status with lung sounds,o2 sats,sob with activity or laying flat?"

This med a nurse neglects to document on this. Reports that is not having any issues respiratory wise,then Monday night res goes into respiratory distress,o2 applies,neb tx q4hrs,abt therapy,and noted ronchi in lungs from RN on nlevening shift.

Tuesday--- med A nurse never documents on the respiratory status or even notes a decline.. Despite myself looking at the patient and knowing she was lethargic,decline adl status,sob with activity and requiring o2.

Today/Wed: ask the nurse if she has saw the above patient yesterday "yeah,she is fine. Nothing is going with her." .....and then proceeds to document that she was independent with adls and no resp distress and clear lungs.

Maybe she is just very stupid?

[CapeCodMermaid, RN]

In all my years in the business, I've never heard of a documentation nurse. The nurse caring for the resident is supposed to document on them, not some random nurse with a funky title.

[Gaby63]

Have to wonder what kind of budget allows a "Med A documentation nurse".....never heard of one either....

still, if a job description and duties are not being followed, then address, correct, educate, fix or terminate.

[LTCNS, LPN]

Many of the nursing homes in my area employ Medicare Documentation nurses and almost all of them are LPNs, BUT, most require the LPN/RN have at least a basic knowledge of Medicare documentation guidelines. If the nurse has little to no experience they are generally sent to documentation workshops or trained on the job by the corporate Medicare Nurse Specialist.

[PsychNurseWannaBe, BSN, RN]

I don't know if she is "just very stupid". I kinda find that offensive. I never heard of such a title. The staff nurse does this. Only RNs are allowed on our Medicare neighborhoods. The only point that I find a little off putting is that the resident had a change in condition and she didn't report it. I would just talk to her and say, Mr. X had the following happen over the past several days and you told me that he is basically OK. Can you explain how you said what you said when the documentation from the nurses state otherwise?

[TigerxLiLy]

...did.. Answer was "I have issues at home and I have not been all there in my head"... I directed her to our DON with that statement.. If you can't focus on the patients because of "home life" then you should not be working.

[TigerxLiLy]

Only RNs care for your Med A's?how does that work? The have their own ward? What's your med A patient:nurse ratio? How do you deal with LTC patients that come back skilled on a different hall?..

Trying to convince my boss to do a ward with just RNs... But with 5 RNs on night shift that end up missing tons of issues and missing documentation on weekends.. Doubt it'd work.