Behind the times?

[paddler]

I have been working HH for almost 4 years, and just started at a new rural agency that seems to be about 10 years behind the times. Their software for charting is literally 10 years old and is TERRIBLE to learn and takes FOREVER to chart with needless areas of double, triple, and even quadruple documentation with several paper forms also required to fill in the gaps the computer doesn't cover.

They don't even use fingerstick PT/INR machines. My supervisor told me it's because of the state nurse practice act does not allow a nurse to perform a lab test (PT/INR or glucometer) and we are not allowed to do this, only to collect specimens for the lab to run. What this means is we collect a venipuncture for INR checks and deliver it to a lab who's courier picks up the specimen within 24 hours, and then we eventually get the result 24 - 48 hours after it was collected. This is not safe standard of care for patients on warfarin who need real time results for dosage calculations/instruction by the doctor.

Also, they severely limit the number of visits nurses are allowed to do. They only employ RNs and HHA, and any other therapies are contracted out which no doubt costs more money to the company than it should. They say they lose money when a nurse sees a patient more than 7 times in a cert period, but of course we should try and see them more than 4 times to avoid a LUPA. So what this means is I have to see my very ill patients too infrequently for me to provide care, assessments and education to be of much good to them. I am kind of thinking, "what's the point in having home health then? How am I supposed to be of any use to the patient?" She said the case managers are expected to do non paid, non billable, calls to check in on our patients. Pshaw!

At previous jobs (have worked for 2 other agences, not rural) there was absolutely no problem seeing a patient 2-3 times weekly for 1-3 weeks and reducing accordingly until they were ready for discharge. Of course, occasionally there would be a patient with short term daily visit needs that I was encouraged to reduce frequency ASAP, but I have never had my allowable SN visits rationed out like this. It seems hokey, like how could these other companies be raking in the money while sending nurses out 2-3-4 times weekly and this place loses money if you even go out once a week?!

Any thoughts?

[Merced]

When I worked in HH as Case Manager, it was very clear that very frequent visits by the RN - in the beginning - would result early, quality discharge (ie: pt & family learning enough to take over safe care & monitoring at home).

In myriad ways, the profit motive takes over the care motive. That's what life is like working in this system.

I don't know if it would be better in another system, but as a nurse interested in good care as my primary motive, it is frustrating, even in my present teaching job.