Hello all...I've been reading a lot of posts recently but havn't seen a topic that addresses my concerns so thought I would start my own.
I'm an RN in HH about 14 months after 17 yrs in a hospital med-surg floor. My agency uses RNs to do only the Admits, Recerts and Resumps and LVNs do the daily/weekly visits. I received very minimal orientation (2 days in the office reading manuals and then followed a nurse on 2 admits) but feel pretty confident now although I learn something new almost daily. We use Kinsser software for charting via our computers at home.
My concern is with my Oasis assessments coming back to me for my signature but upon review of them I have noticed many changes that weren't made by me.
Sometimes it's a Diagnosis (ex: Benign HTN changed to Malignant HTN - I was told that anyone with 2 or more BP meds gets diagnosis of Malignant).
A lot of times it's Sensory (ex: anyone that wears glasses has Low Vision and can't see medication labels).
Also frequently changed is the Braden Scale for skin breakdown risk (ex: most everyone winds up being at risk for skin breakdown somehow).
A biggie is Elimination (ex: urinary incontinence gets checked on everyone! I was told that everyone over 50 has at least stress incontinence and if they deny it, it is only because they are ashamed).
Another is Neuro (ex: Frequently the box is unchecked for Oriented to Time if I have checked that they are forgetful. I was told that you can't be oriented x 3 if you are forgetful!)
Nutrition (ex: Every pt is made to be of at least moderate nutrition risk).
And of course ADLs (ex: every category is typically changed to a higher level/need for assistance.)
All of the above (and more) is being changed by people in the office that did not visit the patient, are not nurses, and without consulting me and they expect me to just sign it with the changes. When I raised questions about this practice I was told that I had a bad attitude and bad reputation for not wanting my documentation changed. The administrator pulled me aside recently and told me that he is auditing my Oasis especially because after these changes are made, the company is making an additional $500.
I was under the impression that my job was to complete an accurate and thorough assessment - not worry about how much money each box I am checking is adding or deducting. Having come from a hospital setting where a nurses charting of her assessment is pretty much sacred and can't be changed or altered by anyone, this just doesn't feel right to me.
So my question is....Is this normal and just an accepted part of the Home Health world?
