Documentation

[miccay]

I am the DON at a 88 bed facility. Right now our census is 76. I am being told that the nurses are staying over on their shift too much and they have to clock out and leave after their 8 hrs. The census is down and we cannot have overtime. The nurses are saying they have too much documentation to do to get out on time. Of course they document on residents who are on antibiotics and any incidents for 72 hours and they have daily medicare A charting. We only have 5 medicare A residents at this time. However, we have about 10 residents receiving part B services. The DON before me implemented that the nurses have to document on the part B residents on Tues and Thurs. Where I worked before, we did not document on the residents receiving Part B. We only documented three days prior to therapy starting to establish a reason for therapy and then we documented when therapy ended. I would like to know how other facilities are documenting and how other DONs handle getting the nurses off their shifts on time.

[CapeCodMermaid, RN]

My facility is quite abit larger than yours. We run between 25 and 30 Med A and managed care residents. The nurses are encouraged to chart throughout the shift but they usually end up staying late. We don't chart on Med Bs at all. I've been in other facilities that wouldn't put anyone on Med B unless there was a nurse's note describing the need. In those buildings we'd write a weekly note.

[DHawkinsrn]

I have the same issue. I just became DON of a 60 bed facility and the nurses were staying over to chart. I immediately implemented a no overtime rule and any overtime has to be approved by me. I had to do this we were over 144 hours in overtime for 2 weeks! I have also been working with them on time management strategies like delegating vitals to the aides, doing assessments while the aid is getting the patients up. I have also been encouraging them to chart throughout the day and not to wait until their shift is over to chart. It's a work in progress, but the overtime has been cut in half and I hope it gets lower. We have to stay within budget.

[noc4senuf]

After the initial 72 hours, I break up the amount of Medicare charting between the day and evening shift, then it is only once daily.

[CapeCodMermaid, RN]

We tried that but the nurses weren't documenting anything useful so we had to go back to charting every shift with the hope that there will be enough information.