Worn Thin From the Paperwork

  1. Well, I am going into my ninth month in Home Health and am not proficient in the paperwork. Ironically, I had been helped all along by one of the other nurses, who is now the Director, and she just found out she can not complete my paperwork (a Federal offense).

    I am repeatedly reminded how important the paperwork is and how very much we have been in violation. I am exhausted both physically and mentally. I feel all this affects my self-esteem and that makes me very angry.

    We are now down to two nurses, one is part time, and I. The director gave me most of her clients in December but is gradually building up her own caseload again. We have fewer nurses and are adding more clients. I am at 14-15 for my caseload with several chronic care patients.

    Now for the paperwork, I really stink at it. I feel so beaten up with this that I feel like resigning from the dream job I have tried to pursue and my reason for becoming a nurse (to do Home Health). This is my second attempt to do Home Health. The other position I held in Home Health was complicated by my personal life being upside down; now, I just wonder and feel like I am just not suited for this (and that makes me very sad).

    You have heard it before but, I love the pt. care but the paperwork is strangling me.

    How do you all cope and get the paperwork done? Do you have a clerical staff that supports your paperwork and reviews it before it gets to be months old? When does proficiency happen? Does it ever?



    Sorry to sound so negative
    Last edit by nightingale on Apr 7, '04 : Reason: remove personal remarks
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    About nightingale

    Joined: Apr '01; Posts: 6,312; Likes: 106
    RN, CLNC, Entrepreneur


  3. by   renerian
    You are not alone. The paperwork feels like you are drowning sometimes. Do you work for a company that splits it with private in one part of the company and skilled in the other to decrease your paperwork?

    I always tell new nurses give yourself one year to feel comfortable. Do you like computers? Maybe an agency with a point of service system would help?

  4. by   J. B.
    there was so much paper work involved in this feild of endeavor.
    And to think I thought the paperwork at the hospital job I have was a lot.
  5. by   nightingale
    Thanks for resposnding Renerian:

    The small community I am living in has few options; I wish we had a computer based set up but everything is paper driven and then the clerical staff keys it in. We do have many private pay but tht is given to one specific nurse. I have helped her on occasion but she does not do OASIS (how lucky).

    I think the Meidcaid clients are particularly trying with the chronic needs and pushing the limits of the system to get them what they need. Honestly, I do not like the case management but everyone says I am fine at it (probably cause I set definite limits but I have saying no to people in need). The CNA support is up and down with their personnel issues that simply need a more mature handling of (for lack of a better word) whinning.

    So now, after a conference with my Director, we have decided to get me off of OASIS paperwork for a while to give me a chance to breath and catch up. I will go in this Saturday to "clean up" what I have etc. I feel so frustrated with just "knowing" I am behind that this clean up should help trememdously on my heart. I guess, overall, I am dissapointed in myself; the last three intakes that I took starting 3-22-04 are not complete yet... I hope to do the 485's this afternoon. Do the nurses usually do the 485's elsewhere?

    Again, thanks for letting me rant and thank you for understanding Ren. I have felt pretty alone and much the guinea pig.

    Very much so, there is the other part of me that is frustrated in putting so much of myself into something and not feeling successful. Thanks for letting me know it takes a good year. To hear the auditor nurse from well... you know... one would think I am just plain sloppy.

  6. by   nightingale
    Quote from John Bosco
    there was so much paper work involved in this feild of endeavor.
    And to think I thought the paperwork at the hospital job I have was a lot.

    Oh yes, intake OASIS about 22 pages, permissions slips up the yin yang (and I am still go after approval slips from what I did last year), HHA (CNA) care plans, yadda yadda...

    The joke is, Home Health is not for the faint hearted... some joke. And now our nurse auditor from well... you know wrote a letter to the owner of the business that I am harrassing her... me... can you believe that? I did refuse to talk with her about her "emergency" (an account that was 3 months old without appropriate permission slips) that needed to be done ASAP; she stopped me in the hallway to "drop it off"... I told her to wait and she insisted on going on about it. I refused to talk with her while she was in that state... oh brother... you get the picture... she then wrote up a complaint about me....

    You can well imagine what I thought of her professionalism.

    So... as I lick my wounds I shall keep a keen eye on other ventures and just wish I had some other HH AGency to go to that had better options but... in this small community (that I must stay in) alas there are none so far.... this is about as stuck as I can get for now....

    Better days ahead... I know this is true...

    So back to the Entrepreneural Forum I go in hopes and dreams of more fullfilling Independent days ahead.
  7. by   renerian
    Do you type your own 485s or just do a load form? Would you like to try some private duty nurse staffing? Shiftwork/hourly?

  8. by   nightingale
    Ren: I would be you are too far away to venture into "giving me some hours". So...

    But I have thought of something "on the side" for private duty.. you know... but honestly... again the size of this community stinks... I am putting my resume out there for some other facilities.

    Come over to the Entrepreneural Board to see our conversations on optional ventures. I am hoping to explore some of these by this summer. And then there is always AGency Nursing (via my business) where I can subcontract but I have to travel and stay overnight.. it is hard on my family to be away (even if I am not to have them and they are at their Dad's).

    I do the 485's manually and someone else inputs it into the computer.

  9. by   renerian
    Hubby and I had our own business, home health/hospice consulting, for 5 years. I hated paying the taxes manually, the social security and such. Was a major pain.

    Good luck in whatever you decide. LOL I realize your to far away to offer you hours lOL I was just thinking that as an option for you where you work. Less driving. The pay can be stinkey though.

  10. by   nightingale
    Thanks Ren:

    I am thinking of advertising in our local paper for private duty and start networking for that for myself. I think I would ultimately feel better having some independence again and more options then this one agency.

    I am up again at an unhealthy hour with worrying about all the details. This too shall pass.

    Again, thanks for replying.

  11. by   renerian
    Can you apply for independent provider numbers for Medicaid in your state? Don't forget your malpractice insurance and have a lawyer check contracts and such.

  12. by   nightingale
    I thought anyone could apply for independent provider numbers but I have never checked.

    I appreciate the suggestions. I have the NSO insurance and worth every penny for the peace of mind.

  13. by   lioneliz
    i guess, overall, i am dissapointed in myself; the last three intakes that i took starting 3-22-04 are not complete yet... i hope to do the 485's this afternoon. do the nurses usually do the 485's elsewhere?

    hey no wonder you are having a hard time keeping up, you're trying to work in the future.

    i have worked in hh for the past 71/2 yrs and i still have trouble keeping up with all the paperwork. i get behind-then i feel stressed, then feel i tired, then i feel picked on then i feel cranky, then i feel guilty . of course none of that helps me get anything accomplished. so i have to give myself a stern talking to, suck it up, prioritize and organize my work, maybe even throw in a nap for some much needed rest, and take one task at a time.
    and yep i am still behind.

    i haven't as yet figured out how to keep up. if you figure out a way to keep up please let me know my pep talks aren't doing much good these days.

    if home health is a job that is dear to your heart then just keep plugging on.

    do the nurses usually do the 485's elsewhere?
    i don't know about other agencies, but we do the 485's (i should say i do since i'm the only f/t nurse).

    good luck!!!!
  14. by   nightingale

    Uh... lol see how easily I screw up? I should have typed 2-22-04...

    Thanks for the encouragement; the week that put me so behind and over the edge I did 29 visits, 3 intakes, and clocked 17 hours of case management with call all week.... nice paycheck but I took a day off just to chill and could not figure out why I was so weepy. Now that I am refreshed, and only working 40 hours this week, I feel much more myself.

    I did get a hold of some tools to organize my work and see where my "holes" are. I am referring to the Clinical Review Sheet that basically audits my own work and paperwork. Funny, I was never offered this tool before. I also am using the Oasis Cert. Sheet that breaks down the weekly frequencies and commitments to make for visits between the different disciplines.

    I spent about two hours at home last night, with a Heineken in hand organizing a better pt. case management binder for myself. I have itemized who needs what and how I can "predict" those needs, certs, and visits. I also need to start a strategy for auditing my own visit paperwork so the nurse from ... uh... you know... doesn't get to it first (we are supposed to audit each others but somehow never get to it).

    Anyone have any other suggestions for paperwork organization and / or self auditing review sheets or tools? I have looked at the OASIS website (thanks to Karen) and it has great info for my knowledge base.

    Thanks for the comments lionez and yes... I feel very dedicated to Home Health still... just not sure about this company and it's poor management...

    Last edit by nightingale on Mar 5, '04 : Reason: add comment