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Discussion

I was hired to fix what is wrong...................

OK, I am an LPN with 14 years experience in home health. I have been Home Care Coordinator which included all aspects of marketing, ADON (Not because I supervised licensed staff in clinical aspects but because I knew the systems), performed visits, been an intake nurse for a national company, written 485's (checked for content and signed by an RN. This was OK with surveyors),set up insurance contracts, maintained provider relationships helped start an agency from ground up and, I think- everything else.

I started working at a company (3 offices and more coming) about six weeks ago and am to be named G.M. on June 1st.

But.............the things I have found.

The 485's are poorly written, lacking proper goals and interventions. I see assess and evaluate on all 485's but little in the way of skills. Dressing changes are being done without orders (for a year!). Nurses are poorly trained. 50-60% of supervisory visits are past due (unskilled cases), nurses didn't know how to document (is better now since I was asked to coach them. I was trained by the best) and there are never any chart audits or 60 day summaries. How can 95% of Dx be "chronic"? I could go on and on...................

I was told when I was hired that I would intimidate the DON because of my experience and the fact I am an LPN. It has been a fight to get even basic nursing started on the right track and there is such a long way to go. In six weeks I will have an even more responsibility.

Does anyone know any websites that have info that will help me get this in order................writing 485's, documentation etc. I seem to have to pull up documents that support what I know needs fixing........seems to be a fight the whole way

Because I am a LPN with the skills and experience I have it is tough to find a job. I need this one (was out of work for almost a year) and want the GM position.

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Sounds like you have your work cut out for you. Was in a similar position and got canned once I got the ball rolling in the right direction, so watch out. I think you have to first prioritize the areas that need to be addressed. What is most important as far as getting dinged by inspectors? What is the worst area? I'm sorry, but if you haven't been given any employee to help you, you will probably have to roll up your sleeves and do everything yourself. I would suggest that each case be assigned a "primary" nurse. This person would be held accountable for seeing that the MD orders are updated onto the MAR, act as the central point of contact, etc. One of my agencies has a form that has to be filled out for the 60 day recert. Basically, it is input for the nurse who is doing the recert, to include the narrative summary. As for the recerts, if you don't have nurse supervisor(s) who handle these responsibilities, then do what one of my agencies did: the senior RN on the case (who could be the primary nurse) is required to perform the responsibilities of doing the 60 day assessment, etc. Do you have any friends or acquaintances filling this role at other agencies? You could ask for their input. One of my agencies had a list of nursing diagnoses and interventions. Our supervisors printed them on a form, then they copied the forms for each case. All the supervisors had to do at their visits was to review and initial along the side to indicate that the dx/intervention still applied. Sorry, don't know of any websites to help. You might want to consider pulling one of your employees to help at the office, even if only temporarily, so that you can get these daunting tasks accomplished. Wish you well with this job. Envy you because this is the type of job that I could really get into at this time. Good luck.

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