Managing my time :-(

Why are you adding "everything about them" to the notes? Take the advice you've been given, and document only relevant nursing information which the other staff need to know. With regard to the laptop, what's taking so long? The typing? The program?

stick to nursing info in your notes. The social worker will add the psychosocial

hi (((weetz))),

you needn't write anything but relevant info r/t the nsg dx's.

s/s? meds? subject c/o? objective data of pt.

any psychosocial and history belongs w/the licsw.

try to keep it focused around the here and now, and the skilled nsg care potentially and presently required.

leslie

Why are you adding "everything about them" to the notes? Take the advice you've been given, and document only relevant nursing information which the other staff need to know. With regard to the laptop, what's taking so long? The typing? The program?

Well, lets say they have lung cancer. But they are also diabetic and have 3+ pitting edema to the knees. Do I just keep it to the lung cancer, which is why they're on hospice and just basically ignore the other problems?

I don't like the comprehensive portion of the program, which has to be done on every visit. I mean it covers everything, and if you wear glasses this week its not likely to change in three days, right? Besides, your vision isn't why you're on hospice. But this is all tied into Medicare so it needs to be done. And, you know typing one little tidbit of info is nothing, but multiply that 'one little thing' by a hundred and it becomes pretty time-consuming.

As far as my typing, its probably about 30 words a minute. Have never needed it to do more than e-mail before.

stick to nursing info in your notes. The social worker will add the psychosocial

hi (((weetz))),

you needn't write anything but relevant info r/t the nsg dx's.

s/s? meds? subject c/o? objective data of pt.

any psychosocial and history belongs w/the licsw.

try to keep it focused around the here and now, and the skilled nsg care potentially and presently required.

leslie

Wa! I'm so proud of myself managing to get both your quotes together. Almost as satisfying as managing to get my avatar to animate.

Yeah, I was told not to worry about more than a smattering of psychosocial stuff as the MSW will cover that. But its more like my response to augigi. You seldom have a patient, especially the elderly ones, who have only one diagnosis.

If your liver cancer patient also has mild COPD, severe GERD and gets splitting headaches, what do you do? I feel like I'm cutting the patient into little parts by only concentrating on the cancer, which is the real problem - but by bringing everything into it I wind up with an total body assessment a medical student would be proud of.

And, ye gads, the meds!!! Calling the pharmacy, giving info to the tech, being transfered to the pharmacist, giving all details about every med, having them re-read them to me, finding out which ones are covered - and then putting them all into the system. Starting with 'searching' through brand names, moving onto dosage and route and then finding out only liquid is dispensed - and having to cancel that and go to 'manual' and typing all the info into the spaces provided yourself just takes up hours. I mean - we have to enter every med they take - aspirin, acetaminophen, saw palmetto, melatonin - and we all know some patients have mini pharmacies in their homes.

I know many of the nurses get there very early in the A.M. and put in ten hour days but never put down for overtime as they say they'll get fired. Hells Bells to that! If I work twelve hours and don't get a lunch I expect to claim it as OT. But that still leaves other nurses who do manage to do it in the allotted eight hours. The only way I can think of doing that is to spend a minimum of time with the patient and somehow cut down on the gathered info.

Please excuse me, y'all. Just kind of thinking out loud. Work was sooo much easier when everything was on paper! Aaaaaaarrrrrrrrrggghhh Can we please get a smiley that is tearing their hair out. I think it would be totally appropriate in many situations.

OK, that is pretty slow typing which may be slowing you down - the good news is that it's VERY easy to improve your typing speed. There are any number of sites online if you do a google search where you can practise.

With regard to the content, I would generally do a head to toe assessment. So if it's cancer, diabetes and pitting edema, of course I would record those. Do you get medical admission notes as well? Are you and the doc doubling up? If not, just try and list the basics and be brief and systematic:

CNS:

CVS:

Resp:

GIT:

GUT:

Other:

Let us know how you go.

30 words per minute is pretty slow. One place that I worked required nurses to take a typing test (case management job) and 30 wpm was the minimum you could type and still be hired...60 wpm was preferred.

I know it is hard to practice your computer skills when you are working 12 hour days but that might be the fastest way to reduce the amount of time you are spending on computer documentation. You might also investigate if you can "cut and paste" some of the data that doesn't change from visit to visit...like past medical history.

Consider candidly telling your manager that you are struggling and ask for assistance from someone in your office who seems to able to get it all done on time (there always one!!). He/she might be able to teach you some shortcuts and quick tips.

Finally, consider revising your practice patterns to include the computer at the end of the visit (once you are bit faster). If there is a space in the home for you to work, tell the pt/family that you find it helpful to write a quick summary of this visit while you are still there so that you can ask questions if you forgot or missed something. Some households are too chaotic or stressed for this but if you develop the habit, you may be able to pull it off. Take care of yourself and good luck....you can't keep working 12 hour days for long!

sometimes the primary dx (liver ca) would negate the co-existing dxs (gerd, mild copd) in that w/gerd, you'll focus on one's alt nutrition.

if this pt happens to get ascites or esophageal varices, then the gerd won't even be an issue.

same thing w/the copd-is it affecting his breathing or activity level,

being in its' mild stages?

what i'm trying to say is if the primary dx is going to affect certain systems, mobility, activity, appetite, ms, etc., then there's a chance one can get repetitve by including the other dxs.

you have to list all the comorbidities, yes.

but focus on the dx that will encompass the most, so you needn't repeat it again with the next dx.

even if they're not fully symptomatic yet, e.g. liver ca, they'll get there, trust me.

i got very creative when i did my assessments....but i wasn't using a laptop. :)

xo

Thanks guys. Would you believe there are some nurses I work with who type with two fingers? It made me feel better to see that.

We don't list all the comorbidities, generally just the diagnosis that brought them on hospice. We do have to list all the meds, though I have been tempted to overlook every vitamin and herb known to man that is taken.

This weekend I'm attempted to get things organized so everything I need to do the computer work is in one place rather than scattered all over, under and around my desk. And am trying to work out a schedule (I know, Ha Ha!) so at least will have some idea of how far behind I am and try to catch up.

Really appreciate all the good advice and ideas.:bowingpur Thank you! Will let y'all know how its going.

My agency has just gone to a computer system, I find that getting as much information as possible on the computer at visit time is useful, however, I do find it difficult at times, especially on admission when trying to get to know the patiet and family, there is usually alot of small talk.

We document by exception in our system, and use the care plan for the basis of our documentation. Many of the nurses are struggling with this, keep at it, it gets easier.

weetz,

i'm glad you're getting the overtime pay.

i've worked with nurses who struggled w/time mgmt, i.e., talking to families too long, slow in writing nurse's notes, etc., and my facility would not pay them the o.t., citing that their colleagues were on track and not behind.

so i am glad to hear they're paying you for all your time.

leslie

I just resigned from a hospice that informed me I was not "organized" because I never got finished on time. On a daily basis, I would have 5 or 6 patients with at least 30 mintues drive time in between each one. The boss never took windshield time into consideration when making assignments and advised me that I could do it in 8 hours because my colleague could do it in 8 hours (all her patients lived in the same town which was also conveniently her home town.) Being salaried, I got tired of donating my time to the company.