Nursing Care Plans

[Katie13LPN]

I am an LPN and I have worked in home health for a long time taking care of sick children and disabled children. I have several questions.

I often feel frustrated with the "medical care plan" that my home care company puts out. I would like to write own care plan for my client. I think it would make my job more interesting too. I know that is not a question and it is just a statement.

It is hard for me to always finish my charting at the home. I usually get the assessment done and some of the nursing documentation. I always feel timid about this issue when I want the family to sign my chart. Should we leave the documentation in the home?

Another thing about home care nursing is that it would be nice to make friends. I usually work alone. I get so down in the dumps because I don't get to talk to the other nurses. The cases I have received are children who need total care. I am not always sure that I am up to the task. I do know when something is wrong though.

I never get to talk to the Director of Nursing and I often embarrassed to do that anyway since I have such a hard time with the documentation.

Anyway so far these are my thoughts. I often document right out of a textbook too.

[JustBeachyNurse, LPN]

It sounds like you are working private duty in the home. Traditional home health is intermittent skilled visits.

What are you charting that you never finish? Are you overcharting?

What is it about the care plan that you don't like? There are specific guidelines for insurance reimbursement.

If you do not get the family to sign your chart the insurance company can refuse to pay (and they do ) which can result in loss of the case.

Most pediatric private duty clients are total care but there are key documentation points that must be written such as vital signs and assessment findings. Treatments given. Progress towards nursing /care goals. Failure to document these points at the time of shift /visit can result in a clients loss of coverage for skilled nursing (and subsequently your job). Do you have a clinical educator ? Ask for an evaluation of your charts and help to be more efficient and complete.

There can be errors in the plan of care. Orders missed. Inappropriate or inaccurate goals. If you find this you need to alert the nurse supervisor or case manager ASAP before a regulatory or insurance auditor catches the error.

[LadyFree28, BSN, LPN, RN]

I am an LPN and I have worked in home health for a long time taking care of sick children and disabled children. I have several questions.

I often feel frustrated with the "medical care plan" that my home care company puts out. I would like to write own care plan for my client. I think it would make my job more interesting too. I know that is not a question and it is just a statement.

It is hard for me to always finish my charting at the home. I usually get the assessment done and some of the nursing documentation. I always feel timid about this issue when I want the family to sign my chart. Should we leave the documentation in the home?

Another thing about home care nursing is that it would be nice to make friends. I usually work alone. I get so down in the dumps because I don't get to talk to the other nurses. The cases I have received are children who need total care. I am not always sure that I am up to the task. I do know when something is wrong though.

I never get to talk to the Director of Nursing and I often embarrassed to do that anyway since I have such a hard time with the documentation.

Anyway so far these are my thoughts. I often document right out of a textbook too.

I have a few questions:

The "medical care plan" has nursing interventions on it..very detailed. Do you have care managers (RN) visit and give you an opportunity to collaborate?

How long have you been a nurse in home care? I understand you stated "a long time" but how long as a nurse? I only ask because the situations and concerns that you have are usually from one who has been there less than a year, usually.

Does you job have classes, etc, where you are able to interact with other nurses?? What about handoffs for your cases, especially with a total care case? When I was in home care (7 years as a LPN) I met plenty of nurses at my agency due to being on several cases, and if we are with similar schedulers, we may find ourselves crossing paths often. I also get to interact with other nurses when we perform annual competencies, educational seminars, etc. I still talk to my care managers for my clients; they are professional references, as well as people I keep in contact with to see all is well. I got to know my office well enough, they saw me through health problems, and my passing of the NCLEX-RN.

I also grew close to the other nurses on the case, especially ones who are on total care cases. There were core ones who don't leave the case, so if there is talk about switching shifts, etc, you learn to collaborate with them as well.

If you are in an area where it is "less population" do you have time to take up a class for a hobby, etc, to get our socially??? Are there any nursing associations in the area to network with other nurses???

I'm not sure how toe agency is structured, but Just Beachy is correct, it is important to finish your documentation while you are in the home. A copy of documentation stays in the patients chart, in the home, according to my agency's policy. Documentation policy was something that needed to be explained to you when you started, even if it's another agency, you do not want to be in hot water with CMS AT ALL.

Amazingly, it is possible to cluster care in home care with a total care patient. Document as you go along, and document according to company policy. Ask for a copy if you are unsure. Make this time making sure you have all the information on your company's policy and engaging with the nurses who compile the plan of care.

[Katie13LPN]

I do over chart I think. Every line of my nurses note is filled out. They say it is Exception charting. I just don't understand how my charting relates to the nursing care plan.

[LadyFree28, BSN, LPN, RN]

It does:

In the nursing portion of the home health plan of care; usually it is clearly stated what system is affected and the interventions are placed under the alterations or risks. My agency had a glow sheet for the assessment portion, a note; and then the outcomes portion to document for example: pt maintained SaO2 between 96-97 with a PEEP of 5; tolerated PRN nebs, etc.

Short with relevant info. When in doubt, utilize SBAR...again, get clarity from your agency regarding documentation policy as soon as you can for your success.