MindyTX

On bad days I would volunteer to be a Wal-Mart greeter. On mediocre days, antiques dealer, write children's books, do voices over's for the Meerkat show or maybe a mechanical engineer. On good days, there is nothing like the thrill of being a nurse.

Hey cathrn64, I also struggle with the small screen and print. Our agency added a device called "red fly". It looks like a small laptop but it is actually just a screen and keyboard. It is lightweight and connects to the PDA via a cord. Easy to take into a home and if you prefer a keyboard. you can rip through narrative documentation.

Could not have said it better. Never forget your primary responsibility to do no harm regardless of the circumstances, fair or not fair.

Your explanation is exactly correct. the Verbal SOC date has nothing to do with coordinating care with the physician at the SOC visit. It only gives us the ability to evaluate the patient. Even if we had very specific orders and frequency when the referral came in, it is required that nurses call the MD office and discuss findings, plan or deviation from plan, concerns etc. Home health is low priority in most MD offices and we commonly get voice mail. If I get voice mail I just indicate I evaluated, any imediate concerns, and freq. and ask that someone call me by the end of the day if they disagree with plan. If you do not get a call by the end of the day yuo have orders and also gave the MD or nurse the option to not have to make another call. I also fax a narrative to MD on the day of eval or next. Document your voice mail message and that you faxed a narrative and you have done everything the conditions of participation request.

Thank you for your courage in reporting fraud. We should never be indifferent to fraud and keep quite. Guess what kids, this is your and my money and our future healthcare insurance when we are elderly. Even if it is the agency that pays us and can make our life difficult for a short while, the long term effects are devstating to Medicare viability. Without knowing your exact circumstances I still think home health is an option for you. Any ethical comapny with an active compliance plan and compliance officer would be grateful to have an employee like you. At the next interview ask if the company has a compliance plan and officer and how frequently staff training occurs. Good luck to you. You appear to be the kind of nurse who needs to stay in home care, ethical, professional and beyond reproach and we need a lot more like you.

RN's tend to become technicians if they work in hospitals for any period of time. We forget quickly that our primary responsibility is assessing care needs, developing a plan for the team to follow, supervision of the plan and evaluation of care. Medicare gave us the OASIS tool for assessment and planning. I agree it is over the top for an assessment tool however we have to do what is asked of the people who pay us. OASIS is primarily an outcome tool and yes it is tied to payment but it also helps us determine if we made a positive difference in the pt's functional abilities and disease management. We sure want to get paid or home health goes away. We don't have private donors, philanthropists or charities handing us money. If you do not enjoy assessing, planning, goal setting and evaluation of care then maybe the RN role in home health is not for you. If you have unreasonable visit expectations and you are working until midnight on paperwork look for another agency. There are many ethical and professional home health agencies out there. To get the goverment to make changes you write your senators and representatives. Our elderly Medicare pt's can also be a very loud voice for home health. I know many patients have told me they had less paperwork buying a house. Those are the pt's you ask to write letter in our behalf. Excessive paperwork in the healthcare field is also due to excessive law suits and CYA documentation. Write your state legislators and complain. Tort reform may stop the excess documentation requirements. Believe me they listen if enough folks write.

Timely documentation works only if your agency's leadership enforces policy consistently. If you are fulltime at our agency and do not get documentation completed in 24 hours you are suspended without pay until documentation is in. If this happens 3 times you are terminated. If you are per diem and have late documentation, all visits are removed until documentation is complete and termination occurs after 3 occurneces.. If new employees are trained appropriately, the policy is emphasized and the preceptor is a role model for appropriate and timely documentation these issues do not exist. It is unfortunate and disappointing that nurses practice this way. I could not leave my shift at the hospital without completing all documentation. Why would a nurse think it is OK to do home health documentation 1 or 30 days later. It is unprofessional and puts the nurse, agency and pt. at risk.