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?
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...
Well, the OASIS frequency sheet my company uses is helping tremendously with keeping track of when I and others need to do visits and not be off on missing, say supervisory visits of the HHA. I have now found the Clinical Review Sheet for self auditing my own charts so I know what may be missing from the charts.
So... I am hoping to find other self auditing and cross matching of documentation records to be more aware of compliance. I do, a lot of OASIS (am on a self apointed break for a while) and daily (what we call) Interpaths for the schedled and PRN visits, case manage (which is a riot cause I do not know this community but am learning fast), and supervise HHA. I still get confused over what they can and can not do; a recent list we recieved from another Agency is helping a lot with what the Board of Nursing allows CNA's to do.
So, to answer your question, I do not know what to ask for. If you have some suggestions I would be grateful. I o think I need time to digest all of this and have insisted on not working "so frantically" and refuse to be reactionary.
How would one organize their workload to case manage 25-35 patients (including therapies), schedule the recerts and sups, "do" the recerts and sups, plus admits, and adhere to the "all socs and recerts must be in by 48 hours" rule...in a territory that extends to about 40 miles or so out?
Email me your addy and I will look this weekend and fax some tools to you. Let me think what might help you best. If I have them on word I will email them. I know I had really nice tools that when my computer crashed I lost them.
Sounds like you work for a very disorganized agency. I have been in home health for 15 years and wouldn't dream of doing anything else. The paperwork is demanding but with an organized system in place it is managable. Hate to see you give up on it,, I have always found it very rewarding. I worked on the road seeing clients for many years and have been in an office position(scheduling, audits, performance improvement, ect.) for the last couple of years. Would be happy to offer suggestions on anything you might need a hand with.
I bought a little credit-card sized weekly organizer in Wallmart, they have a web site http://www.daytimer.com and this little thing is my brain. I plan the next appt with pt's while I am in the home, I wrote when they have a doc appt, so I do NOT schedule them that day, I wrote in all HHA sup's, when recerts are due, when foley's are due to be changed, etc... It really helps me to stay organized.
It sounds like you had very little organization. Does your agency have the copy of the hcfa/cms guidelines to oasis? It tells how to interpret those questions, and makes things go much smoother.
no notice given... I am no longer with this business... what an experience.. glad it is over... never again... what a crazy place.. I have never seen a small business run in such a horrible way.... again... glad it is over...
I am at 14-15 for my caseload with several chronic care patients.
nightingale, RN
2,404 Posts
:rotfl: :rotfl: :rotfl:
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...
night