Is It Just Me or Is ALL Your Work This Bad?
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First of all...
Before I start, I want everyone to know that I am so very glad to be back at work and I really do love home health. It is my passion and I hold high standards for myself about the care that is given for our little old people and our young people as well in home health but I am very frustrated this week and need to let off a bit of steam
In addition, I want you all to know all the nurses are good nurses. They just do not take credit for their work. As a manager it is up to me to read all the notes, sift through all the information, try to make a picture of all of it and make sure it is tied in a pretty Medicare bow so we will be reimbursed and not have to pay any money back to the government.
I also want you all to know there are two nurses in particular, I would tell your names but that is a HIPAA I bet and besides one has already made it plain she is not "awesome" dont say that to her, she is just a good nurse. I want to be like her :)
However, I give a presentation on documentation next week and am very unhappy still about the poor quality of the information coming across my desk and the corrections I am continually asking the nurses to make. As home health, we hold Medicare standards as our standard and it is very exact. Nothing but the absolute truth and every item addressed to the fullest is expected. I am telling you home health nurses out there things you already know aren't I? So why is the clinical supervisor made out to be the ogre when we read your notes and put on the yellow stickey’s that say please add, dont you think...did you call the MD, please write more specific instructions, etc
managing with positive and negative feedback
There is a ton of information out in the internet about how to manage people and how to give both positive and negative feedback. All of that is good advice but what do we do at the end of the workweek when we are so tired of putting sticky notes on work we cannot see straight and there is still no improvement in the notes?
The tone of our sticky notes changes not only according to the day but also by the day of the week.
The way the work week goes
Monday I start out well, with a good note for every three advices to perhaps you may want to say such and such instead. Wednesday it gets harder, there is not improvement and worse the notes are not turned back into me from Monday so I cannot tell if the corrections have been made. Come Friday and I am having a meltdown but that’s OK cause here comes the administrator to tell me the sticky notes are “causing some difficulty with the other nurses” Apparently they find me demanding and treat them like kindergarteners. I tried at first to just ask for more specific details on their instructions since “taught disease process” will not fly with Medicare…what disease process, spitting on the ground?
Open up baby birds!
So then, I began to spoon-feed them the instructions. I would say I need more information on use (for example)of lovenox such as don’t aspirate, don’t force air bubble out don’t massage it don’t give at 45 degree angle but rather at 90 degree, give in the love handles not where heparin goes, alternate sides. I think it was this type of note they found like a kindergartener/ but then again not writing sufficient information is why I thought maybe they don’t know so I will spoon feed it to them for a while…open up little bird let me poke this information in your mouth…OK….now spit it out onto paper thank you.
Helplessness about the nursing process and some nurses in particular
I have never in my life felt as helpless about nursing as I am feeling in this place. Surely, they know they must substantiate their work with specifics and surely, they realize especially with Medicare that our work is inspected as soon as it is transmitted onto the Ethernet. Am I then to just push the paper along the trail and continue to suffer through 68% surveys?
That was such a huge embarrassment to me even if it was not my work that was being scrutinized. Do they not realize that it is their documentation that can land them sitting in a court of law years down the line and they will have no clue about that patient except that they saw him and took vital signs and instructed on disease process. It is astounding that any registered nurse would turn in piece of paper with so little vital information.
HELP I NEED SOMEBODY!
In addition, they are the nurses who will be taking care of my hubby and me in less than a decade as we are in the baby boomer stage. Someone please help me. What can I do as a manager to motivate them to step up to the plate and do their job before they slash my tires?
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When it comes to the profession of nursing we are talking about life and death issues. An omission on a report could cause a tragic accident. I think that point has to be stressed over and over again. I worked with nurses for a few years and I have to say that many of them simply got burned out and were too tired to care. I think on the whole the profession is undervalued and nurses are overworked. Better working conditions might just lead to better performance.
well my part of the 4 part module on improvement comes up next wed the 29th/documentation...and I have 3 very good notes with the names all blacked out of course, as examples plus a blank note with all the fields from the 485 (MD orders) written in for them to use as a template and breakfastpop my part starts out with the information of the legal issues involved with proper documentation...I know they can do this/it is the fact for the last 2 yrs no one has held the nurses accountable for their actions and they stopped doing all the things they know they have to do to justify their work...I am really hoping this will finally take root because we all want to succeed/I just need to find the balance between giving positive feedback and negative feedback without getting frustrated....not let my emotions come through onto paper you know? and sometimes I just call the nurse in for a one on one but that is really stressful for the nurse especially if they are having a long hard day out in the field...so I have to pick my battles but we need to fix the problems of poor documentation fast! its difficult...wish I could hire you guys to audit some charts for me and give objective criticism :) home health working conditions are really one of the best, autonomous, down time between patients, outside in the air all day long, the ability to call you own hours and schedules, only come to the office 3 times a week...really a nice working environment for a nurse no call bells no MD rounds no phones but your own,....the hardest part is knowing and adhering to Medicare rles and regulations regardless of the insurance...because we hold Medicare as our standard as they are the highest...so the documentation is what provides the justification for Medicare to pay the agency so everyone can keep on working and the patients get to stay in their own home for the care they deserve!thats in my part next week too/thank you both Amanda and breakfastpop and I love you/ barbara b
Hey Barb! Wow, you are having a humdinger of a week. Good thing they hired YOU. Yes,YOU. they obviously needed you, and knew you were up to the challenge. push on!
I'm thrilled you found this job but sorry you are dealing with this behavior!
hey there you guys yea jackie I am up to it/in a few hours its my turn to give the furth and last mandtory inservice on all the changes/mines on documentation :)haha how to write lets see can I do that? and then myself and the other 3 nurses will continue to push the nurses to success like it or not and I am hiring new blood all the time and have been very pleasantly surprised! they are taking to it like dcks to water without complaints!! course we are letting them know how an what we want up front too...
hey there wanna b western whered you guys end up? still in AZ? I hope you get settled well and are happy I am thinking of you
Jackie,and wannab thank you both I love you both barbara b
I am so glad that you are back at work and I am sure that you will soon be able to sort out the problems with the work practices in a positive way where both sides come out the winner.
all four of us clinicl supervisors are trying our best! I am glad to be working again as well/still get very anxious but my director is very mellow and tells me to "Chill Bethard!" I dont/I want my work to shine of course but it helps to know she hs mine and all of the other nurses' best interests at heart/shes a very good manager and since I wrote this hub the nurses' documentation has improved tremendously!! all four of us gave inservices/one a piece/on different aspects of home health/mine was on documentation/and they are coming together very well as a team! course none of us made our inservices as harsh as I wrote here/this was an outlet for me before I wrote my power point!I am so glad to hear from you Maggie love you so much!! Barbara B
Hi Barbara,
So happy to hear that they are taking to the better practices of documentation "like ducks to water." Examples of one horrific court case could be incentive to keep them on the right track.
Slightly off topic but perhaps related...When I took driver's ed in high school they showed a movie of car crashes. It was very graphic. I went home and told my parents that I did not want to learn how to drive. Haha! My parents said that they would want me driving because they knew that I would be responsible. Sound a lot like your parents!
I am a latecomer to this hub, but I do think that what you did was right. Perhaps you could do it at least 4 x's a year to keep them on track. Do it when they aren't expecting it to be done. Keep them on their toes.
hello Peggy!! we did two court cases as a matter of fact and that does help get their attention just as the signal 30 movies did for us in high school!!
now myself, it took until I was 18 to pass the stupid drivers test/wrote a hub on it can you pass the drivers test in an el dorado/that thing was a yacht!!!!!!!! I couldnt parallel park that thing!!! I had been on a motorcyc since I was 12 and knew how to drive but in the 60's you know they made you parallel park/finally the poor cop took pity on me and that was AFTER I HIT THE TELEPHONE POLE IN THE EXPLETIVE CAR LOL
hello guinevere what a gorgeous name I love the king arthur stories/well we already started the surprise supervisory visits and already had one nurse quit on the spot/Ive been 86'd for the time being from doing any supervisory visits...oh well, personnally I think if you wash your hands once upon entering the home then put in a catheter and break sterile field 3 times and dont wash your hands before doing wound care on the same patient you should quit but then I am only an egg/slightly cracked :)
I am not an easy supervisor I know/ I am type A/ I know/ I am service oriented/ I know/ I do expect nothing but what I have done and continue to do from my nurses/I know/ I do expect that patient care should be quality and evidenced based practice/ I know/ I do expect them to use their critical thnking skills, they are registered nurses not licensed nurses/I know/
so...I suppose thats too much to ask?
sorry/had to vent a bit thak you for the comment abd I do so hope my venting hasnt made you run for cover from me :) its been a MONDAY!!!!!!! tomorrow will be better I hope
love to both of you!! barbara b
Hi Barbara,
The first supervisor that I had in home health was a lot like you and I LOVED her! Why? Because she was very specific about what wording and documentation Medicare required, and explained to me how poor Medicare survey results could jeopardize funding for the whole agency, and was always willing to give me extra training in a particular skill if I requested it.
Before I fully understood everything that was required for Medicare reimbursement my supervisor was writing full page notes reminding me of omissions, wording, etc. The day I got back a chart with only 2 words written on it, "GREAT DOCUMENTATION" I gave out a loud YAHOO!
My attitude from day one was that I was glad that she reviewed each chart thoroughly because it meant I had time to make corrections before Medicare reviewers showed up.
Is there an internal utilization committee in your agency? If so, are the regular staff nurses allowed to participate in it on a rotating annual basis? That's a great learning tool because they have to do a peer review on each other and sign off on it.
Hang in there. It sounds like you're finally getting through to the staff and things are gradually improving.
it is getting better and the learning guides are finally being turned in with their notes/long gone are the days of "taught on pain, med and safety" under instructions!! yippee!!
and yes starting this month as a matter of fact, everyone, from the ones who have been ther 5 yrs to the ones who have been there 5 days are going through orinetation AGAIN and this time a peer audit of one chart apiece will be required by everyone once a month/all together, in the same room every week/what a drag right?
well actually statistics prove if you do this your survey scores increase exponentially!!!!!!!!
now thats what I like to hear!!!
and it is hard and we do good work and we are good nurses/but we must take credit for all that we do and if it isnt written....
need I say more?
love to you and I wish you were here with me to help!! barbara b
arent you tired of retirement by now happyboomernurse? hey its 85 F here today!!!! gorgeous days for the next eight months!! then you can complain like the rest of the world for the next 5 mo/hey it beats shoveling snow for sure!!!!!! come on!!!!!
Congratulations on the progress!
Love the idea of everyone repeating orientation and the new peer audit requirement.
Retirement is still great. No desire to return to traditional nursing. Am having too much fun writing, but am glad there are still nurses like you training a new crop of nurses to take care of us baby boomers in the future! Much love, Gail
yea well I am a baby boomer too haha born in '53/man I hope I get to stop at some point and just write and play in the desert all day!!
but for now I am glad to have work and very glad the nurses are changing/love to you! barbara b
- Home Health Agency (HHA) Center
This is a one-stop resource for Home Health Agencies. - Give Negative Feedback Properly
when you need to give negative feedback, here are the things to remember
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Amanda Severn 20 months ago
I'm not a nurse, though I admire those who have that vocation. I have, however, come across the attitude you're describing in other walks of life. This is about people being totally unable to see the bigger picture. Maybe you could take your juniors further along the process and have them investigate some incomplete notes to discover what might have gone wrong in a treatment plan. Perhaps then they might begin to understand the importance of detailed information? Good luck with this. It's a tricky problem.