Paperwork-It Will Only Get Worse!


Two hours working on paper work and I am beat!

Visiting patients is the easy part of my day. The part that gives me the greatest satisfaction and reaffirms my choice of career. The paperwork doesn’t. I’ve read that paperwork is one of the top four reasons nurses leave the clinical setting. Is that surprising?

Paperwork takes time. My typical day starts at 8am. I carry a laptop when I make my home visits but I try to do most of my computer work outside the patient’s home because I value my patient-nurse relationship. A computer gets in the way. I work through lunch documenting the care I gave in the morning. I make more home visits in the afternoon and I’m back in the office about 2 or 2:30 pm. And then begins the hours of paperwork.

Our software package sets up our documentation template to meet the Medicare rules and regulations called OASIS. When the patient is a new one or has just returned from the hospital, is being recertified or discharged, the OASIS template is longer, more demanding. Built into the software program is our clinical note (“nurse’s notes”). In years past, nurses often used a SOAP (subjective/objective, assessment/plan) format. Now I’m writing my note to meet the demands of the Medicare reviewer. A typical note may begin “Skilled nurse visit where the primary focus was on skilled assessment and observation. Minimal education was done at this visit”. I’m writing for the insurance reviewer.

In my line of work, paperwork includes plans of care for home health aides, review of doctor’s orders, faxing updates and a summary of medication interactions to primary care physicians, to name a few.The bane of my day is the feedback sheets we get reviewing our documentation. Every time we do a new, returning, recertified, or discharged patient we get reviewed. And that happens a lot. Like a teacher reviewing a paper you turned in, the supervisor reviews the documentation and always finds something wrong. Her job is to function like a Medicare reviewer, challenging every detail of the documentation you have done, always expecting that it can be done better but never finding that it was. For a senior nurse it is necessary but degrading experience. For a perfectionist like me, it is devastating.

It is nearly 6 pm when I am done. The fingers are cramped. The mind is overwhelmed. The joy of helping people sick and in need is diminished. But then there is tomorrow and the first person I see gives me a hug because she is happy to see me and it all is worthwhile again..for awhile.

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