Congrats, you’re a hospice nurse! You may feel like you’ve finally found your calling. If so, you’re in good company. Hospice nursing is rewarding and exhilarating. However, I’d like to talk about one of the trickier parts of hospice nursing-DOCUMENTATION. Yes, it might feel like a puzzle, but that’s what I’m here for. Let’s talk about common barriers to hospice charting & how to overcome them!
The Ugly Truth about Hospice Charting
One of the things, I promised myself when I started Hospice Nurse Hero, was that I’d be honest about what it means to be a hospice nurse. Sometimes, it means saying hospice nursing is not all angels and mystical butterflies.
I understand that using the term angel is meant as a compliment, but sometimes, it minimizes the level of knowledge and skills nurses rely on.
But, I digress!! 😊
So, why do so many nurses struggle with hospice charting?
First, the charting requirements for hospice charting are not typically taught in nursing school. (sad but true)
And, there’s a good chance you didn’t learn how to use “negative” charting in the acute care environment.
Additionally, depending on your agency and clinical setting, you might be required to chart using a documentation system (or EHR) that’s not hospice-friendly.
I won’t call any names, but they know who they are!!
To make matters worse, hospice charting is not one size fits all.
The good news is that the barriers keeping you down can be overcome!
5 Barriers to Hospice Charting & How to Overcome Them
#1 Lack of Time
When I worked in the field, this was one of the areas that I struggled with. It seemed like I could never get it all done in time.
Worse yet, if I had an admission, I found myself charting for hours when I got home.
What I discovered, was that I had to make time for charting. Now, I’m not trying to say it was easy. Honestly, it was HARD!!
I’m not sure about you, but for me, there were so many competing interests in the field.
If you can relate, then you should continue reading.
Before you can overcome this barrier to hospice charting, you need to understand why you don’t have enough time.
For instance, ask yourself these questions:
- Have I properly prepped for my day?
- Do I know what happened with the patient since my last visit?
- What administrative tasks will I need to complete, i.e. ordering supplies, medication refills, calling families, etc.?
- What are my views/feelings about charting at the bedside?
- What resources and tools do I have to keep me organized?
How to Overcome:
When trying to overcome barriers to hospice charting, a good place to start is setting a small goal to start charting at the bedside or in real-time. Figure out, what’s holding you back!
For example, if you feel it’s rude to chart in front of the patient, GET OVER IT!!
I have some examples of phrases that I use that work every time. Once you get comfortable explaining why you would like to open the chart in front of the patient, you will be less likely to get pushback from the family.
💡PRO-TIP: You can say, “I’d like to take a minute to open my computer and chart my assessment. I want to make sure I didn’t miss anything, and I want my team to have all the information from our visit today. You can also use this time to think of any other questions you might have.”
#2 Case Loads and Complex Needs:
Well, it goes without saying if you’ve been a nurse for more than a day, then you know that having too many patients is a problem.
Sadly, hospice nursing does not exclude you from having a high caseload.
What is a typical caseload in hospice? This number varies between agencies. However, if you have more than 6 patients in an 8-hour shift, you might find yourself getting behind.
Additionally, if your patient has complex wounds or symptom management needs, your visit time might go longer and you could get behind.
I didn’t even mention family drama!!
It always amazes me how crazy things can get when someone passes away. (I experienced this firsthand last year when my dad passed away. I’ll spare you the ugly details. lol!) 🤦🏼♀️
The key is to remember that each patient has unique needs, so try to prepare in advance for things that may come up during the visit.
It’s easier to overcome barriers to hospice charting when you have a game plan.
How to Overcome:
Develop a personalized checklist for each patient. This can include medication schedules, symptom management, and specific care plans, ensuring you cover all bases during documentation.
Also, avoid the temptation to try to fix everything. Consult the hospice social worker if there is family drama brewing.
Trust me, family drama can eat away an hour-long visit in what feels like the blink of an eye.
#3 Poor Training
Brace yourself! Not everyone receives comprehensive training on the ins and outs of effective documentation.
I’m saddened to say that this is one of the barriers to hospice charting. Mainly because every nurse regardless of their practice setting or experience is entitled to proper training.
If you’re fortunate enough to have a hospice education team at your hospice, then you are more likely to learn the fundamentals of hospice nursing. However, many nurses do not get adequate training on the rules and regulations of hospice.
I’ve even had nurses who started seeing patients before their orientation ended because their agency didn’t have enough staff to cover the patient load. This goes back to my earlier point.
If you aren’t trained, you will make mistakes, and sometimes you will spend more time fixing mistakes than you have to.
If you don’t feel comfortable, speak up! Let your supervisor know that you need additional support or training.
DOCUMENTATION IS THE #1 STRUGGLE of Hospice Nurses
Are you charting everything you need to for your GIP transitions? Click HERE to find out!
How to Overcome:
Seek out additional resources and training. Many organizations offer workshops and online courses focused on documentation best practices. Peer support can also be invaluable; don’t hesitate to ask experienced peers for tips and advice.
#4 Inefficient Charting Systems
Unfortunately, there’s no easy way to say this. I’ll try to be as nice as possible.
Many electronic charting systems are clunky and can slow you down.
It has been my experience that some systems were designed for home health use and “adapted” for hospice.
Unfortunately, the result is redundant, unnecessary charting for hospice nurses.
When home health charting systems are used, hospice nurses are often forced to pick care plans and interventions that are too long and unrelated to the primary needs of the patient and family.
I won’t go too far down this path for my sanity and yours.
So, let’s talk about how you can overcome this, even though you have little control over the charting system your agency has.
How to Overcome:
Familiarize yourself with the EHR system. Often, keystroke shortcuts and other features can make documentation quicker.
Use a checklist to ensure consistency in your assessment and charting.
Also, keep the contact information for your IT department handy. You never know when you’ll run into an issue in the field that requires IT support.
#5 Emotional and Physical Fatigue:
The emotional weight of hospice care can make documentation feel like an extra burden, especially by the end of a long day.
Sometimes, you may be the only healthcare professional in the home so you will have to perform patient care by yourself. This can be physically exhausting so be kind to yourself.
Burnout is common among nurses, and hospice nurses are no exception. I could go into this more, but I’ll save it for another day.
Do you want to learn more about SELF-CARE? Click HERE.
How to Overcome:
Self-care is key. It’s important to develop healthy self-care routines. Don’t sacrifice family time to chart.
Recognize the signs of burnout and take steps to address them. Simple actions like taking short breaks during your shift, practicing mindfulness, and staying hydrated can significantly impact your overall well-being and focus.
Get it done as soon as possible so that you’re not up charting all night.
More importantly, resist the temptation to come home to do other tasks before you chart. Find a quiet place to chart and get as much done as possible during your workday.
Your future self will thank you!!
Conclusion
Remember, every challenge in documentation is an opportunity to streamline your process and enhance patient care. Your notes provide a critical continuity of care and help paint the picture of each patient’s journey. With the right strategies, you can tackle documentation with confidence, ensuring you have more time for what matters most — providing compassionate care to your patients.
To all my new hospice nurses out there, it’s okay to feel overwhelmed at first. Documentation is a skill that improves with practice. You’re not alone in this journey, and with each step, you’re making a significant impact. Keep going – your dedication and hard work are truly making a difference.
I would like to chart at the bedside-but its not happening, and not stricly by choice. Our platform is internet based. Most of our clients are in areas where you cannot get a wifi singal or internet, and many times its so slow and may not download all the way, may not save your work, and may not be able to sync your charting to a desktop PC to complete. So, unless I have at least an hour between patients AND have a connection, AND a good connection, my bedside charting consits of a small notebook in my pocket. I preplan/prep for my visits, and as long as the previous nurse puts their notes into the sytem in a timley manor, all is well. But then again there are set backes. Out in the field I get tons of calls from the office to call, triage or make a visit. Those times happen on a regualr basis and I can not prep for them. However, I do keep a hard copy up to date chart with me at all times, which helps. I typically see 4-5 patients a day but I have seen as many as 6. The distance I drive anywhers from 5-60 miles for one visit. Complex visits varry. I generally allow one hour for those visits, and 30 minutes for routine. However, occasionally that changes as a routine 30 min visit most recently turned into a 3 hr death visit. I won’t leave a patient or family who turns to actively dying in fromt of me-luckliy I did have team support to complete my unfinished routine visits for that day to focus on this one family and Pt. It does not always turn out this way-but I was prepared having the documents I needed to fill out in my car. I’m 60yrs old. Ive been in medical since 1983 and a nurse since 1985. This is by far the most rewarding career, and is flexiable with sechedules. So little set backs ad frustrations; I’ll take those any day over the 30 patient to 1 nurse ratio and 7 min to see each patient (in other facilites).
My motto I addapted is this: “Hospice is helping others simply pass into a calm eternity” Kelly Kiser
And my personal motto I developed is this “We are never too old, too young, too intelligent, too experienced, to learn and do more.” Keep your mind and options open. You’ll be surpirzed what you can learn-or, re-learn. Each day I learn something new from either: a patient, family member of a patient, care giver, CNA, nurse, etc the list goes on. The day I quit learning, is the day I no longer walk this earth and breathe its air.
EDITED VERSION:
I would like to chart at the bedside-but it’s not happening, and not strictly by choice. Our platform is internet based. Most of our clients are in areas where you cannot get a wifi signal or internet, and many times it’s so slow and may not download all the way, may not save your work, and may not be able to sync your charting to a desktop PC to complete. So, unless I have at least an hour between patients AND have a connection, AND a good connection, my bedside charting consist of a small notebook in my pocket. I preplan/prep for my visits, and as long as the previous nurse puts their notes into the system in a timely manor, all is well. But then again there are setbacks. Out in the field I get tons of calls from the office to call, triage or make a visit. Those times happen on a regular basis and I cannot prep for them. However, I do keep a hard copy up to date chart with me at all times, which helps. I typically see 4-5 patients a day but I have seen as many as 6. The distance I drive anywhere from 5-60 miles for one visit. Complex visits vary. I generally allow one hour for those visits, and 30 minutes for routine. However, occasionally that changes as a routine 30 min visit most recently turned into a 3 hr death visit. I won’t leave a patient or family who turns to actively dying in front of me-luckily I did have team support to complete my unfinished routine visits for that day to focus on this one family and Pt. It does not always turn out this way-but I was prepared having the documents I needed to fill out in my car. I’m 60yrs old. I’ve been in medical since 1983 and a nurse since 1985. This is by far the most rewarding career, and is flexible with schedules. So little setbacks and frustrations; I’ll take those any day over the 30 patient to 1 nurse ratio and 7 min to see each patient (in other facilities).
My motto I adapted is this: “Hospice is helping others simply pass into a calm eternity” Kelly Kiser
and my personal motto I developed is this “We are never too old, too young, too intelligent, too experienced, to learn and do more.” Keep your mind and options open. You’ll be surprised what you can learn-or, re-learn. Each day I learn something new from either: a patient, family member of a patient, care giver, CNA, nurse, etc the list goes on. The day I quit learning, is the day I no longer walk this earth and breathe its air.
Hi Sherlynn. Thanks for sharing your perspective. I appreciate your transparency, and I’m sure there are other hospice nurses in similar situations. In one of the rural areas that I worked at in the past, I couldn’t even get a phone signal, much less access to charting online. At one facility, my GPS would say, “get out and walk.” lol. It was in the middle of a national forest preserve. Sometimes our biggest barrier isn’t our lack of efficiency, it’s the very nature of the job. It sounds like you have a great attitude and a strong plan for staying efficient. Your agency, patients and families are fortunate to have you.
If possible, charting at the bedside really did make all the difference with me. You had the majority of your resources right in front of you (patient/caregiver). Best of all, it was such a stress reliever to get home and not have hours of documentation in front of you.