As hospice care continues to evolve, you might find yourself caught in a complex web of regulatory pressures and compliance requirements. While this may leave you feeling overwhelmed, understanding regulatory standards is an important aspect of your role as a case manager. I want to tackle compliance for hospice nurses and help them overcome challenges while maintaining compliance and upholding the principles of compassionate care at the end of life.
The Regulatory Landscape in Hospice Nursing
When I started as a hospice nurse, things felt less complicated. Hospice was still fairly young and didn’t have some of the rigorous requirements it has now.
So, you might be wondering why things have changed.
The answer to this is simple. MEDICARE!
Did you know that Medicare is the largest payer for hospice services?
Therefore, they set the regulatory standards influencing how hospice care is provided.
As a hospice nurse, you might wonder what that has to do with you, right? After all, you just want to take care of your patients.
If you’ve ever felt like your company only seems to care about regulatory requirements, then you might be onto something.
While they absolutely care about the patient, they also know that to stay afloat, they have to ensure they are properly reimbursed for the quality care you provide.
However, when nurses feel so overwhelmed by the charting, that the patients get the short end of the stick, that’s when it gets frustrating.
The Balancing Act: Delivering Compassionate Care Amid Regulatory Demands
1. Documentation Challenges & Compliance for Hospice Nurses:
Have you ever felt like the only thing your agency cares about is how fast you can get your admission entered?
If so, you are not alone!
Sometimes, the demands of documentation can feel overwhelming. Finding the right balance between fulfilling regulatory requirements and maintaining the human connection with patients is an ongoing challenge.
First, I’ve been on both sides of this discussion and to be honest, I wish we didn’t have such tight regulations on turning in CTIs and HIS. Seriously, if you are seeing multiple patients and charting an admission, you could end up working well past your 8-hour day.
This is the part of hospice nursing that no one wants to talk about.
If you want to overcome documentation challenges, you will need to adopt better habits such as real-time documentation and scheduling administrative time to prepare for IDG and recertifications.
2. Staffing and Training Struggles:
If you’re like many hospice nurses, you may have received an abbreviated training. There’s also a possibility that you were asked to take on patient care before your orientation ever ended.
Even more so, you might have been asked to train someone even though you were a new hospice nurse yourself.
Unfortunately, this happens all too often.
One of the reasons that I started Hospice Nurse Hero was to help support hospice nurses as they grow into their roles. I’ve heard so many horror stories about nurses who didn’t get much training on how to write nursing narratives, and it breaks my heart.
Hospice Care is highly nuanced and often feels like learning a different language. So make sure you advocate for the best hospice orientation and don’t say yes to coming off orientation too soon.
RECOMMENDED ARTICLE: 5 Tips to Stop Feeling Incompetent for New Hospice Nurses
Additionally, take time to learn about the requirements for your agency, and state.
Often, regulatory requirements vary from state to state, so understanding those standards can help you as a hospice nurse.
For instance, some states allow chaplains and social workers to attend a death. If so, then your agency can use these team members to relieve some of the pressure off of the nurse.
3. Ethical Dilemmas in Compliance:
Compliance requirements may sometimes pose ethical dilemmas for hospice nurses. Striking a balance between adhering to regulations and respecting patients’ wishes or families’ cultural considerations requires a nuanced approach.
For instance, your patient does not need to have a DNR in place to start services. This common myth can lead to frustrations and patients not getting the service they need.
Also, you CAN’T “revoke” your patient just because your hospice doesn’t want to cover services. I learned this from an amazing hospice QI nurse. Only the patient and family have the right to revoke hospice services.
Navigating these ethical challenges is an integral part of the hospice nursing role.
Strategies for Managing Regulatory Pressures:
1. Continuous Education and Training:
Hospice nurses must prioritize ongoing education to stay informed about regulatory changes. Workshops, seminars, and online courses can provide valuable insights into evolving compliance requirements.
2. Interdisciplinary Collaboration:
Collaborating with other healthcare professionals, including social workers and administrators, can help hospice nurses share knowledge and insights about regulatory changes. A collaborative approach fosters a team culture that collectively addresses compliance challenges.
3. Technology Integration:
Leveraging technology can streamline documentation processes and help hospice nurses meet compliance requirements more efficiently. Electronic health records (EHRs) and other digital tools can assist in maintaining accurate and up-to-date records.
4. Advocacy and Professional Organizations:
Engaging with professional organizations and advocacy groups provides hospice nurses a platform to voice concerns, seek guidance, and contribute to discussions about regulatory changes. These organizations often offer resources and support to navigate compliance challenges.
https://www.advancingexpertcare.org/For example, the National Hospice and Palliative Care Organization (NHPCO) offers education and best practice information. I also enjoy the Hospice and Palliative Nurses Association (HPNA)benefits such as their magazine, study materials, and the ability to maintain my hospice certification.
CONCLUSION
To wrap it up, you can’t get away from regulatory requirements as a hospice nurse. It is important to learn the key terms and to understand negative charting. When you learn how to pain the picture, you will find that hospice charting get easier and you will get faster.
Key Takeaways Regarding Compliance for Hospice Nurses
- Learn the requirements for each level of charting i.e. recertification, LCDs, and how to document decline
- Understand Medicare rules and regulations
- Set aside time for IDG preparation
- Participate in ongoing education and get certified
- Ask questions and advocate for proper training
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