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I suspect nurses are an odd lot when it comes to dreams and fantasies, so it's perhaps little surprise that my recurring fantasy is this.


I arrive at a patient's home with my bag of tools and a few supplies for a dressing change. The patient and I chat and I assess the patient, check medications, and teach about self-care of his leg ulcer. I leave and drive to the next patient. So goes the rest of the day until I have completed six visits. After the final visit I return to the office, complete my time sheet, and go home.


That is the end of my fantasy.


Home care nurses will understand the unrealistic nature of this fantasy. Others might label me as quite disturbed, scratch their heads for a few seconds, and feel a bit sorry for me. This scenario is a fantasy, divorced from current reality, because it omits the hours of paperwork required to be a diligent documenter and help the agency meet statutory, regulatory, and reimbursement requirements.


Nurses working in most settings have an unreasonable paperwork burden; however, in my 26 years of nursing working for a variety of healthcare providers, I've realized that home care is at the top of the list for paperwork load.


With regard to meeting home care regulatory and statutory requirements, the burden of responsibility mostly falls on nurses. Nurses want to spend their time caring for patients, yet over the years our secretarial and clinical documentation demands have become an increasingly painful burden.


The big question is, "Is there hope for change?" In a world of harsh realities, cutting down or eliminating paperwork for nurses seems as about as likely as finding a cure for AIDS by the end of the year. Yet, I think several issues can be addressed.


My thoughts?


Home health agency administration and staff should join together now to show regulators that well-trained clerical staff can competently assume more of the responsibility for documentation. Nurses must be allowed to refocus on clinical data collection.


These changes should be centered on the admission process. Relaxing the rules about who can gather demographic and insurance information, as well as expediting the collection of certain OASIS data could lower costs and promote efficiency.


Change must focus on how this reduction lowers the episode cost of providing home care. A sense of urgency could be linked to the reform if nurses quantify their ideas in dollars and sense and impress upon politicians and the media how much money could be saved by streamlining the regulatory burden.


Imagine an organized nursing march in Washington, DC. One million nurse executives and staff nurses marching arm in arm down Pennsylvania Avenue carrying banners that proclaim, "Regulations do not heal, nurses heal."


As the marchers reach the steps of the Capitol they hold up a huge sign that reads, "Our patients are not the only ones who are sick and tired," as each of the 1 million nurses throws down a ream of paper and silently walks away.


Technology is tool that may help, but it is not a total solution. Technology supports the bureaucracy of documentation, but fails to isolate to the root cause of the problem: too much regulation.