Let’s Talk About Documentation…

Before we start talking about documentation, I want to be completely honest here and tell you that my least favorite part of being a nurse is…you guessed it, documentation! However, I also know that it is one of the most important things that we do as professionals.

Why is it important for faith community nursing? As I tell every nursing student who comes my way, documentation provides us with 3 important benefits, each of which is equally as important as the other.  (Please try to save the yawns and eye rolls until the end!)

Video “Why Do We Yawn?” courtesy ASAPScience.

Three Benefits of Documentation

for Faith Community Nurses

  1. Communication.  Our documentation tells everyone on the care team (including ourselves when we follow up) what we did with the person during a visit.  What was the reason for the person’s visit with the parish nurse? Was there relevant medical history?  Were they taking medications? What interventions were tried? Which ones helped and which ones didn’t?  What was the treatment plan and goal of care? Were there changes to the plan of care? Were they counseled on dietary changes? Were they referred to someone for medical care?  or a support group? How can we contact the person for follow up?  Chances are, we won’t remember what we were thinking the last time we saw this person. Writing it down helps with our own thought process and helps to communicate it to others involved in the person’s care.

  2. LegalityDocumentation protects you and your organization. It provides evidence that you performed your responsibilities as a licensed nurse and as an organization.  I’m sure you know the saying, “If it wasn’t documented, then it wasn’t done.”  According to the scope and standards of practice for nursing and faith community nursing, did you provide appropriate nursing care within our professional standards?  Did you practice within the scope of licensed nursing as defined by your state?

    My well loved book.

    My well loved book.

  3. Reimbursement.  As a nurse practitioner, this means my documentation must justify my selected billing code for insurance companies.  You may be thinking…well, what does reimbursement have to do with faith community nursing?  I believe if we have quality documentation, then it can positively impact our reimbursement for services.

If you are a member of the American Nurses Association, you can also read their “Principles for Nursing Documentation” for more guidance.

Clear, accurate, and accessible documentation is an essential element of safe, quality, evidence-based nursing practice. The RN and the APRN are responsible and accountable for the nursing documentation that is used throughout an organization. This publication identifies six essential principles to guide nurses in this necessary and integral aspect of the work of registered nurses in all roles and settings. ~ANA

If someone were to ask you, has your work as a parish nurse helped your faith community? Is the service you are providing valuable? Should we (healthcare system, hospital, faith community, insurance company, denomination) support your nursing care financially?…How would you reply?

If you are like me, you might think…well, I wouldn’t be doing this if I didn’t think it was worth my time?  I have nothing to prove because I KNOW what I do makes a difference in people’s lives in a way that my other nursing roles didn’t.  I’m following my calling and this is what I’m going to do with my gifts regardless of pay.  However, realistically, we know the healthcare system doesn’t pay us based on faith.

So, how would you reply?  Would you tell them case stories about individuals (HIPAA protected of course)? Could you show them aggregate data of improved blood pressures? weight loss? controlled blood sugars? or any other measurable health outcome?  For me, this would be difficult to do. The good news is that documentation can help us validate the work that we do.Doc Pic

I realize that payment for faith community nursing services is not something that we all agree upon.  As the American Nurses Association and the Health Ministries Association note in our Scope and Standards of Practice, one of the major factors complicating reimbursement for faith community nurse services is “a faith community’s tradition of donating time and expertise to care for its members” (2012, p.18).  Some nurses consider their service to be part of their stewardship of the church.  Add to that the “limited objective data that demonstrate the positive health effects and benefits of faith community nursing so that external funding will be more available” (p.18) and the “lack of financial resources in many faith communities for an expansion of services” (p.18), and we certainly find ourselves in a complicated situation.  As a specialty, we are challenged to work together toward overcoming this barrier to increasing the number of faith community nurses doing this good work across the country and the globe.

Believe me, I am not the number one fan of documentation, but I do believe it can lead us to eventually receive compensation for our work.  According to the ANA & HMA (2012), demonstrating our positive health outcomes may influence the number of paid faith community nurse positions in our healthcare system. I also believe that if faith community nurses were compensated, then there would be more nurses doing this awesome ministry AND they would be doing it more hours per week than they do presently! This can only be of benefit to our faith and wider communities!

If you were paid for your work as a faith community nurse, would you contribute more hours to the role? According to a study by McGinnis (2007), unpaid faith community nurses spend less time in faith community nursing roles than paid faith community nurses.  Are there things that you would do to expand your role that you don’t do now? Do you think it would impact the quality of your care? The number of people served? The number of programs that you could implement? The number of home and hospital visits that you would make, especially regarding transitions of care from the hospital to home?  Do you think payment for your services would impact measurable health outcomes in your faith community?

Please share your thoughts on any of these questions in the comments.

Ready to document?  I found some systems that are already out there for us to use, so you don’t have to reinvent the wheel for your ministry’s documentation…

  • The Henry Ford Macomb Faith Community Nursing Network: “…Faith Community Nurse-designed, Internet-based documentation, web communication, policies and procedures and health projects such as classes, grant projects, support groups and fairs. Congregations are provided on-going support to assure excellence in ministry and clarity of community-based goals while achieving measurable health outcomes.”
  • Computerized Documentation System at Mercy Parish Nurse and Health Ministry Program: “Seeking to develop a state-of-the-art,comprehensive documentation system tomeet the evolving needs of FCNs, Conti turned to Executive Service Corps, a national organization of volunteer professionals who provide expertise, pro bono, to nonprofit organizations. Volunteer database developer Nancy Campbell Marshall worked closely with Conti, this author [Dorothy Mayernik], and other Mercy staff to translate FCN documentation standards into a program using Microsoft Access, a relational database.”
  • Integration – A Parish Nurse Documentation System developed by Lisa Burkhart, PhD, RN, MPH.  “The system is free to use with permission by completing a request survey form included in the manual and e-mailing it to eburkha@luc.edu.”  Scroll to the bottom of her faculty page for manual and forms. 

How do you document? Do you know of other documentation systems for parish nurses?

What are your thoughts on FCN documentation?  Let us know your thoughts on any of these questions in the comments section.


References

American Nurses Association & Health Ministries Association. (2012). Faith community nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD: American Nurses Association.

About courtholmes

Nurse Practitioner, Faith Community Nurse, Parish Nurse, Certified Wound Specialist, DNP Student at Quinnipiac University, Social Media Enthusiast... Passionate about integrating faith and health! CT Faith Community Nurses on Twitter @CTFCN

Posted on November 1, 2014, in Documentation, Resources and tagged , , . Bookmark the permalink. 9 Comments.

  1. As an unpaid professional in my church, I do keep notes on all my contacts and activities connected with my Congregational Health Program. I also keep all kinds of stats, because that documents the value of what I do, not only to the church, but in case I ever want to write for a grant. As professionals, even if we’re unpaid, I believe keeping stats and documentation are an important part of what we do, for all the reasons listed above. Not the most fun part, but important.

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  2. Agreed, not fun but important. =) For others interested in discussing this topic, there is also a nice conversation going on at the Parish Nurse group on Linked In: https://www.linkedin.com/groups/Parish-Nurse-2398951/about

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  3. Unfortunately, I think you are right that we would spend more time in a Parish Nurse paid position vs. Volunteer position. A set number of hours and a “work” schedule would ensure time solely devoted to Parish Nursing. As it stands now, I have a separate job/life that requires a lot of time and energy. My “volunteer” role, as Parish Nurse, definitely is something I do in my “spare” time. I do believe I would broaden the scope of what I am able to do to expand my role that I don’t do now, if in a paid “regular” position. I think it would impact every aspect of what I “try” to accomplish as a volunteer. It would also foster more “accountability” due to the nature of it being a paid position. You make some valid points. I am one of 3 (active) Parish Nurses in a church of about 1,000. Sometimes the requests and expectations can become overwhelming! Our Wellness Center is open every Sunday morning and I get regular calls and requests, most times, throughout the week. It’s convincing our church leaders of this need that is the hard part. They appreciate everything we do, but I’m not sure they’re ready to put it in the budget. What would be a reasonable rate for a church to pay? How many hours should they reasonably offer?? If one Parish Nurse is paid, how does that affect the others who volunteer?? Lots of questions!

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    • If there is anyone reading this who is part of a paid model, do you have any words of wisdom? Personally, I don’t think a faith community should shoulder the pay alone. I believe a healthcare system/hospital or insurance company is in the most accountable position to fund a FCN paid role either fully or possibly in part with the faith communities. After all, the work of the parish nurse can improve the health outcomes of the healthcare system’s patient population. Especially with the new “Efficiency” category in Medicare’s Value Based Purchasing program, parish nurses can play a role throughout the entire time period…from three days prior, during, and 30 days post hospitalization that hospitals will be scored on. For example, parish nurses can educate and empower the community to know the signs of stroke to get them to the hospital door sooner than present for stroke treatment. For more on Value Based Purchasing see http://www.hfma.org/Content.aspx?id=17510

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  4. I think insurance reimbursement would ruin FCN. I myself has seen and been asked to falsify records to reflect the need for more reimbursement in the HHC setting When the answer was “no” paychecks were withheld. A colleague lived off her credit card!!!. NO insurance reimbursement!!!!

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  5. Wow jp, that sounds horrible and unethical! I know there are parish nurses out there who are currently paid. I’d love to hear what they have to say on this problem.

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  6. As the Director of the Faith Community Nursing Program at St. Peter’s Health Partners in Albany, NY, I also agree on Documentation. I also believe that the reason most nurses balk at documentation is that it fails to capture what it is we truly do. Personally, if I can write about how I made a difference in someone’s life, it is much more meaningful than checking off boxes or filling in what is required. Although numbers are important, I strongly believe that because Faith Community Nursing is a very different entity requiring faith, then our documentation also needs to be different; to capture what it is we truly do including how faith works in our ministries. there is something called “Evidence-based Narrative” that I am exploring that may work for us.
    When we do get funded by insurance companies and health care systems, it will be according to our terms on how we practice. They CANNOT dictate to us on how our practice will look according to funding, this WILL ruin Parish Nursing, it will destroy the ART of NURSING which is very much alive in parish nursing still today. WE KNOW what we need to do to promote and maintain health in people. We need to be free to do it while being reimbursed. And yes, this model can only become what it was designed to be if the nurse is fully compensated at a competitive professional salary

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    • Thank you for saying this. I love your thoughts on how our documentation needs to be different regarding the faith component. I also agree that the art of nursing thrives in this specialty. Passion and creativity abound in care for our faith communities!

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  7. Sorry the link to the Integration Documentation System wasn’t working. I fixed it.

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