Double Whammy

  1. I started here as a unit manager 11 months ago, exactly one week before the entire facility went out on strike for three weeks. I had never done MDS or PPS or care planning, and I had a couple of days with the outgoing MDS coordinator (the position was eliminated); then I was completely on my own. I also had to take over the clinical management of the unit; they had never had a unit manager before, so that took some getting used to for everyone. None of the nurses do anything with the MDS or the care plans. Every clinical issue is passed down by the DNS/ADNS, or up from the nurses/CNAs to me. Not to mention that I never had an orientation to the facility (because of the strike, I just had to jump in and work). I'm still learning new things every day about how this building is run.

    I just endured the week of hell. We had JCAHO in on Monday for a two-day recertification survey, and the state came on Tuesday for their annual survey! So we had overlapping auditors. The state had no problem with my MDS or PPS, but found a missed nursing diagnosis on one care plan for which we will be cited and possibly fined. I can't stop blaming myself, even though everyone tells me not to be upset.

    I just wonder if it's realistic to expect one person to do all the MDS, PPS, care plans, and run the clinical unit, and do them all well. Yet when I hear about MDS coordinators/RNACs with 200 resident case loads, maybe I think I'm just not good enough. I feel like I have a 60-hour job that has to get done in 40 hours (no overtime approved), and I'm always running like a rabbit. I'm constantly being interrupted by staff, residents, visitors, and the front office, and everyone wants their need met *now*. I've worked really hard to learn this job and to get the unit running well, and I think it does run pretty well, considering the acuity and the lack of regular staff. My head tells me that it's a wonder I haven't missed more things, but my heart tells me I let my facility down.
    •  
  2. 8 Comments

  3. by   Tim-GNP
    First of all, don't blame yourself--- remember surveyors from DOH are there to find 'deficiencies'--- if they didn't, they wouldn't have jobs.

    In most cases, no, it is not realistic to expect one nurse to do MDS/RAPS/and plan of care. It depends upon facility size. Time was, before MDS 2.0, one RNAC could handle it all--- I know, I did.. I was the RNAC for a 120 bed facility, as well as the ADON/ Infection control nurse, and staff development person. Then came MDS 2.0--- the resident tracking forms, medicare 5, 14, 30, 60, 90 day assessments, etc.

    Unfortunately most NHA's don't understand the whole process. They know that the CMI comes from the MDS, and that's what generates the revenue, but other than that--- forget it.

    If an RNAC is handling MDS/RAPs and plan of care for 200 people, rest assured, SOMETHING is being missed.

    Don't beat yourself up over a deficiency--- get used to the fact that they will happen... no matter how good you are.
  4. by   tigger2sassy
    i agree with tim-- if the surveyors don't find something to call a deficiency then they might not have a job-- i think that you are doing great for someone who just took over a job with no support and it takes a gutsy person to make a unit go-- not many people have the stamina to keep up with all the changes and the interruptions-- one word of advice-- when you go home leave the unit at work-- it can take its toll on you mentally and physically-- best wishes on your endeavor--
  5. by   ktwlpn
    Originally posted by catlady
    I started here as a unit manager 11 months ago, exactly one week before the entire facility went out on strike for three weeks. I had never done MDS or PPS or care planning, and I had a couple of days with the outgoing MDS coordinator (the position was eliminated); then I was completely on my own. I also had to take over the clinical management of the unit; they had never had a unit manager before, so that took some getting used to for everyone. None of the nurses do anything with the MDS or the care plans. Every clinical issue is passed down by the DNS/ADNS, or up from the nurses/CNAs to me. Not to mention that I never had an orientation to the facility (because of the strike, I just had to jump in and work). I'm still learning new things every day about how this building is run.

    I just endured the week of hell. We had JCAHO in on Monday for a two-day recertification survey, and the state came on Tuesday for their annual survey! So we had overlapping auditors. The state had no problem with my MDS or PPS, but found a missed nursing diagnosis on one care plan for which we will be cited and possibly fined. I can't stop blaming myself, even though everyone tells me not to be upset.

    I just wonder if it's realistic to expect one person to do all the MDS, PPS, care plans, and run the clinical unit, and do them all well. Yet when I hear about MDS coordinators/RNACs with 200 resident case loads, maybe I think I'm just not good enough. I feel like I have a 60-hour job that has to get done in 40 hours (no overtime approved), and I'm always running like a rabbit. I'm constantly being interrupted by staff, residents, visitors, and the front office, and everyone wants their need met *now*. I've worked really hard to learn this job and to get the unit running well, and I think it does run pretty well, considering the acuity and the lack of regular staff. My head tells me that it's a wonder I haven't missed more things, but my heart tells me I let my facility down.
    >>>>>>>>>>>>>>>>>>>>>>>>>>>>The MDS is the bottom line-it does not benefit the facility in the long run to spread you so thin.You can make a case for another position in your dept-our facility utilizes nurse assessors(LPNs) with the RNAC's...The floor nurses are also responsible for updating the care-plans as needed.Several years ago this facility did not have an RNAC team- the charge nurses on each unit were responsible-they lost a great deal of money in fines and missed re-imbursements before they saw the light.Maybe somene can post some links to the RNAC sites-also the national professional organization.You need some statistics to make a case and get a team together....
  6. by   sassynurse78
    You do not say how many pts. you have to do MDS for, my facility uses two nurses to do it (it is 160 beds) But I give you a hands up for only having one deficiency! Our two MDS nurses usually have several deficiencies after the survey. And MDS is the ONLY thing they do, no unit management at all! I think I would ask for a rasie
  7. by   ChainedChaosRN
    Definitely ask for a raise, it sounds like you are doing an excellent job! And they are all right about wanting to have at least one deficiency or it will trigger the Feds to come in and survey. Sheesh...when we finally got down to only 1 tag...it was major party time.
  8. by   RN2007
    Catlady, All I can saw is Wow, to all that you have done, and done well!! You sound like a superwoman and I am sure you are great at your job. I honestly would NEVER want your job because I would not like that level of stress and responsibility and I hope for your sake that you get some help. You should only feel proud for all that you have achieved thus far. And, I sincerely mean this! I think our employers are expecting WAY too much out of people in your position and the nursing profession to begin with and only hope that soon some positive changes will be made so that nurses, mgmt, drs., etc., will be able to come up for air and start enjoying their careers a little more because hopefully we will be given more competent help to do the job. Best Wishes at Your Facility.... April
  9. by   renerian
    NO that is unrealistic. Your facility is being cheap.

    renerian
  10. by   catlady
    Holy cow, was I surprised to see my name at the top of an active thread. I posted my original message over a year ago. I resigned from that position shortly thereafter, went to work in managed care for six months, and am now the clinical reimbursement coordinator in another long-term care facility. Lots of *new* issues...maybe I'll post about them.

    But thanks for the thoughts. They were very short-sighted in their efforts to save money. I have learned so much more about PPS in my current job--if my previous employer had been willing to train me properly, I would have made them so much more money by maximizing my MDS reimbursement factors and tweaking my case mix than they "saved" by not spending the money to train me.

close