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.