Mds Job

Long Term Care Columnist / Guide · Jan 23, 2003

In a word: NO.

This is one of the hardest---if not THE hardest---jobs in LTC. You really should have a few years' experience under your belt, especially if you're going to be in a supervisory capacity as a resident care manager/MDS coordinator. Learning the MDS and RAPs is an ongoing process; I was in this position for almost 2 yrs. and still feel like I barely scratched the surface. That's not the hard part, though---the hard part is managing every aspect of each resident's care and having 24-hour responsibility for that care. LTC's also have a nasty habit of making an MDS nurse responsible for waaaaaayyy too many residents, with the end result being bad surveys, and all too often burnout. You also tend to be held responsible for this by the upper management, and yours will be the first neck on the chopping block because LTC administrators and owners don't LIKE bad surveys.

Then, there's the credibility gap that's bound to come up between you and your staff when you haven't been a floor nurse, or any kind of nurse for very long. I've seen RCMs come straight out of nursing school who were never even CNAs before, and they have absolutely no idea of what is possible or do-able out there on the unit. Staff members almost universally resent this, and with good reason; so they are unlikely to cooperate with this type of leadership. My advice to you is, unless you've worked in LTC as an aide or a nurse, you might want to get a year or two in as a floor nurse and work your way up from there. At any rate, think carefully before you decide; management ain't all it's cracked up to be.

Hellllllo Nurse, BSN, RN · Jan 23, 2003

I started (another) job in LTC, first shift last noc. I was the only nurse for 58 residents, I was supposed to get 4 CNAs, ONE showed up. I stole one from the other unit, which also worked short. We had exactly FIVE incontinance pads for the whole unit. The Kangaroo pumps were a new kind I'd never seen before. The off-going shift had no idea how to operate them and couldn't tell me a thing. There were not monojects available, so for my 20+ am fbs, I had to manually push the lancets into each pt's finger, making things much more uncomfortable for them. Also, no cups to be found. Finally scrounged some old beat-ups ones up, but used them all. None left for day shift.

You know what? That is nothing unusual. No matter what the MDS nurses write/say/do, good care can't be had in today's LTC environment.

Do you really think that MDS is one of the hardest jobs in LTC?

Really?

:/

My advice is don't take any job in LTC!

ChainedChaosRN · Jan 23, 2003

HellllloNurse, sounds like you had the shift from hell. LTC is not all like that...thank God. My advice for anyone taking a job ANYWHERE...do some research. For LTC, check past surveys, check the new Quality Measures. There are troubled facilities, there will always be so. One bad LTC facility doesn't make them all bad, as does one bad nurse make us all bad.

MDS is one of the best jobs in a LTC facility, for someone with experience, excellent assessment and communication skills (oral and written). As in any job, know what your strengths are....then look for the right job.

A nurse with less than one year experience "might" be able to do the job, odds are against it. You will be setting yourself up for failure, mostly likely the residents and the facility. Any DON who would hire a new nurse for MDS really doesn't know what she's doing.

Just my two cents...don't throw us all away, some of us are trying hard and making it in LTC.

Dawn

Hellllllo Nurse, BSN, RN · Jan 24, 2003

Hi Dawn,

I have worked as a nurse (LPN, then RN) in LTC for over 6 years, and as a CNA for 3.

I have worked in two cities in TX and two cities in AZ. Unfortunately, that "shift from Hell" expereince has been pretty typical in my LTC experience. I have even worked agency so I've seen many LTC facilities. I've yet to see a good one!

I love working w/ the elderly, but I've about had it in LTC. I've just accepted a job in an area that is new for me, dialysis. I wanted to give my new LTC job a chance, but the first shift told me all I need to know. =0(

The whole industry needs to be dismantled and started over again from scratch, IMHO.

I'm glad things are going well where you work. Are they hiring?

ChainedChaosRN · Jan 24, 2003

Hellllo Nurse...sorry we are full up, but if you come to MI come see me, you never know.

I agree good ones are hard to find, but they are out there. Revamping the whole industry will never work as long as LTC is basically taking care of the poor. The majority of most facilities are Fed/State funded. What needs dismantled and started over is America and the way they view their elderly. There is a large percentage of Americans in nursing homes who can be home with their family...but the kiddies are just to busy to deal with Mom and Pop. Let the gov't do it...right? Which is everyone of us...the working stiffs.

Nursing homes are no different than a household budget. If you don't follow your budget, you are eventually bankrupt. Ever been in a nursing home that has to close due to financial reasons? I have. It's a nightmare for the residents who call that place home, and for the staff.

Long term care has been on a train to hell for years. Recent funding cut backs didn't help the situation, with more to come. I could go on and on here, but I won't. Please contact your gov't officials and let them know your experiences, the voice of the people can change things. Last but not least raise your family with a sense of respect and responsibility for the elderly. Someday it can and probably will be a decision the majority of us will be facing: nursing home vs living with a family member.

Peace,

Dawn

Long Term Care Columnist / Guide · Jan 25, 2003

I don't know if this will help, but I'm currently working on an essay for Newsweek that I hope will be published so we can bring LTC to the attention of the public, as well as the government. (They have a "My Turn" section in the magazine that contains commentaries written by ordinary people.) I'm outraged that we taxpayers are providing free health care to the political ruling class while they think up new ways to cut Medicare and Medicaid funding, and it makes me furious that the system our parents & grandparents paid into their entire working lives is failing them when they need it most. So, I'm going to try to get this article published in order to reach those outside the long-term care industry. Something's got to happen, and soon....LTC is going to hell in the proverbial handbasket, and if this is the best we can do for the "Greatest Generation", what hope do future generations have for decent care??!!

oregon-rn · Jan 25, 2003

Please what is an mds position?

Thanks

zuchRN · Jan 25, 2003

oregon--- MDS is a minimum data set. The MDS is ahuge thing for long term care. basically you have a huge amount of questions to answer...everything from does the resident wear glasses, is there long or short term memory impairment, to projecting how many therapy minutes someone will have. It is meant to drive your careplans. But it has a huge financial impact. In IN we have RUGS for medicaid as well as medicare and depending on the casemix for medicaid will determine our re-imbursement from medicaid. The rugs aslo drive the reimbursement for med a. It is a huge process. you cannot just answer all the questions...you have to assure that the info is documented and sometimes examples provided --in a seven day reference period to be able to answer the question.

It is a huge undertaking and requires a loy of patience and tremendous organizational skills.

A few things to ask prior to accepting this kind of position is:

1. how often will you be pulled to the floor to work

2. how much on-call time will ou have?

3. if a larger facility, will you have an assistant?

4. will you be responsible for any other programs?

the answers to 1,2,4 should be no and you shouold get this in writing.

Hellllllo Nurse, BSN, RN · Jan 26, 2003

Well, I am done with LTC. I will never go back. The DON told me "I want the nurses to do their work, just as they are taught in school. I have exacting standards."

With one nurse to 58 residents, total lack of sufficient supplies and procedures in place?

What dream-world is this woman living in?

I told her that adm cannot just demand results from staff, they must provide an environment in which it is possible for staff to do what is expected.

Sometimes, the worst nursing homes are the ones that look the fanciest, with beautiful decor and landscaping. All that is just window dressing and has no bearing on what kind of care it is possible to provide for residents.

I took a really good look at the nurses at the facility: they look tired, worn down and worn out. I don't want to become one of them.

In my opinion, if you really love your family members, you will never permit them to be admitted into LTC.

MJLRN97-

Good luck w/ your article.

Nursenan0 · Jan 26, 2003

I've been in LTC for 16 years as a cna and 7 as an RN....I dont believe there are "good" ones. Some maybe better than others but none are good in my experiences. I recently took an MDS position in a different facility. Mainly because I was burnt out from the charge nurse position. I enjoy the MDS but it is overwhelming even after all my LT experience. It is an ongoing process of education. For you and the staff you manage. Its an ever changing world of paper work. We have a major RN shortage here in Ohio. We only have 4 in our entire facility. 2 of us work MDS, 1 works restorative and the other is our ADON. Needless to say we are on call every other weekend and whenever we have services ordered that require an RN provide the care. I still love LTC after all these years but.........the system leaves much to be desired!

Nursenan

debRNo1 · Jan 26, 2003

Originally posted by Hellllllo Nurse
Well, I am done with LTC. I will never go back.

In my opinion, if you really love your family members, you will never permit them to be admitted into LTC.

Me too Im done I spent 10 yrs in LTC trying my best to do my job with the barest of staff and supplies !!?? I was med nurse then charge then supervisor of a 51 bed unit and it sucked the life right out of me. I too will never go back even though I really enjoyed it for many yrs. You cant do it all and get it all done.

They promise the families the world and sometimes KNOW they cannot provide it. A head in the bed is BIG bucks and thats the bottom line. My advice to ANYONE thinking of LTC as a career is to research and ask ALOT of questions. MDS coordinator ? NEVER its a sucky job and it cant be done in the amount of hours they give you to do it. Every MDS job comes with strings attached- being "on call" ect ect. God forbid you dont have the back-up documentation or make an entry error you just might wind up in nursing jail for medicaid fraud !!!

Same advice goes for families who are in the position of admitting a loved one to LTC- Tour several facilities more than once and look with eyes wide open. How does it smell ? Do you see any staff ? Listen to what you hear.... Are call bells ringing ? Are people calling for assist ? ASK lots of questions. Check past surveys to see what issues have been discovered ask about the corrective actions taken........and after they are admitted visit frequently and often it does improve the quality of care your loved one receives open your mouth and speak up the very first time something is not right.

deb