MDS-RNAC...HELLO?

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    My facility has 2 full time RNAC's..there duties are primarily to go over and make corrections to the MDS after all of the departments have completed there appropriate sections...They then issue us a "report card" detailing any mistakes we may have made...Is this a trend elsewhere in the country? This is not how it is done in any other facility in this area...How do we make administration see that this is a misuse of valuable resources?With the nursing shortage so acute in this area we need to be on the floor as much as possible...Is this as ridiculous as I think it is? I have only been there 7 months and am not ready to rock the boat...we are without a DON at the moment-hopefully a young innovative person will come along and try to fix the things that are broken...

    [This message has been edited by ktwlpn (edited December 19, 2000).]
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    The trend across the country seems to be that nurses are slowly being pushed in to management.We are being replaced on the floor by PCT's. (patient Care Tech's)We are being forced to be responsible for understaffed and under trained individuals on the floor. There is a grass roots organization trying to get started to stop this from happening. Go to WWW.MillionNurseMarch.org see what thier doing?
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    Unfortunately, the RNAC role is one nursing managerial role that should NEVER be eliminated. First of all, I should mention that I was an RNAC under MDS 1.0 and filled in for about 6 months during 2.0's implementation.

    For LTC facilities, it is important to have a nurse obtaining the appropriate reimbursement for the facility. When nursiing can demonstrate to administration that the acuity is there [based off of CMI], then there is a stronger argument to hire nursing staff. So, technically, by serving as a competent RNAC, you can be helping the floor shortage problem.

    Unfortunately, MDS is mandated by HCFA. Its real purpose was a reimbursement tool [cloaked in a 'quality of care' enhancement package]. The answer is to be the best RNAC you could, be accurate [keeping the new attestation in mind], and work on ways to develop tools to acquire credit for EVERYTHING your nursing staff does for your residents. In the past, the higher the CMI, the more money the facility made...now, surveyors want to see staffing that supports the high CMI. They are basically using the "Well, if you provide all of this care, where is your staff???" mentality.

    I have read the million nurse march literature... I will reserve comment. As for me, I belong to my states nurses association, and I can be as involved as I want to be politically. I recommend all nurses join their state's nurses association.

    The problem with these various organizations that claim to help nursing is that as a result "Nursing" keeps developing more and more 'unified voices.' Just keep it in the back of your mind...all of these organizations that claim to represent the interests of all in such an unselfish manner... caveat emptor.
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    Postaledde, if the only people that belong to your state nurses associations are administration types, who do you think the association will represent? It represents the members of the state association; or at least only the ACTIVE members of the association! My state association has 15,000+ plus members, and staff nurses are a large part of that number. Those that are active in the association are the ones who direct what is happening in the state. And nationally, also. When the staff nurses (and I am one) are motivated, we can accomplish a lot. If the staff nurses sit around and let someone else do it; the state association takes on the appearance of being run by managers. You can change things by being involved (sorry I'm off topic here).
    I came to this site to find out what MDS and RNAC's were; and I still haven't a clue. From Tim-GNP's reply I figure it has something to do with reimburcement pay to the institutions, though.
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    I was an "MDS Assessment Nurse" and so I am familiar with MDS, PPS, HCFA, SOB, etc. , but I am not sure what a RNAC is. Registered Nurse All Care, or Registered Nurse Acuity Care or I could go on and on. If you are the MDS nurse and you have these RNAC's checking up on you, I don't understand it either. We had PPS meetings every morning and weekly care plan meetings to make sure everything was in order. If you are a regular floor nurse putting in your part on the MDS, then yes, you need somebody to help you with what "they" "MDS nurses" need to put on the tedious computer/paperwork they need to do their job. As an MDS nurse I was constantly going to the floor nurses to please document what they were actually doing. But unfortunately, they don't have time to do it. I was a floor nurse, too. So I understand. Long term care nursing is in for a major crisis. But the real losers in all of this are the patients/residents. I have no answers, but I am thinking hard. Because I will be one of those geriatric patients not too long from now. I do not want to go to some of the hellholes I have seen. Good luck with the MDS. Thanks for letting me vent. In the meantime, try as hard as you can to give what the MDS/PPS nurse needs to get reimbursement for your facility so you can continue to get a paycheck.
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    R.N.A.C. is the acronym for Registered Nurse Assessment Coordinator. I was fortunate enough to have been one of 'those' management people who [by virtue of being one of those management people] always had to stay and work when there was NO staff. I would often have several jobs throughout my shift also... I might have begun the shift as the nursing supervisor... picked up the LPN med nurse slot for 6 p.m. meds, and by 8 p.m, be the nurses aide putting people to bed. I can tell you from personal experience, I don't buy that S--- about 'not having enough time to document.' It all goes back to something my father once said: "There's never enough time for you to do something right the first time, but always enough time for you to do it again." I guess that always stuck with me. You make the time. I have seen firsthand the result of increased CMI, and it's impact on my being able to hire additional nursing staff.

    Insofar as the State Nurses Association, Jenny P's thoughts are right on the money. I will not engage in political discourse here. Others may... I however, will not. Just remember, there are those out there who would prey upon people who have unmet needs and promise to make their deepest dreams come true [remember the medical quacks of the 1800's and early 1900's with their 'miracle cures'... see any similarities here]. They give us the illusion that they are out to help us, but in fact seek to serve themselves.

    Before all else, I am a NURSE. I stand by my States Nurses Association and the A.N.A. They are my voice, and I support them, and they work for me. Membership dues to the association are expensive... why??? Because they have people in Washington LOBBYING on our behalf. Not a group of radical political activists that have the potential to give us a bad reputation.

    That, my friends, is my humble opinion.
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    Tim-GNP, your comments interest me. I actually DID experience ONE manager who helped out in a crunch, and actually recruited others in management to help too. I will miss this manager until the day I die! Mostly though, I have experienced the OTHER TYPE of managers, who would NEVER, EVER offer a hand during a crunch, which is just about EVERY single shift, EVERY single day now, but they would collect healthy bonuses for every shift where nursing hours were saved. I have turned down management positions, because I could not divorce myself from the trench and knew I simply COULD NOT make the decisions that managers are forced to make in the current health care climate, and live with myself, it would so affect my core. I'm not sure who these "radical political activists" are, that you believe may give us all a bad reputation, but I suspect That they are simply nurses like me, who throuh it all, are just trying to diliver good patient care in a climate that is so fraught with obstacles, that we've approached meltdown, and fear the future, if we somehow, some way, cannot turn things around. If it cannot be done, we will not go down without a unified voice, and for that reason, I and others like me will be marching come this May. I require no response, but have considered your comments thoughtfully, as you seem well informed, but I wonder about the ANA representation, since the situation for the nurse on the floor and the patients we are trying to care for is in such dire need of repair. Thank You All.
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    Unfortunately, PPL, we have all worked with idiots for nurse managers. When I began in nursing, I started as a nurses aide. I remember having a lazy LPN charge nurse who wouldn't help me boost a patient up in bed. I remember many nights being the only nurses aide for a 48 bed intermediate care unit, where this nurse would call me away from patient care to give another patient a drink of water [a task which she had more than enough time to perform]. When I became an LPN, I remember being degraded and demeaned by two RN's in particular... who often refered to me as 'only the LPN.' All of these experiences were filed away and have helped me consciously choose the type of nurse I would be.

    Yes, we are as a profession, overworked and underpaid. Yes, we do need a unified voice... A [meaning single] unified voice. How much unity can come from 5 different voices? I cling to my state nurses association because it was expected of us to be members as students. I had some wonderful nursing professors in my undergraduate program support our professional development via participation in the student nurses organization [a subsidiary of our state nurses association]. That is my reason. As Jenny-P stated before, of course the voice of nurse managers will be heard... they are the ones who are active. If front-line staff got involved, guess whose voice it would be??? IMAGINE how powerful we can ALL be if we collectively represented our discipline! That is my only point. The future can be defined by us, but we have to take the first step and make our voices be heard. Preferrably by an organization who has a proven track record. I had an Advanced Pharmacology professor who used to have a saying: "Tried and true is better than new."
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    My state nurses association has a news scan e-mail they send out whenever something pertinent to nursing hits the news. An article that came to me today is from last month's issue of Hosptials and Healthnetworks; a publication that "voices the interests of hospital administration". The article is entitled "Norma Rae, RN" by gloria Shur Bilchik. It talks about how nurses are becoming more militant and politically savy and nurses unions are helping us get that way. It also talks about nurses who don't know how to get managements' attention and the nurses' needs met. It talks about how nurses are a very divergent group also. If you can read the article, maybe it can help. I would never have even known that there was such a magazine if it wasn't for my SNA.
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    As for your comment about joining your state nurses associations I have a few comments. Our state nurses associations continue to take our dues and appear to be pro management. They are not working twords fixing the problems that have been around for about 10 years. If the state organizations were helping us out as nurses there wouldn't need to be a grass roots organization to try and fix the problem.


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