can my DON force me to work the floor?

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    I need some advice. I have been an MDS coordinator for the past 21 years. Due to some restructuring in management, it looks like I might be put on the "on call" rotation. For my building, the on call person usually has to go in and work at least one shift per weekend on call.
    Now, I have not worked the floor in 21 years. I am not up to date on the current meds, equipment, etc. As it is, I do my MDSes with a drug book nearby since nearly every med is now in generic form. I haven't done trach care, IV meds, tube feesdings, etc in 21 years. I am truly afraid that I might hurt someone...or worse! I'm also not familiar with much of the paperwork that needs to be completed such as incident reports, SBAR, Interact to name a few.
    I am so against this I can't even tell you. I have at least another 40 years to work and I truly feel that I would be risking my livelihood and my residents' lives by trying to give meds, tube feedings, treatments, etc after not working the floor for so long.
    When this first came up we were told that "we are all NURSES" so we can all work the floor. I disagree. Yes I am a nurse and my license is the same as every other nurse, but I certainly wouldn't want my mother to get dialysis from a nurse who's area of expertise was not dialysis! But hey, we're both nurses, right, so why not????!!
    I'm really just wondering what my legal obligation is to my company. Can they legally force me to do something that I am so uncomfortable with and that I truly feel puts my residents at risk? Can they fire me for not agreeing? I thought the nursing standards of practice made it MY responsibilty to NOT do something that I do not feel qualified to do. I would rather lose my job than make a mistake that hurts or kills someone.
    I'd be interested in hearing what others think or about any experiences like this. Thanks so much!
    Bella'sMyBaby likes this.
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  3. 29 Comments so far...

  4. 1
    This type of scenario also happened to me in a prior position. They stated I needed to be in the on call rotation, and that it was part of my new job description. I refused, and they said that if I chose not to comply, I was no longer needed - and that my refusal was my choice, so I was resigning from my position. They can 'make' you work on call, if they so decide -- and if you won't, they will try to find someone who will instead. I assume in order to fulfill this duty, they should have to give you proper training to work the floor -- that is unfortunately difficult considering you already have a full time job doing MDS's. Wishing you luck. Tara
    imintrouble likes this.
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    glm777....I know exactly where you are coming from; I would feel the same way.
    Do you work for a Corporation and if so, what is their policy?
    Some Corporations do not allow the MDS Dept to be on call or pulled to the floor.
    Do you have a Consultant and if so contact them immediately.
    I can tell you this, if you work the floor and something happens, it will be your license on the line.
    Yes, Nursing is too specialized to be bounced around.
    The previous Company I worked for pulled this on me but I stood my ground.
    If this issue can't be resolved, then perhaps a "Leave of Absence" might be in order....
    Stand firm and hold your ground....and if necessary get another MDS Position....
    Companies are begging for good MDS Coordinators....
    imintrouble, Psychcns, and badmamajama like this.
  6. 1
    They can make it a "Do it or be fired" type of thing. If that happens, you will have to decide what you want to do. MDS coordinators are in demand.
    I think you should be given orientation to the floor prior to being put oncall. Yes, we are all nurses. Any nurse can assess. We assess as part of the MDS process. No, I don't use a stethoscope, but that is only part of an assessment. If you have doubts with what you hear, someone can double check for you. As far as doing the meds, is that going to be part of the on-call, or do you have a CMT or LPN to do the meds?
    How big a facility? Makes a diffrence if you have 20 residents on each unit or 60. Behavior or Alzheimers? Orientation is needed, for sure.
    If you hold your ground, you may win and not have on-call. You may also push the limits and they will fire you, or make you quit. If you are a corporation, find out if all the other MDS are doing on call, if not, find out what makes your building different.
    If you are a small home, you may have to wear more than one hat.
    I am curious, OP,... if you have been an MDS coordinator for 21 years and plan to work for 40 more, how old were you when you graduated and took your position? LOL the math kinds looks like you were born an MDS coord. LOL, or, that you plan to work into your 80's!
    Either way, best wishes to resolving this......
    imintrouble likes this.
  7. 8
    Tell them that you will need 4 weeks full-time orientation so that you will be safe to take call. And that you will not be able to do your MDS role while you are orienting. And did they want a proctocologist doing eye exams? After all, a doc is a doc is a doc.....

    Not seated in reality, are they?

    So sorry thay they have put you in this position.
    Last edit by merlee on Feb 16, '12 : Reason: spelling
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    First of all, Yes, they can. You are a nurse, you have a license that meets their needs for staffing purposes, and their rear ends are covered. It's yours that is bare.

    You are an MDS coordinator in what setting? I am not aware of MDS coordination done in a dialysis setting?
    imintrouble and noc4senuf like this.
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    "I am curious, OP,... if you have been an MDS coordinator for 21 years and plan to work for 40 more, how old were you when you graduated and took your position? LOL the math kinds looks like you were born an MDS coord. LOL, or, that you plan to work into your 80's!"

    LOL - I'm just looking at the fact that I'm NEVER going to retire due to a recent divorce:/


    And I was just referencing the dialysis center as an example.

    Thank you all for your responses. I'm in a 175 bed building and the on call is for any of the five units - including the sub acute unit. The on call person is directly responsible for all meds, treatments, etc. If I had to do an off shift, I would have total responsiblity of up to 49 residents! This has actually come from our corporate office in response to some restructuring of our sub acute unit. There are already 6 nurses on the schedule which puts them on call only every 6 weeks. I really don't want to leave here - I've been here 17 years but I am prepared to move if it comes to that. I could never live with myself if I seriously hurt someone.
    sharpeimom and GrnTea like this.
  10. 1
    I am sorry you are going through this...

    We are not lawyers and per TOS cannot give advice. But, it has been my experience, that essentially "they" can do whatever they wish (unless you have a signed contract), but you as the nurse can refuse any assignment that you feel you are not qualified to safely perform. Many, if not all, BON have statements that give specific information and regulations within the stats nurse practice act.

    Maryland
    http://www.mbon.org/practice/assignments.pdf
    and my state of Massachusetts
    Massachusetts Nurses Association - Nursing Resources - Nursing Practice - Accept or Reject an Assignment

    What I would do is let you DON know of your concerns and tell that you cannot accept an assignment that you have not been properly oriented to and feel safe to do, that they as a nurse as well, should understand this......and that you will require an orientation in order to full fill your new duties and develop the "proven" competencies as required by The Joint Commission. See where this new directive goes from that point.

    Now, Unless you entered into a written contract that states exactly what your duties and compensation are/were to be prior to the start of your employment there is not much you can do. Contracts such as this are usually only offered to very high level employees, 99% of the rest of us poor slobs have an "employee-at-will" relationship with their employer, meaning that the employer can dismiss the employee at any time without notice (although most employers will provide some notice and perhaps severance pay). Your job description does not rise to the level of an employment contract.

    Unfortunately, in this economy, you are not alone -- these kinds of things are happening all over the country because of the poor economy and there is simply not much you can do about it. In this economic climate, employers know they have the upper hand, and some companies are doing well and still laying off people and making others remaining do more work than ever before. It is a catch 22 -- you can leave the job but may have problems finding another one right now.

    An employer may hire someone for a particular job and then the job is eliminated or changed over time. Just because the employer hired someone into a specific job does not mean that the employer is obligated to maintain that specific job no matter what transpires regarding technology, for example, and other factors that affect company operations.

    The employee always has the right to leave if the changes in the job title, job requirements or responsibilities are not acceptable to him/her. But employers have the right to determine what workforce they need to run the company efficiently and effectively--and profitably (code for getting rid of the expensive employees). Especially if you live in an "At will" state.There are "right to work" states that may cover this somewhat......that is where you need to talk to an employment lawyer or your states DOL website.

    I know it's not what you wanted to hear.....I wish you luck
    imintrouble likes this.
  11. 2
    Both of the MDS nurses in my building are on the on call rotation. Up until recently, their primary focus was to cover any call outs. You can imagine how motivated they are to cover a shift if it means they don't have to come in to work the floor!
    I think it makes for a stronger team. Some of the nurse managers haven't done a med pass in a while, but if it's their turn, they either fill the slot or come in themselves.
    I've been in other buildings where the MDS nurses were not on the on call rotation. It made for resentment among the rest of the team.
    imintrouble and noc4senuf like this.
  12. 2
    I can't imagine how scary that is! That would be worse than being a new grad getting shoved to the floor! At least if you were straight out of school you would have had recent clinical experience! I think the PP who said you should ask for orientation and training first was right. You won't get it, I'm sure. The LTC I worked at gave new grads three days orientation if they begged and everyone else got only one or two. At least ask and DOCUMENT that you did! Document everything, and if you have access email your DON so you have everything in writing. If they give you the ax and then try to say you resigned by refusing an assignment then that's a load of crap. Apply for unemployment and talk to the EEOC.

    I wonder what your state BON would think of this? Hmmm...
    imintrouble and Bella'sMyBaby like this.


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