MDS Nurse burned out and going back to the floor - page 2
I have been a LPN for over 16 years. For 14 of those 16 years I have been a MDS Nurse and have just accepted a job in a LTC facility as a floor nurse with more pay and better benefits. I am so... Read More
Sep 17, '12 by LTCNS, LPNThank you both so much. I have been praying and asking if I made the right choice, did I make a mistake, but reading your posts, I feel more confident that getting out of the office is something I need to do for now. I start my first evening shift orientation in less than three hours and feel somewhat nervous, but ready for the challenge.
Right now, the only thing that is really bothering me is that my youngest son (21) is coming from West Palm Beach Florida for Thanksgiving, and I am so afraid I won't get to spend much time with him since I will still be in my 90 days probation and won't get to ask for the holiday off. I haven't seen him in over four months and miss him like crazy.
Sep 17, '12 by BrandonLPN, LPNAs a floor nurse in LTC I have to admit that I'm a little surprised anyone would want to leave the MDS office and return to the med cart. That MDS job sure *looks* like a cake job from where I'm sitting. Of course, the med nurse job looked pretty cushy when I was a CNA, too! I guess the grass is always greener..... Since you've worn both hats, you must know what's best for you. Good luck either way.
Sep 18, '12 by LTCNS, LPNQuote from BrandonLPNYou should shadow an MDS Nurse for one week. You would quickly see it's not as much of a "cake" job as you think it isAs a floor nurse in LTC I have to admit that I'm a little surprised anyone would want to leave the MDS office and return to the med cart. That MDS job sure *looks* like a cake job from where I'm sitting. Of course, the med nurse job looked pretty cushy when I was a CNA, too! I guess the grass is always greener..... Since you've worn both hats, you must know what's best for you. Good luck either way.
Sep 18, '12 by Bella'sMyBabyI understand exactly how you feel.
Only another MDS Coordinator really understands the constant demands...yes, most think it's a fluff job....have heard that one too...there are two of us in the MDS Dept and when I hear the comment, "There's two of them up there" I know they're clueless.
I was in the same boat, but for me, going back to the floor was not an option; that's when I knew it was time to start looking for another MDS Position.
You have to keep in mind that some Companies are better than others to work for.
My goal eventually, is to be a Traveling/Interim MDS Coordinator.
I wish you luck & always know that you can go back to MDS if you so choose.Last edit by Bella'sMyBaby on Sep 18, '12 : Reason: typo
I was just let go after 3 whole days of orientation because I have been an office nurse too long so they didn't think I would last Thread explaining is in Geriatric Nursing.
Sep 20, '12 by artsmomOh, well, good thing they gave you a fair chance to re-learn the floor. Not. Are you kidding?? How do they know after three days that you aren't cut out for the job? I am so sorry for you. You quit your MDS job for this, and now need to scramble for another. Best of luck. Not all places are that impatient. Believe me, my job keeps people on long after they have proven to be inadequate .
LOL! Thanks artsmom. I've worked with many a "warm body" myself
The nurse who was orientating me has been there over a year and while she appears to be an excellent nurse as far as skills, she is not patient at all. If they keep pairing new hires, and God forbid new grads. with her, they will continue to lose nurses who have the potential for greatness.
As I took my time flipping through the MAR to make sure I had all the right meds. for the right patient, I could see her rolling her eyes as if I was stupid and not worth her time. I feel that had I been paired with someone older and more patient, I would still be there. The patients on the rehab. side have many more meds. and procedures so I wanted to make sure I was not going to make mistakes. I could have done well if given the time I was told I would get and patience.
Sep 20, '12 by artsmomOh, even better. They got rid of you based on one (sounds like young) person's assessment of your skills? Whenever I orientate new people to LTC I always tell them go along at their pace, but when we are running short on compliance time I will step in and help, and that each day they should progress further along independently. It normally works pretty well if they are okay with taking tips on how to keep on moving quickly, but safely. The amount of meds passed are incredible, and until someone is familiar with them, you have to keep looking to make sure something was not overlooked. Three days is not enough time to be whipping through MAR's!
Quote from artsmomOh, even better. They got rid of you based on one (sounds like young) person's assessment of your skills? Whenever I orientate new people to LTC I always tell them go along at their pace, but when we are running short on compliance time I will step in and help, and that each day they should progress further along independently. It normally works pretty well if they are okay with taking tips on how to keep on moving quickly, but safely. The amount of meds passed are incredible, and until someone is familiar with them, you have to keep looking to make sure something was not overlooked. Three days is not enough time to be whipping through MAR's!
I would say she's probably in her late 20s. I heard a lot of sighs and just felt bad vibes overall from her. The male LPN I orientated with on my first evening was very patient and I felt very comfortable and enjoyed my shift, but unfortunately he is a floater and works on the long term care side so I wasn't able to orientate with him after that one time since I was going to be assigned to the rehab. side.
Anyway, she became very frustrated and snapped at me a few times so of course I was nervous which slowed me down even more. I would've been better off telling her to just sit down and let me do it.
I studied the MARs during down time and made notes. I did all the skilled documentation and incident reports, did all the electronic charting on the wall kiosks, called family members and put in orders.
I wonder of there is something they aren't telling me? I wonder if they think I would've left as soon as I found another office job so went ahead and let me go to get someone who has only worked the floor? Maybe it was because I seemed to be more comfortable with the dicumentation side than the floor work? Afterall, documentation is what I've done for years in an office setting. All I know is that since I'm rusty and am not used to floor nursing, I wouldn't work out according to management.
I do have an interview tomorrow at another home for a PRN position so if I can get that, it will be something at least until I can get something full time.Last edit by LTCNS on Sep 20, '12
Sep 25, '12 by iheartangelinajolieHow did you get your medicare rates up? I have no control over our admissions and most of the medicares we get are barely a RU. I'd love to hear your suggestions.
Sep 26, '12 by LTCNS, LPNQuote from iheartangelinajolieFirst of all there is a lot of competition for admissions to skilled LTC homes so I would suggest your Marketing/Admissions person have a very good relationship with the Case Managers at the local hospitals. Who determines eligibility for skilled services on referrals? As the MDS Coordinator you should have some input as to determining eligibility. I know this is not always the case, but IMHO, it is very important for the MDS Coordinator to have some input. Who attends the Utilization Review meetings?How did you get your medicare rates up? I have no control over our admissions and most of the medicares we get are barely a RU. I'd love to hear your suggestions.
What are the most common dx you are seeing for new admissions? If your home is accepting admissions who can only be skilled for nursing for a few days, and are not eligible for skilled rehab services to step in after 5-8 days, as you know, you will always get a clinical RUG. If you have a new admission with exacerbation of COPD or CHF for example, then therapy should be able to step right in. If you have an admission with new onset of Diabetes Type I, then nursing can skill for the first few days, with therapy coming in after.
It pretty much all boils down to admission dx and understanding of eligibility for skilled rehab. services, and an interdisciplinary team who understands every aspect of the process. Do your admissions person, your Administrator and your DNS have a solid understanding of Medicare reimbursement guidelines and what determines eligibility?
Do you have a Corporate Reimbursement Specialist you can express your concerns to? Maybe he/she can conduct training sessions to ensure everyone is on the same page and understands all aspects of the process for determining eligibility.
These are just a few suggestions. As you know, there is a lot to the process and everyone needs to be on the same page.
Mar 20, '13 by DavidKarlThe MDS Coordinator has the most responsible job in a SNF, and the most thankless, and grueling- and and enilghtened DON or ADM would easily say the same thing. Must constantly know every detail of every patient. Must complete and update every care plan. Sends survey unformation directly to the state. For example- when the surveyors enter, thay are armed with a myriad of reports gealned from the MDS. If the assessments ate behind, or incorrect, the surveyors have bad information, which can lead to citations to the SNF. Aside from that, imagine trying to coerce and coddle 50, or 100 employees, daily, to keep up their own paperwork, so that is is always in sync with the MDS? And let's not forget- the MDS drives reimbursement? It is hardly an 'office' job- there's no way you can sit at a desk all day and be able to keep up with the required pace, know wha's going on in every bed, with every patient's family situation (in order to function as the care plan meeting coordinator/doer/etc.), be aware of every admit and discharge before they happen to be able to keep up and plan, and? It's always extra fun to be told you have to work the floor at times. And even way MORE fun to prepare to creats an MDS, and the patient has been there, say a week? And the chart is...blank/empty of any assessments? Yep- cush. Like walking on fire...But I miss it, and am teaching myself the 3.0, to get back into it. I go back to the floor at intervals, though, when I just can't take it any longer- usually, when there's a social worker that can't or won't participate fully/keep up with the mountainous flow of paperwork...that's the straw that normally breaks my back, because I refuse to do everyone else's work. It called 'interdisciplinary care plan', for a reason, eh?
Mar 20, '13 by Nascar nurse, ASN, RNQuote from DavidKarlOh you make me chuckle. As an "enlightened" DON with 10+ years MDS experience and 4 years ADON/DON experience I SO beg to differ with you as having the most responsible,thankless and grueling job in LTC. But, until you've actually done both jobs you will never get it.The MDS Coordinator has the most responsible job in a SNF, and the most thankless, and grueling- and and enilghtened DON or ADM would easily say the same thing.
I mean no disrespect. I agree the MDS job is difficult, stressful & extremely important and most have no clue what you are doing but if you really believe it is more difficult than the DON job than I have some oceanfront property I would like to talk to you about.