MDS Nurse burned out and going back to the floor

CoffeeRTC, BSN, RN · Sep 17, 2012

You will do fine. Unless you've been locked in your office over the last few years and clueless as to what goes on in the LTC world, it will be okay and reading your posts you say that you have been on the floor filling in.

Even though it was many moons ago and I wasn't an RNAC for but just a year and in management for a few....I love the transition to being "just a floor nurse"

My kids are small, I work pt and not is it just 8 (hahah with charting ot) and out the gate. No deadlines, no chasing IDT memembers around. Work stays at work.

LTCNS, LPN · Sep 17, 2012

Thank 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.

BrandonLPN, LPN · Sep 17, 2012

As 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.

LTCNS, LPN · Sep 18, 2012

As 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.

You 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 is

Bella'sMyBaby · Sep 18, 2012

I 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. :nurse:

LTCNS, LPN · Sep 20, 2012

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.

artsmom, BSN, LPN · Sep 20, 2012

Oh, 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 :).

LTCNS, LPN · Sep 21, 2012

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.

artsmom, BSN, LPN · Sep 21, 2012

Oh, 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!

LTCNS, LPN · Sep 21, 2012

Oh, 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.

iheartangelinajolie · Sep 26, 2012

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.

LTCNS, LPN · Sep 26, 2012

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.

First 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?

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.