MDS Nurse burned out and going back to the floor - page 3

by LTCNS

8,090 Views | 29 Comments

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 burned out and so tired of the... Read More


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    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!
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    Quote from artsmom
    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.
    Last edit by LTCNS on Sep 20, '12
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    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.
  4. 0
    Quote from iheartangelinajolie
    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.
  5. 0
    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. 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?
  6. 0
    Quote from DavidKarl
    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.
    Oh 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.

    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.
  7. 0
    I'll modify my answer, because I sense that you're one of the 'other' type of DON. The enlightened type. The real type? "The MDS Coordinator is the second most thankless jobs in the typical SNF". DEAL?
  8. 0
    Quote from DavidKarl
    I'll modify my answer, because I sense that you're one of the 'other' type of DON. The enlightened type. The real type? "The MDS Coordinator is the second most thankless jobs in the typical SNF". DEAL?

    Deal - but I bet most aides would beg to differ with us both. I've been in LTC for 25+ years, have done every nursing position available (aide to LPN to RN) and I have yet to find a job that was easy, non-stressful and not thankless most of the time. I'm pretty sure every one of us in LTC think we have the hardest job - because they are all hard.
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    My second clarification- I was talking licensed staff only. Obviously, CNAs are taken for granted, abused, unappreciated, paid slave wages, and many have personal strife to deal with. I have always advocated them, and usually taken their sides in arguments, nurse vs aide bickering, and have never allowed a nurse to treat any CNA badly, if I was aware of it. I tried that gig way back in the 1980's, when everyone was tied down, and it took an hour to change those cloth diapers, and all the patients were drugged and immobilized. At least now there are disposables, few restraints, patients are more mobile and helpful, and etc. But, it's still 'the most difficult job in a SNF', if not in the WORLD. I've always thought up ways to ease their job, help them be organized to prevent repeating steps, stay calm, and the like. They love it when I'm working their assignment, they think I'm from another planet because I answer lights, toilet folks, feed them, help them change folks, insist that they take their breaks, and the like.
    Nascar nurse likes this.
  10. 1
    Quote from Nascar nurse
    Deal - but I bet most aides would beg to differ with us both. I've been in LTC for 25+ years, have done every nursing position available (aide to LPN to RN) and I have yet to find a job that was easy, non-stressful and not thankless most of the time. I'm pretty sure every one of us in LTC think we have the hardest job - because they are all hard.
    And there might be some LPN floor nurses who beg to differ with all y'all.

    Seriously though, I see first hand how our MDS nurse is pulled in a dozen different directions, leaving her little time to do any of the MDS charting.

    And I do see that our DON and ADON never get to leave work at work. I'd hate that, too.
    Nascar nurse likes this.


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