I really think that delegation of duties and who actually does what varies from building to building, company to company.
Where I work, I do 90% of the MDS and usually all the CAAs. Everyone is always busy. Staffing is always less than ideal. In all my years of MDS, just this past year I started going entirely case mix. With everything going on with the changes, it wasn't that hard to give up PPS. Doing case mix has made me see things in a different light though. Our charts have stickers for MCR (we use them for mgd care as well). The floor nurses are in tune to look for those and usually chart fairly well. Other areas like the rehab depart, SW notes etc are good sources for me when doing PPS. For case mix we make out lists ahead of schedule as to what date which resident is having an assessment done, but honestly with the Mcr/Mcd reimbursment changes it's all anyone can do to do the minimum. We had layoffs, pay cuts, layoffs again and again. (I was actually part of the last tier of layoffs.) Then of course something comes up and an assessment has to be added and another postponed.
For case mix, I had to do quarterly nursing assessments on each of the residents I was working on which consisted of Brayden scale, fall risk, transfers, bowel and bladder, pain, all psychotropics for consent for present dose, aims if needed, smoking if needed as well and restraints, but we didn't have any in the building. I gleaned the chart for changes etc, interviewed the resident and usually because of time constraints, if anyone's part wasn't done, i would do it. More times than not I was doing it. I didn't mind if it was something that I came across anyway or could find easily, but I hated having to interview the resident for mood. After all my interviews and data input (or before) I had to write a lengthy nurses note that covered each of the items that there was no documentation for, such as behaviors, seat cushions and pressure reducing mattresses, the results of the restorative nursing, any changes in adls or any temporary condition that might cause a temporary change and not a significant one.
Very often, unfortunately, I would come across something that was missed. Perhaps something as simple as MD needing to be notified of recent blood sugars and current insulin or oral hypoglycemic doses. It might be something I saw during my interview that needed further assessing and follow up or even sometimes hospitalization. Labs were not put in the chart regularly,or were kept in a different place until filed and all x-rays, MRIs, CT Scans, I called the hospital for a copy to put on the chart. The same with hospital discharges or notes from an ER visit or dialysis notes. It could even be an order written that no one took off. I took it upon myself to pitch in with these things because I am the patient advocate. I am supposed to be his champion. The nurses love the patients and follow up as best they can, but we seem to be more interested in filling in a square, signing off on some lame "inservice sheet" that someone just made up because of something that happened or going to more and more meetings to see that we are doing our job and catching things. And most facilities I've worked at the residents have so many medications. They are coming in sicker with poor prognoses and nutritional intake just waiting to become pressure ulcer candidates. Or they may be bariatric patients with personality disorders and demanding demeanors. whew! Well.... I guess we all know we are in a mess and in this together.
I enjoy working. I'll do almost anything as long as it's ethical and in my scope of practice and I feel it's in the best interest of the resident. But like everyone else, my time is limited. I have deadlines. Who do I perfer to get mad at me? Why do I have to ask this question? If I'm salaried and work way way over 40 hrs, I put off my own appts., MD, dentist. If I'm on the clock, I can't get overtime. We need clones. I read where one of the CEOs (won't mention any names) in his quarterly report to the board and stock holders "we're cutting back all we can and nurses won't work for pauper pay you know" No, but now we get the privledge of doing the work of two people.
By the way Cape Cod Mermaid, what is your position now? Are you DON? Katoline