time management and priority setting: Guru needed

[findgina]

Just registered, so apologize greatly for jumping in with a looong list of questions and more than a little frustration. I'm an RN with eleven years of clinical experience: three in ICU and ER, four of LTC management and four of MDS coordinating. My current facility is Medicare-A and private pay only. We hold a total of fifty-eight beds. Of these, about six are assisted living and another six to eight are private pay- insurance or family. We've been open a little over a year, and I've been here about four months. The facility is gorgeous; I love the staff, and I'm generally happy to be here.

Average length of stay on our Part A claims is thirty two days. Doing the math, this generates on the average about 120- 130 Part A assessments per month. This doesn't include OBRA, which are submitted for the private pay residents but only completed and not submitted for assisted living. And yes, Virginia, there is only one of me.

RAI/MDS were about sixty assessments behind when I took this job, and they are as caught up as they can be when each week 20-30 more assessments open up. In this facility, therapy sets all the ARDs for Part A claims, so I have little to no input on the flow of the workweek. Even if I did, it would change little. Bad is bad.

Now, survey window is open. It appears that prior to my coming that exactly ZERO care plans were put on the chart. Zero. There was a one-page "temporary" care plan (read that as "meaningless") that I was told would be good enough for the first 21 days of stay.

Meanwhile, we've hired a new DON, who is nothing but organized and wonderful, with pretty good vision if no experience in management. The DON has graciously hired me an assistant, who cannot start work for two weeks. Meanwhile, survey clock keeps ticking. It sounds like a time bomb in my head.

As of Saturday, I have twenty-nine assessments on my desk- all opened over three days. I have eight PartA charts with careplans, and have most of the 16 private pay and AL residents careplanned. I'm short thirty careplans. I'm sad to report that I've been told that I am now responsible for all OBRA assessments, some of which are four months behind; creating careplans for all of our residents; and responsible for all quarterly tracking-type assessments: braden, etc. Half of these forms are not even available in my facility.

I am not this person who cannot function, who has late work, or provides substandard care. I do not whine or make excuses. I'm your basic, Type-A, gotta be done right the first time person who has just lost the end of her coping skills. I *teach* this stuff, for goodness' sake. Yet far from being the GURU, I find myself in need of one.

What takes priority here: careplanning or assessment? What tags can I expect- which are avoidiable, which are unavoidable, and how do I tell that to the people signing my much-needed paycheck? Any clue, roadmap, cheat sheets, or prayers that can be thrown my way? Is there any way to salvage this problem? At this point, I'm thinking I should just start working the plan of correction I've already written in my head. I would actually just bolt, but I really think we cound have something spectacular in this facility if we could just get the organization right.

h e l p

smiles,

gina

[achot chavi]

Perhaps you are expecting more from yourself than one person can handle. In such a situation I find myself working overtime to get the work done, Don't forget that your assistant will need orienting (which will steal more of your time and energy)

Take a deep breath and do the best you can. Good Luck!

Remember you didn't create this "monster" situation.

[Rascal1]

Wow, you really did inherit a monster. If your DON is receptive, I would ask her if the unit nurse's could be respondsible for the nursing assessments,(fall,pressure,etc)and do the nursing sections of the MDS's that are not Med A. They could be split between the shifts with yourself overseeing and teaching.This would help for the long run. But,for now,you're doing as much as one person possibly can. Overtime and prayers...

[Nascar nurse, ASN, RN]

Can you quickly create some kind of "canned careplans" with the basic stuff, make a zillion copy of each problem (ADL, Fall, Pressure, etc).. assign each nurse a certain amount and have them add in the individual stuff (alarms, barrier creams, splints, etc). It should be pretty quick and easy to show them how to follow the monthly physician order sheet to add in the individual things. It may or maynot fly, but could be a quick starting point until you have more time to refine.

I would think the unit manager should be responsible for subassessments like the Braden forms

Then I would focus on assessments, but then again I tend to think like the money queen and no MDS = no reimbursement!

Just my

Good luck, sounds as if you are in a tough situation.