Advice for a New RNAC?

[Terse]

Hello, colleagues.

This is my first post to AllNurses and I have a question:

I have worked at my facility as a CNA and a floor nurse and was just this past November (this being July) asked to work as an RNAC. We are a Pennsylvania SNF with 120 beds, approximately half of which are short-term rehab (average length of rehab stay about 8 to 10 days as a general estimate). Our reimbursement structure is roughly 45% Medicaid, 30% Medicare/Medicare Advantage and the remaining 25% private insurance. Needless to say, we're hopping.

My supervisor, very knowledgeable and sincere, remarked to me as to how quickly I managed to learn the data-mining required for MDS completion. I also began feeling increasingly familiar with the MDS despite occasionally referring to the Manual for new situations. As time progressed, however, she began to comment that the MDSs needed to be completed more quickly than I had been finishing them. I was told to "do whatever it takes." As I focused on speed, accuracy suffered. The converse occurred when trying for accuracy. To curtail a long story, I was dismissed for insufficient or(/and) inaccurate work.

I really like my colleagues and feel crushed at having let them down. I also LOVE sifting through the data to know what's up with the residents we're treating. Plus, despite the silent derision I received from the "real nurses" on the floor, I know we RNACS directly impact patient care as we help inform other disciplines and move the facility mission (no margin, no mission, as the phrase goes). It really is an important job. So if you were in my shoes, what would you do to win the job back?

I know passing online training courses isn't enough--I must demonstrate competence.

But how?

Thanks.

[mlbluvr]

MDS can't be mastered by an online prep course. It requires tons of in your face on the job training. Why would they hire you with no experience, to turn around and fire you for no experience? Were you the only coordinator? If not, what did the other(s) do to help you? Did you have a corporate MDS nurse? What did she do to help you? Seminars, inservices, practice, reading, and lots of all of it? Total immersion will get you there. If you're an RN, and certified, you'll find another MDS job, for sure.

[mlbluvr]

Are you still employed as a nurse? Ask if you can hang out with the new MDSC, maybe so you can be the back up MDSC? You're articulate and intelligent, and other than slow to master MDS, you must otherwise be a good employee, else they would have fired you from your nursing job, is my opinion. If they say no they wasted a lot of their money getting you to the point of MDS you're at now. So, their loss?

[mlbluvr]

An illustrative analogy: Think of an MDS as a tax return. There are short tax forms (entry, DC, quarterly) and long tax forms (admission, change, etc.). When you complete any tax form, the difficult work (planning and information collecting) that takes most of your time has already been done. Collecting all the information onto the tax form is relatively basic, and quick. The planning is important because any error inputted on the tax form can cause problems, such as a reduced refund. And you must have supporting documentation for every line on every tax form (MDS), in the event you are audited. Also, the filing date for any tax return (MDS) is set in stone. So if you miss the 'tax deadline' (the MDS due date), you face at least two issues- possible lost revenue, and the increased chance of an audit. A third may be losing your job. In a busy place you describe, to put things into further prospective, those MED-A 'tax returns' can easily add up to a couple hundred thou$and in revenue every month. So, it's important to be well -versed in what MDS is due, why, and when, and plan accordingly- even better, before the patient even leaves the hospital. It's easy for even a well-oiled MDS machine to get behind.

[Terse]

You mention certification. According to the AANAC website, earning an RAC-CT will be $560.00--10 classes at $45 apiece not including the $110.00 AANAC membership. Is the program worth the cost? I calculate that it is but need to learn more to be certain. What do you think? And thanks.

[Terse]

Aside form my supervisor I was the only full-time MDS Coordinator in the office. Two others worked half-time each, making a third of sorts. All but one (who often asked me for advice) were very approachable and cooperative, answering questions I might have. Our Corporate RNAC was not directly accessible by me and was responsible for multiple (20?) facilities in three states.

Training consisted in hour-long once-a-week teleconferences each of which covered two or three MDS sections line-by-line, not far removed from simply reading the manual. I did complete some self-directed MDS courses on the corporate Continuing Education website and these were helpful to reinforce some of the information.

My duties also, of course, consisted in care planning, resident interviews and interdisciplinary meetings. I scheduled rarely.

Perhaps worth mentioning is that our facility, still reeling from CMS reimbursement cuts, had just undergone a terrible Survey with 15 F-tags and correction plans followed by a management change. Perhaps Corporate's patience was already minimal.

[mlbluvr]

'RNAC' really doesn't mean anything, really, unless you get that title from some online MDS 'certification' program, which I assumed you had- else you'd refer to yourself as 'MDS Coordinator', which is also a generic term for the position that doesn't infer either RN or LVN. There is no legal state or federal requirement for any nurse to become 'certified' in MDS. Hence, the programs are all voluntary. In fact, any 'MDS Coordinator' may well be a monkey, even (none have to be a nurse)- as LONG as a registered nurse (ANY registered nurse- even one who works in the kitchen) signs the MDS as 'complete' (not even 'accurate') . There's always ongoing confusion about this, which can be fixed by simply more people reading the RAI manual. I assumed you took an online class to get your 'RNAC' title, like I said before. That said, any MDS 'certfication' course can be considered 'MDS Kindergarten', which means you passed a few basic exams, that have no legal requirement. But they will certainly give you some insight into the process, yes. You seem to have a well rounded image of what LTC involves, to include the games/the politics/and assorted nonsense, so what I say you should find is hand's on MDS work. Take the 'certification' later, if you want- as long as you don't have to pay for it? Good luck. BTW- the RAI Manual, etc. is free online. And check youtube for any question the manual doesn't answer.

[Terse]

...Or maybe I'm just making excuses.

[Terse]

Thanks.

[mlbluvr]

With all that stuff going on even a seasoned MDS pro would likely not be able to function, much less a newbie. The whole SNF is somehow involved with the MDS process, and if the whole SNF is in a state of chaos, the MDS is generally the last thing on anybody's mind. Good learning curve for you, though.