CNA coding and QMs

It can't be a one-man role. DON and staff ED should definitely be involved. Let the regional team know that the matter is already brought up to the attention of the Nursing Admin and beyond your authority. Should they have issues, have a conference call with the entire team, including the Administrator. Good luck!

I am an CNA licensed in approximately 25 states and I have 10 years experience.  I have traveled all over and I have seen most everything.  One thing I know for sure is that there is always somebody who thinks you are doing your job incorrectly but it is ALWAYS somebody who has never done your job.  A CNA sees what others do not.  We help patients/residents up close and personal so we have inside knowledge which changes day to day with patient condition.  Nobody in any facility is ever independent.  This should be common knowledge but it isn't.  If a patient/resident gets their meals cooked for them, their laundry done, their meds given to them, etc.  they are NOT independent.  If they were ambulatory yesterday but not today, they are given a higher dependency rating today.  You CANNOT CHANGE WHAT SOMEONE ELSE CHARTS.  You can insert a note saying what you believe is actually the rating but you cannot change what someone else charts because you did not witness it personally. The only reason to even insert the note anyway is to get more money from Medicare because the patient has a higher dependency rating.  Talk to your staff and share with them the financial importance of proper charting.  Give them a written explanation of what each level of dependency should be charted as but NEVER  change what someone else has charted.  That is illegal, unethical and could cause you to lose your license.