DNS/DON question

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I am wondering if any other DNS/DON's have run across this before. SO....I have MDS experience, a lot, very skilled at it actually. It helped me get the DON position. In a new facility, talking the usual MDS stuff in the AM meetings, PPS meeting and particularly Medicare meeting/UR meeting. Rehab manager (SLP) doesn't seem to understand half of what I say. I drive the MDS, I never let it drive us. It has been about a month now, SLP STILL inflexible, resistant, un-educated and NOW with "new" behaviors, including running to MY administrator, about ME. SHe works for a sister company, facility owned by same parent company (would think that would make things easier? Nope.). Administrator good, supportive, no MDS knowledge but gets that there is to be a meeting everyday and we are to talk about minutes, although he really didn't get that until I walked him thru it last week,and showed him the ARD form. SO....whole team has little to no knowledge of MDS, how to drive it, capture higher rates etc etc etc.

After we had the little impromtu meeting prompted by SLP running to MY administrator, about ME...Adminstrator comes to me and says these fateful words "You know......you don't want to be perceived as.......being part of......having behaviors.................. causing her to have her behaviors..........should have been able to have effective meeting without my interventions.............things are in flux/changing........set her off...............".

Ok here is my dilemma. I am pretty much done with all of this, over it. Have been here before, done that. JUST left a difficult building where NO ONE could cooperate and focus on the task at hand, or take care of the residents.

This whole month has been a huge transition for this building, NOW,of course, all of this is MY fault (well of course it is, I am the new team member, hired to get some stuff fixed.... lol). I really, really really am tired of having fingers pointed at me as I HAVE A BEHAVIOR when (as I told the administrator):

1. this is business, not personal

2. this is about minutes, timely, from slp, without having to chase her all around the building.

3 should be able to change the ARD date without a congressional hearing, AND the MDS nurse's MUST know about the changes (not a secret)

4. HOW MANY TIMES DO I HAVE TO SAY THE WORD MINUTES?

5. It may be that I will have to instruct the MDS nurses to submit without minutes and do amendments, as this SLP apparently cannot get minutes timely, and she certainly cannot figure out how to get minutes for all residents that she is treating, including the Medicare B.'s

Don't get me wrong, I get paid good money. I was hired for a specific job, (that is ALWAYS what they say BEFORE they hire you..afterwords????)

My question for DNS/DON: how would you handle this? WHat if you thought the MDS nurse's would get frustrated and quit and then?..... As we all know this affects the nursing budget, how far to push this?...... Regional's are fine, but distant, focused on pychoactive meds right now, aware that MDS is in flux, 3 RCM's doing MDS, with only one really knowing what is needed plus me.

Have another offer to work in another building, starting to re-look at that offer, is this bad? I think I can help this building get thru survey then....(we are in survey window now) probably October...I struggle though with loyalty issues, don't want to seem ungrateful for the great offer that is now my job, but not what I expected and under no circumstances am I going to allow this building to personally and professinally attack me with their bad behavior. Unacceptable and I have other offers and things that I would like to do. I JUST crawled out from under the bus, not willing to go back under there.

Please speak freely, looking for some tough love here.

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Oh yeah, I forgot the best part of this issue. I came across all kinds of very recent training that this whole team has attended, saying the same stuff I have been saying, yet? my words are falling on deaf ears?

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Specializes in MDS/ UR.

If it is as you say, I would say get out. It will all come back to bite you.

I find it hard to comprehend that there are so many without an understanding of MDS besides you. Are they all newbies?

It seems that they are part of a coroporation? How can this be the case when the new changes are coming down the pike in less than 30 days.

Maybe you should just stay with an MDS job.

Oh, if my DON told me as an MDS nurse to sign and submit an MDS that I knew was inaccurate. I would flat out refuse even with threat of firing. The defense of my DON told me to wouldn't fly with any board of nursing or CMS audit or legal actions. It's wrong and you should know that as an experienced MDS nurse.

If you think that is what you need to do, I'd say - you sign and submit it.

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Specializes in MDS/ UR.

I am not trying to be B""""chy towards you but knowingly submitting an MDS that is inaccurate- even if it is a lower RUGS- is fraud as I see it.

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I am not trying to be B""""chy towards you but knowingly submitting an MDS that is inaccurate- even if it is a lower RUGS- is fraud as I see it.

If you don't have the minutes, you can't enter them in the MDS. The fact that we know there are minutes, is at the heart of the issue here. If we don't submit MDS's by the due date, we default. It isn't fraudulent to submit MDS that you don't have data for. Nursing cannot simply "guess" what the minutes are. No one is telling anyone to submit fraudulent MDS. Not sure where this misconception from my post is arising. I am not the MDS nurse, I am the DNS. What I posted is, we don't have the minutes, how to get them in a timely fashion and submit them with the accurate information. If you don't have the information, you have to send the MDS and amend it later, when YOU do have the information. DOn't make this harder than it is, and don't look at how we function in SNF/LTC with MDS with rose colored glasses. Does this make more sense? We aren't "knowingly submitting an inaccurate MDS..is fraud" . Please re-read your 3.0 MDS handbook, you cannot enter information you do not have.

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The whole team of MDS nurse's have very little experience, one just learned and is doing (freaking out as sheisdoing it), the 2nd is a little better, barely understands and a 3rd understands and has tons of experience, and no one will listen to her. It is a very large corporation, sister SNF and sister therapy, under big corporation. It would seem, walking into this, the therapy company would have this dialed in, they do not. We also have some compatiblity issues, they have own "therapy" computer and we have our systems, and MDS tracking etc. Problem is SLP has no true working knowledge of MDS, barely comprehends minutes and ARD.

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Specializes in MDS/ UR.
i am wondering if any other dns/don's have run across this before. so....i have mds experience, a lot, very skilled at it actually. it helped me get the don position. in a new facility, talking the usual mds stuff in the am meetings, pps meeting and particularly medicare meeting/ur meeting. rehab manager (slp) doesn't seem to understand half of what i say. i drive the mds, i never let it drive us. it has been about a month now, slp still inflexible, resistant, un-educated and now with "new" behaviors, including running to my administrator, about me. she works for a sister company, facility owned by same parent company (would think that would make things easier? nope.). administrator good, supportive, no mds knowledge but gets that there is to be a meeting everyday and we are to talk about minutes, although he really didn't get that until i walked him thru it last week,and showed him the ard form. so....whole team has little to no knowledge of mds, how to drive it, capture higher rates etc etc etc.

after we had the little impromtu meeting prompted by slp running to my administrator, about me...adminstrator comes to me and says these fateful words "you know......you don't want to be perceived as.......being part of......having behaviors.................. causing her to have her behaviors..........should have been able to have effective meeting without my interventions.............things are in flux/changing........set her off...............".

ok here is my dilemma. i am pretty much done with all of this, over it. have been here before, done that. just left a difficult building where no one could cooperate and focus on the task at hand, or take care of the residents.

this whole month has been a huge transition for this building, now,of course, all of this is my fault (well of course it is, i am the new team member, hired to get some stuff fixed.... lol). i really, really really am tired of having fingers pointed at me as i have a behavior when (as i told the administrator):

1. this is business, not personal

2. this is about minutes, timely, from slp, without having to chase her all around the building.

3 should be able to change the ard date without a congressional hearing, and the mds nurse's must know about the changes (not a secret)

4. how many times do i have to say the word minutes?

[color=sandybrown]5. it may be that i will have to instruct the mds nurses to submit without minutes and do amendments, as this slp apparently cannot get minutes timely, and she certainly cannot figure out how to get minutes for all residents that she is treating, including the medicare b.'s

[color=sandybrown]don't get me wrong, i get paid good money. i was hired for a specific job, (that is always what they say before they hire you..afterwords????)

my question for dns/don: how would you handle this? what if you thought the mds nurse's would get frustrated and quit and then?..... as we all know this affects the nursing budget, how far to push this?...... regional's are fine, but distant, focused on pychoactive meds right now, aware that mds is in flux, 3 rcm's doing mds, with only one really knowing what is needed plus me.

have another offer to work in another building, starting to re-look at that offer, is this bad? i think i can help this building get thru survey then....(we are in survey window now) probably october...i struggle though with loyalty issues, don't want to seem ungrateful for the great offer that is now my job, but not what i expected and under no circumstances am i going to allow this building to personally and professinally attack me with their bad behavior. unacceptable and i have other offers and things that i would like to do. i just crawled out from under the bus, not willing to go back under there.

please speak freely, looking for some tough love here.

i still see this as fradulent knowing there is information out there.

you come across as very hard core, angry and unapproachable in your posts along with the statement that you have been thrown under the bus.

i suspect you are contributing a great deal to the situation at hand. you may want to get some objectivity.

best wishes to you and your team.

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Specializes in LTC, Hospice, Case Management.

Sometimes it is not what you say, but how you say it. It can keep people from listening. Love the saying "Say what you mean but don't say it mean".

Anyways - I think I would be tempted to let a couple default. I would put it in writing every morning before stand up what I need and when I need it by. The day prior to default I would nicely announce in stand up that XYZ will be in default tomorrow if minutes are not obtained. I would also submit this in writing to the ED at that time.

It won't take long and someone will be taking this seriously.

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Specializes in LTC, MDS.

Like Nascar Nurse said, document, document, document your requests for minutes. I'd let the MDSs go into default, too (I used to do MDS). Once the company starts losing money, they will have to look at why, and if you've documented that you've asked for minutes and can't get them from the rehab coordinator, then you've covered your butt. Be sure to go to your administrator first, I think, and explain exactly what you are expecting and what steps you are taking so that you have back up and the rehab coordinator can't twist your words/behaviors.

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Sometimes it is not what you say, but how you say it. It can keep people from listening. Love the saying "Say what you mean but don't say it mean".

Anyways - I think I would be tempted to let a couple default. I would put it in writing every morning before stand up what I need and when I need it by. The day prior to default I would nicely announce in stand up that XYZ will be in default tomorrow if minutes are not obtained. I would also submit this in writing to the ED at that time.

It won't take long and someone will be taking this seriously.

Yep, it was corrected by the higher up's, we got all the minutes now, no more drama, and nor more finger pointing. Interesting.......No defaults either (although we got a boatload of OMRA's now). I guess it also is important WHO is saying it, lol.

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If it is as you say, I would say get out. It will all come back to bite you.

I find it hard to comprehend that there are so many without an understanding of MDS besides you. Are they all newbies?

It seems that they are part of a coroporation? How can this be the case when the new changes are coming down the pike in less than 30 days.

(yes, corporation. What happens 10/01/2011 is completely different, still needs minutes)

Maybe you should just stay with an MDS job. (Huh?)

Oh, if my DON told me as an MDS nurse to sign and submit an MDS that I knew was inaccurate. (Not telling anyone to do anything, it was a question...when we didn't have minutes). I would flat out refuse even with threat of firing. The defense of my DON told me to wouldn't fly with any board of nursing or CMS audit or legal actions. It's wrong and you should know that as an experienced MDS nurse. (I never told anyone to do anything, I was ASKING IF we should or should not, and there is no crime here.)

If you think that is what you need to do, I'd say - you sign and submit it.

(Ok, thanks for the advice, but it didn't address the question of missing minutes, that nursing cannot get, imagine, make up, etc).
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I am not trying to be B""""chy towards you but knowingly submitting an MDS that is inaccurate- even if it is a lower RUGS- is fraud as I see it.

Ok, no one is knowlingly submitting anything.....it was a question regarding missing minutes. RUGS are a term from MDS 2.0. Fraud is a crime, interesting that as nurses we just love to identify crimes, yet not solutions, I was asking a question, 3 or 4 or 5, and the title of the thread is DNS/DON question. I will reiterate: If the MDS nurse doesn't have the minutes, but SUSPECTS there are minutes, what can one do to get the minutes? SUggestions?

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