DNS/DON question

[pixie120]

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.

[pixie120]

Primary responsibility for accuracy lies with the person selecting the MDS item response. Each person completing a section of the MDS is required to sign the Attestation Statement (AA9, AD, and AT7) that reads:

�I certify that the accompanying information accurately reflects resident assessment or tracking information for this resident and that I collected or coordinated collection of this information on the dates specified. To the best of my knowledge, this information was collected in accordance with applicable Medicare and Medicaid requirements. I understand that this information is used as a basis for ensuring that residents receive appropriate and quality care, and as a basis for payment from Federal funds. I further understand that payment of such Federal funds and continued participation in the government-funded health care programs is conditioned on the accuracy and truthfulness of this information, and that I may be personally subject to or may subject my organization to substantial criminal, civil, and/or administrative penalties for submitting false information. I also certify that I am authorized to submit this information by this facility on its behalf.�

This is what I base my practice on. It would be interesting to see how people interpet it.

Umm...exactly. and when other's won't participate, give that information, it becomes quite a quandry doesn't it? Another great thing we just had implemented, MDS nurses now have direct access to the therapy documentations and minutes, how wonderful!!!! We are though, struggling with this COT issue... oh, well, we will figure it out soon!

[montecarlo64, ASN, BSN, LPN]

I would just give a list of the minutes I need, with due dates, to the therapy manager and the administrator & l ask the administrator to help track so that you do not get default days..I would not get emotional or upset..It is not your income, but the facility revenue that is at stake..If the words "default days" do not get your administrator hopping, I doubt that anything will....May have to just submit late...It will be out of your lap & into the lap of the therapy mgr & administrator..You will have your paper trail that proves that they both are fully aware of when the information is needed for when their higher ups notice too many default days! good luck:)