MDS-RNAC...HELLO?

postaledde · Dec 14, 2000

Here is a little tidbit copied from the MNA.

ThNinety-three percent (93%) of the nation's registered nurses do not belong to ANA, yet ANA claims to be the voice of the entire nursing profession. Last month Dr. Peter Bearhaus, a nurse researcher at Vanderbilt University commented in the press that IN FACT, "nursing has not been adequately represented in Washington." is reiterates my point. What has the ANA benn doing?????

We all need to join the Million Nurse March and be heard in Washington!! WWW.MillionNurseMarch.org

Tim-GNP · Dec 14, 2000

The reason for MNA's concern is simply explained... the leaders of ANA recently expressed upset with the unjust action of the Massachusetts Nurses Association (MNA) Board of Directors who fired staff members because they opposed MNA's talks to split from the ANA. If anyone wants to read the whole story, follow this link:

http://www.nursingworld.org/pressrel/2000/pr1204.htm

RNIN97 · Dec 15, 2000

It seems as if all the responses I have read have gotten away from the origionally asked question which was basicly-How many nurses does it take to coordinate MDS/PPS! I have been an MDS Coordinator since before PPS came into effect, and my opinion is that if you are an effective manager with a GOOD working knowledge of PPS, there should be no need for more then 1. Anything more is certainly NOT cost effective. It is also my experience that many Nursing home Directors and Administrators don't have a clear understanding of PPS and it's impact.

Good Luck!

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Jenny P · Dec 16, 2000

Postaledde, I have a couple of tough nights at work, come back and check this website, and find that somehow you think I'm an administrator! Sorry, I don't want that job title. What I meant by my comment about the hospital magazine is that the hospitals have their own information and media, which I, as a BEDSIDE NURSE, am unaware of. The article was really interesting and I'm glad that my state association is reviewing all of the health media and passing it on to those of us nurses who are interested in what is happening in this field today. I work nights and I'm tired of being used by the hospital as a cheap undervalued work horse that can be plugged into any time slot without consideration of me, my health, or my family's needs. I want to know what is being said by the opposition. We need to change things, and I plan to use any available methods to change what I can. I have found my state nurses association has been very good at getting info out to me. I USE my association the way I think it was intended: it is an organization by and for nurses and those that use it have a voice. I have a family too, and they require as much (or more) energy as anyone elses'. I'M TIRED!!!!!! THAT"S WHY I'M INVOLVED IN MY ASSOCIATION! Read this months' AJN (Dec. 2000) pp. 75-76 Issues Update to see what ANA has done for the bedside nurse. After reading this article, can you still say ANA is not supporting us?

ktwlpn, LPN · Dec 19, 2000

Originally posted by ktwlpn:
My facility has 2 full time RNAC's..there duties are primarily to go over and make corrections to the MDS after all of the departments have completed there appropriate sections...They then issue us a "report card" detailing any mistakes we may have made...Is this a trend elsewhere in the country? This is not how it is done in any other facility in this area...How do we make administration see that this is a misuse of valuable resources?With the nursing shortage so acute in this area we need to be on the floor as much as possible...Is this as ridiculous as I think it is? I have only been there 7 months and am not ready to rock the boat...we are without a DON at the moment-hopefully a young innovative person will come along and try to fix the things that are broken.....

[This message has been edited by ktwlpn (edited December 19, 2000).]

Great comments-but off topic.Possibly I did not make myself clear.What I am asking is what are the duties of your MDS co-ordinators or RNAC teams?I realize that the MDS is the bottom line...shouldn't the RNAC team be responsible for the complete MDS?(2 full time RNACS for 100 residents)In all other area facilities the floor nurses do the 7 day assessments and monthly summaries which should contain all the information needed for the RNAC to complete the MDS.Seems redundant to for our RNAC team to redo each MDS we have completed.And-in this facility with the shortage we have and the number of call offs at this time(we seem to have a large number o staff with chronic health problems-they miss alot of work)often the charge nurse much pitch in and help with ADL's so there is not time during normal work hours to get all the paper work finished-any ON topic comments for me?

nursejanedough · Dec 23, 2000

ktw, I see you are still looking for answers regarding MDS. I think it is different all of over the country. We had an MDS nurse (me) that put in all the nursing part on the MDS. I was trained that this was how it was done. Then when I went to meetings to train for the PPS (Prospective Payment System) implemented by Medicare, I found out there were MDS nurses from other places that would "make sure the floor nurses were doing their part correctly on the MDS". Well, I was envious that they had "help" on the MDS from their nursing staff. Well, to make a long story short, I ended up doing the new PPS, (the new MDS nurse left), also, did the activity part, social workers part, dietician's part, (they never had time) and making up most of the PT, ST, OT parts because I couldn't track them down half the time. Talk about creative writing. I went to the MDS position from floor nursing hoping I could work honestly and maybe spend more time with the residents and give them a little TLC. Keep up with the floor nursing and filling in your part on the MDS as long as you can. The residents need good nurses.

I feel guilty that I bailed out. Good luck.

mustangsheba · Dec 24, 2000

Hi guys! I didn't comment on this when it was first posted because I figured it wasn't in my bailiwick. However,now I can't resist. A modicum of quality assurance is certainly warranted in our profession, however it has reached ludicrous proportions. If we could stop the channeling of money to "police the nurses" and reroute it to patients, we would all be better off - and so much happier. The increased paper work we're required to complete and the surveillance required to make sure it is completed correctly is incredibly expensive. Health care workers are still trying to give good care to patients while having to tap dance to the requirements of the governments. The plural pertains to the Feds, the state, HCFA, OSHA, etc, etc, etc. Of course, there should be one form that would satisfy them all, but that would be too easy and wouldn't satisfy the criteria of "government". Redundancy above all. Jane, don't feel guilty for bailing out; feel smart.

Nancy1 · Jan 8, 2001

You might want to have your facility look at other methods. We went to electronic charting that feeds right into the MDS and RAPs and it does not take me long to do them because I have the nurses notes at a click of my mouse. It seems to me that the floor nurses have enough to do without having them fill in the MDS. If the charting is reflective of what is on the MDS it makes it much easier.

There are many other systems out ther, one just has to have an administration that is open to suggestions.

NA

reylem · Feb 23, 2001

I have been an RNAC from 1996 and I tell you I love every minute of it.

It's not really that hard if you have good time and management skills and of course you have the support of the Administration.

You learn as you go along. I started by reading the RAI manual which is the RNAC's bible of course. Making your own MDS roster which contains a list of residents and the corresponding MDS due dates throughout the year is also a must because you cannot rely on the software to give you an accurate listing of MDS due dates.

A monthly MDS schedule is also a good tool to guide the team members to keep track of the schedule of ARD and Care Planning dates.

If you have medicare, it would be wise to make a separate list of your medicare patient's ARD for the 5 day,14 day, anticipated LCD, discharge plan etc.

You should be on top of everything from scheduling to family attendance in the care planning meeting. Browse the web, join discussion groups, attend seminars. You need to be uptodate with the latest trends and newest regulations.

A positive attitude is needed as well as great deal of patience of course. You should know how to listen at the same time you should be mindful that team members don't manipulate you or boss you around. If it is a big facility, you need assessment nurses to help you out or you will drop dead. Refrain from accepting added responsibilities because come survey time

when your MDS is not done, your care plan is not updated, you'll be tried, fried and fired. Do not be discouraged, move on and

find yourself a more supportive environment.

nursejanedough · Mar 9, 2001

Hi, Nancy1 and reylem, first of all, Nancy1, most of the nursing homes in the south are not close to electronic charting. I was hired as the MDS nurse and then started hearing about PPS. Boy, was I duped. And reylem, maybe PPS has not affected you but at our facility, they had to lay off most of our Physical Therapy,PT and OT, Occupational Therapy. I agreed to do PPS and they hired a new MDS nurse. The MDS was in wreck and never returned. I was it. RT (Respiratory Therapy) was fired. They are not even covered under the new PPS system in nursing homes. I did the "best" I could do. As floor nursing I did the "best" I could do. I found out that working short, understaffed, required charting(even PPS/MDS) that the "best" you could do was "LYING"!. Most nurses here know what I am talking about.

freddy · Mar 10, 2001

Nursejanedough, sorry to hear about your bad experience. I'm so glad to find and hear from other nurses who have a similar job.

So how many RNAC's does it take? My facility (121 beds) has 2 MDS nurses (an RN Coordinator and an LPN) and 2 Care Plan nurses (I'm RN Coordinator and an LPN). Until last month we also had another RN who floated between MDS & Care plans, but we can't replace him until the floor is fully staffed (I'm not holding my breath). From the sounds of it, I should be thankful that we have as many in my office as we do.

We did not always have this many. When I took this position 2 yrs. ago, there was only the MDS Coordinator & myself. At that time we had 74 beds, and the facility's care plans left much to be desired. About half of the residents, who were mostly intermediate, didn't even have a POC and the MDS's were always at least three weeks behind schedule. Last year my facility acquired the beds from another LTC, and we moved all those residents to our place over about a week.

We have intermediate and skilled care residents; we have a very high rate of admissions and discharges because most of our new admits are rehab patients who go home after two to four weeks.

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ecb · Apr 26, 2001

WOW for you, having 2 MDS Nurses and 2 for care plans for 120, We have 180 residents At my facility and we have 2 RNACs who initiate and review MDS, and the Unit Manangers are responsible for care plans AND MDS (except for a couple sections for other departments)

I have between 4 and 9 each week to do, and all the care plans and MDSs include the ADL sheets, the Bradens, the fall, skin, pain,restraint assessment forms...THEN there is my managerial work, and i get pulled to the desk +/o the floor if we are short staffed.

BTW I also do the PPS, and Ihave had a grand total of 2 1/2 hours training in all of it

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*** May we all have the serenity to accept what we cannot change, and the determination to change what we cannot accept. ***

[This message has been edited by ecb (edited April 26, 2001).]