How Long Did It Take To Have A Good Grasp of MDS/RNAC Job?

[MichelletheRN]

Been at my new job as RNAC/MDS nurse for not quite 6 weeks now. Still feeling QUITE out of my element. I have been an RN for 17 years, the vast majority of my experience being as a floor nurse in a small acute care hospital. My prior LTC experience was only having worked as a CNA during high school and college in a nursing home, and filling in just a little at a nursing home in our prior town as an RN when they were short of help, basically as a favor to the DON there who kind of hounded me to do it. At the time, i didn't particularly want to, because I already had a full-time job, and a family, but I of course can't say no, and felt bad for them. We did, however, have swing bed patients at the hospital at times, so I had an awareness of what MDS was, its purpose, and what they looked like. And why we had things that had to be done by certain days. O.K.

Applied for MDS position in the new town we moved to, initially because the local hospital had no openings, but upon researching it, thought, well, this is a chance for me to learn a TOTALLY new skill, how interesting and exciting this will be. Had my interview, sent in my references, visited the facility. I really like the administrator....she is very sweet. Facility seemed clean and okay. Was offered the job, a cut in pay, but I was okay with that. Reassured that I would be given three months of one on one training, by the current MDS nurse, who I get along with smashingly well, who is very knowledgeable and intelligent, but who having just graduated from RN school, was interested in doing other things, too. In theory, even after training me, she would still be with me 1-2 times a week, as well as going to the corporate branch office forty miles away once a week, and going to some other area homes helping them get their MDS and care plans on track and caught up, kind of a consultant. Also, there is training with a corporate consultant, who I have contact with several times a week, and webex classes. Peachy, right? My schedule would be Monday-Friday, 35-40 hours or slightly more in busy times, each week. No call. Manager on duty rotates, generally being about once every 6-8 weeks, and occasionally helping with lunch or supper trays. OK. Maybe in an emergency, helping on the floor or whatnot...but not expected to work the floor and try to somehow squeeze everything else in.

Reality check.

By the first weekend, due to being short of help, I was filling in on the floor, but as an aide, because there basically isn't enough help to train me to the med cart (since there has been a recent pharmacy change, no more pill cards or casettes, even the experienced folks are struggling). That's okay. As long as it isn't taking up all my learning and MDS time.

So far, I'm generally working the floor at least once a week. Usually, it's on a weekend. It varies, though...sometimes, it's stay on after and work 6-10. Sometimes, 2-10. Sometimes, 10-6, and the worst, coming in in the middle of the night. I'm kind of between a rock and a hard place; if the DON asks me to, I don't have much choice, but then I get in trouble with the corporate lady for not being in the office 40 hours, because I had to go home and sleep.

Then, they pulled my lady who is training me. Currently, I get her 1-2 days a week, and the rest of the time, she is pulled to the floor or sent to other facilities. I'm still doing my calls and stuff, and classes, and have literally read the entire RAI manual, but I'm anxious. There is alot I don't understand...mostly, the COT, EOT, and SOTassessments, and the rules for combining them in order to reap the most financial benefit possible. The trainings, I feel, are above my head....I generally am not stupid; but I really have to be shown or told what to do at least once, and maybe up to three or four times, before I understand it. I feel like I have been thrown into calculus without algebra first. Am I smart enough to do calculus? Sure. But first, I need algebra, geometry, and trig... I have expressed my distress to the corporate lady, who I suppose thinks I'm stupid by now, and says, "Well, you aren't going to have tge other lady there to hold your hand forever." Well, I know that, but I need her for a bit still. Is it normal? Or do most people pick up on it a lot sooner?

Then, I hate when I am not told I am supposed to do things, and don't know. The medical records lady told me I'm supposed to do the certs, but the lady training me says medical records has always done them. I will, but I have to know. Then, I don't even have computer access to do them. But I guess if they don't get sent in or signed and back, it's my fault? The SSD has always I guess called families for care plan meetings, and told me she does, but then she didn't, and I was told it's my responsibility. But if I ask if I'm supposed to do it, they get mad.

The constant short of help thing is depressing. I've said I would be willing to come in on the weekend to work on my stuff like every third or fourth weekend so they have 8 hours/day of RN coverage. But then, I will end up having to work the floor, and be in trouble for not getting my stuff done.

I'm comfortable with the assessments, fairly comfortable with doing the MDS forms, because I have my book right there with me, and if I don't find the answer, I will search it out. I can review the charts for information, do my interviews, etc. I have a beginning-rough knowledge of when to set my ARD dates and when the time frames are, and have obtained a wheel. But as far as combining assessments, COT and anything else in particular, and RUG levels....oh my, no.

Another thing is, I seem to have some kind of issue with PT/OT. Every day, we go over the dates and how people are doing, etc. Bt I swear to God, EVERY time I am told someone is going off Medicare A or B, and I can confirm exactly what is goung on five times in a day...the day AFTER I call and issue a denial letter, they tell me they decided to keep them on. This has happened so far I believe six times. ..then, I have to call and say, oh sorry about that call yesterday...throw that stuff away now...oh, now we picked them up for one day, now I have to call again. Yippee!

I was literally in tears the other day, Monday I guess, because we had a lady getting ST but almost out of days...issued a denial Friday, when I arrive Monday, the PT reams me out for not calling to tell her the patient fell Sunday night about 8 pm, and had to get stitches (yes, i was there, of course). So they are not releasing her. I call the corporate to find out what to do cause she is no longer ST; now, she will be OT...I think...I'm in trouble and going to have to amend it...but God smiled down on me, somehow it didn't go out with the other mail in the box over the weekend, so I was able to intercept it. Still. And, it almost happened again...the OT emailed me he was discharging a part B patient 6/9...so I would have issued a denial letter tomorrow....but he told the lady training me he was keeping her another week...and she said this, I said, "uh oh, that's not what my email said!" and so it got caught.

And everyone is so snarky. I feel set up frequently...I don't know why, or even how it will happen...but I am on guard, especially when my lady who trains me isn't there.

Don't get me wrong, there are some people I really like, but there are some I feel nervous around. I find the work interesting, if I could only be trained more. It's definitely new and challenging, but I don't know about all the other.

Is it normal to be still quite unsure of myself after a bit over a month? I am trying my best to not give up. Am I just dumber than normal? The lady who trains me says I am doing fine, but maybe she just doesn't want to hurt my feelings. (not sure why, as it doesn't bother anyone else lol...sometimes, it seems they enjoy it). I'm willing and have even suggested I could take the class, as soon as I learn more, and I will even pay for it, gladly. Or is it best to just give up? I don't want to, but I feel so unsteady and like I need guidance, and like everyone thinks it's no big deal and why can't I just figure it out?

[Ruas61, BSN, RN]

You should not be working the floor.

They are shooting themselves in the foot.

The certs not being done is a big problem. That needs to be addressed immediately.

I sent you a PM.

[MichelletheRN]

Thanks...I tried to pm you, and actually had a huge message typed up, but it says i don't have enough posts yet lol. Ah, well, i will make some more posts first. I dont know how to IM or anything, im just on my ipad, i haven't even got my desktop computer set up yet in our new house. Or i can email you maybe, if you can send me yours. I am hesitant to post anything much that isnt in a private message or such, not that it really matters, I guess....there isn't anything I've done wrong, or that I'm ashamed of. (and that's SUCH an unflattering profile pic of me, but....my eyeliner always runs when it's hot out lol).

After the freaking circus of absolute ridiculous 5th grade BS that went down up there today, to be honest, I don't even know if I want to keep trying. And it's a shame, kind of, because I have become interested in it, and I think, with training and support, I could probably be pretty good at it. I've become attached to many of the residents. And it had nothing to even DO with the actual job...just catty, petty, stupidity and nastiness. I have cried more today then i have since the day my dad died, it just hardly seems worth it at the moment. I am supposed to go in Sunday in the late morning, because I have to be manager on duty for some guy, and the lady training me is going to come in, too....i need to talk to her about this train wreck that today was.

[MichelletheRN]

Oh, and the certs are being done, by the medical records. It is no problem if they wanted me to do them...all I need is to be told what I am supposed to do, and shown how. The thing that makes me crazy is when everyone there expects a different thing from me, and for me to know how to do it without ever showing me how.

[amoLucia]

I can't tell you MDS things - not my thing. But I do see a few other issues dragging you down. Limited LTC experience can be really a problem as well as you being a new person at the NH. But they shouldn't be as bad as you have it. And others have succeeded.

But I do see where people ARE dumping on you - things that others used to do are now being pushed off on to you. Medical records and social service are taking advantage of you and dumping on you. Just know, at some places, the MDS/RNAC does do everything. But that's usually with a very experienced person doing the job. If someone else has been doing something, they need to keep doing it until such time that you're up to speed and can take over. You're being suckered.

You should NOT be working the floor. Hard to be avoided if it's coming from your DON or Admin. As a result, I suggest you NOT come in extra just to do your own thing as you will be constantly interrupted or even shanghaied. And this becomes a freq habit.

When you are MOD (manager-on-duty) try as hard as you can to be MOD - not a nurse. Every admin nurse I knew who was MOD always got pulled onto the floor to deal with nsg issues. All the other dept MODs could stay in their offices and do their own thing!

And make sure that guy you're covering MOD for pays you back time. Also, there might be a checklist for MOD duties/responsibilities. Just so they don't jump on you for something you weren't told about - like who does tours on weekends? If you have a nsg supervisor on duty, let her handle the nsg problems (that's HER job despription).

BIGGIE here! Therapy acts like the fair-haired princess at many facilities. They generate the money so they act like priviledged, spoiled kids and they can be b-busters. And they freq get away with it. I have worked with some terrific Therapy depts. but yours is very dysfunctional as far as I see.

??? As a question to the MDS people on this forum, could therapy issue their own cutoff letters??? Is that allowed? That would be a big burden off OP.

If you can, get your predecessor to go to bat for you. I'd be curious if she was facing similar problems, so I'd be careful about being too negative around her.

I read this forum all the time. I thought about MDS; did MDS 2.0way back. But 3.0 is so much more detailed and specific that I'm not interested. Good luck to you.

[MichelletheRN]

Yesterday's fun included, among other things, the LPN who is the director of the Alzheimer's unit and the ADON passing notes back and forth at stand up and giggling, apparently thinking I'm too stupid to read upside down, saying "look at M, *** is up with her hair" etc etc how I'm stupid, yadda yadda....are you kidding me? Right across the table from me? Because of course the lady training me was sent out, i went back to the office and cried. I couldn't focus the rest of the day, and left at like 2:30, because the DON and ADONs office borders mine, and the LPN from the Alzheimer's and the guy i am MOD for Sunday were all in there all day with the door shut laughing about me and how I'm so weird and let my highlights grow out and my nails chip and I'm getting fat, am not going to last long, etc.

I have not experienced anything like this in my life, but I'm fairly sure it means I'm doomed. Really, not even in junior high. And these people are my age....early 30s to early 40s. I was at my last job nearly fifteen years...im furious and disgusted with myself for whatever it is i have done to cause this.

[HappyWife77, BSN, RN]

I would gracefully bow out.

Look somewhere else. MDS nurses pulled to do CNA roles? That would be the first sign to jump ship.

Run is my advice.

Don't even think about the immature letter passing, seriously they call them selves professional?

You are above and beyond that nonsense! Best wishes for another door to open.

[amoLucia]

HappyWife77 is right! It is so sad and totally ???????? that you have to endure this (I don't even have a word for your ordeal!).

If you must hang in there because you just have to, then so be it. But start looking elsewhere. Any chance you can go back to your old employ? If you can leave, then just do it.

If you're an at-will state, LEAVE NOW. Leave with some gracious reason, don't burn your bridges. I don't mean to tell you as a professional something like this that you already know. But your place is toxic.

Like I said earlier, I wonder about your predecessor's experiences there.

Hugs to you.

[Ruas61, BSN, RN]

It seems to be the extreme of cliques.

I am just bewildered that anyone would act like this.

[MichelletheRN]

You and me both, hon. It is beyond my experience and really seems like something from another universe.

I am pretty well convinced I am done with it. They called the lady who is training me in to work as an aide today, and told her to call me and see if instead of coming in for a couple hours tomorrow in the office, i would work 2-10 to provide 8 hours RN coverage for the day. Lmao the DON and ADON were afraid to call me themselves.

I said not only no, but **** no, and why. The note passers can do it.

Unfortunately my old job is 3 hours away, but my move has placed me within a 40 mile radius of many opportunities, and we are financially comfortable enough that being without a steady income for awhile won't be devastating. I'm already searching for something new. And regardless, I've gained a valuable skill..a basic, rudimentary understanding of MDS and what it means. I do think, in time, I could have been competent. But it's okay...it's not worth my sanity.

[Ruas61, BSN, RN]

I would advise you to move on.

There is no repairing this bridge.

I would lodge a complaint with the corporate offices.

It is a shame, the money spent on training you cost them more than a few bucks.

Idiots is all I can think.

[Ruas61, BSN, RN]

I did get your PM and sent you back a response.