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?
