Mds Job

TracyB,RN, RN · Jan 27, 2003

our MDS nurses get pulled to the floor often. I am the treatment nurse & get pulled 2 times a week at least! That is a good week.

UUUGGGHHH. Only 2 more weeks till my last day! YEA!!!!!!!!!!!!!

Getting out while the getting is good.

TracyB,RN, RN · Jan 27, 2003

our MDS nurses get pulled to the floor often. I am the treatment nurse & get pulled 2 times a week at least! That is a good week.

UUUGGGHHH. Only 2 more weeks till my last day! YEA!!!!!!!!!!!!!

Getting out while the getting is good.

And our place is really pretty & clean. Too bad the staffing & care is crap!

Catsrule16, RN · Jan 28, 2003

I worked as an MDS nurse. I liked the investigation part of the job but the case load was entirely too much. I worked in 2 different facilities as an MDS coordinator. A 44 bed hospital based unit and a 120 bed facility. At both places I was pulled to work the floors, I had to take call, and I didn't earn overtime. The MDS is a federally mandated form. It is used in Longterm care facilities to determine how much Medicare will pay the facility. In some states it also determines how much Medicaid will pay. It is the basis for determining what should be care planned. The person who does this job needs to have a good care planning skils. It's not for the inexperienced. :confused: I suggest you work in Long Term Care for a few years before taking a position like this. The MDS Nurse is the most unappreciated person. :scrying: Over worked and underpaid. Other nurses resent the fact you dictate in the care plan how they should take care of their residents. Few even look at the care plan. :devil: The MDS nurse in the first to be blamed when the survey is bad based on the assessment even though he/she is just the gatherer of the information based on the documentation in the records. Think before you take this position.

:chuckle If you take it, buy stock in an antacid company for the heartburn you'll experience, Lilly Pharmacuticals for all the Prozac you'll need, get up to date photos of your family and loved ones so you can remember what they looked like, and make sure your insurance plan covers nervous breakdowns from the pressure that comes with the job

adrienurse, LPN · Jan 28, 2003

Thanks for explaining this whole MDS concept to me. We don't really use it in Canada, but there's big talk of bringing it in. Do y'all find that it's really a necessary thing, or just a grand make-work project?

Long Term Care Columnist / Guide · Jan 28, 2003

Catsrule: I couldn't have said it better myself. Never again!!!

adrienurse: In all my years of LTC, I have never seen a single improvement in bedside care that resulted from the reams of paperwork thrown at every conceivable problem. I didn't really mind the MDS, but it's really only as good as the documentation performed by the other nurses, the aides, and the therapists. (There's no way an MDS nurse can be present through all 3 shifts for 7 days to do these assessments herself.) So their use as a payment determinant, or as a snapshot for where a resident is "at" in a given 7- or 14-day observation period is limited. Hope they don't push you guys into that where you live......it's not exactly a smashing success here in the USA either, where Medicare and Medicaid programs are the first on the chopping block when the economy goes in the dumper.

FrazzledRN · Feb 4, 2003

:roll I am a MDS nurse in a 120 bed LTC facility, have been doing this for 3 years, was charge for 5 years and worked in acute care for 2 years,and am still learning something new every day. They are forever changing the regs and the forms and the manual...its a challenge. We are pulled to the floor at times and are asked to do admissions when they're short staffed which is often...we have alot of skilled residents who come and go quite often. One week in January we had 16 admissions and readmissions in one week...keeping up with the asessment caseload is difficult and takes 4 of us. They are often pulling fom us because we have 4...Butting heads with the DON is daily, the mds nurse is definitly not appreciated. It helps if the DON has some clue about the MDS process, mine does not but pretends that she does...which is why we are constantly butting heads on things. I am wondering some things about other facilities...we try to have care conferences Q week..but the only attendants are usually the MDS staff and the social worker...noone else makes the time to come..we are left with the family complaints on our own...who attends at your facility (our DON always has excuses as to why she can't come). We have our restorative nurse, SW, activities, dietician, and treatment nurse fill in their sections...which are usually inaccurate, or not complete..so we end up doing things ourselves...we had a resident who staff told us was incotinent of B&B almost daily, yet the 3day assessment did not reflect this, and documentation in the record is the pits, the restorative nurse coded this resident based on the pitiful documentation, but did not take into account what the STNA's voiced...we ended up coding it the way she wanted yet didn't feel that this accurately reflected this resident..if state should choose to ask staff then it will differ from the mds which concerns me...any thoughts?? Also, this restor RN codes the residents down in B&B to 4's so they will not trigger on the QI's for incontinet with no toileting plan, i am sincerely concerned regarding an accuracy issue...yet when I voice concerns about this to the RN and the DON they blow it off...we are expecting a survey any day. Anybody else dealing with anything similar or have any thoughts or suggestion am very frustrated and need to hear from people that understand the process!!! Thanks!!

ChainedChaosRN · Feb 5, 2003

Hi Frazzled,

My facility is 160 bed skilled. I have 2 MDS Coordinators, and I NEVER pull them. We usually run 30-35 skilled residents. They work 40 hour weeks and rarely work overtime.

You didn't say how many skilled you had, but in all honesty, if I had 4 for 120 bed, I would pull. That's quite a bit for that sized facility unless you are running a sub-acute.

I rarely attend care conferences either, only if there is a troubled family, or a resident with family issues that needs addressing. The interdisciplinary team attends care conferences which includes Unit Managers and the Rehab Coordinator if the resident is having any therapies.

The CNA's have a ADL performance record to fill out each shift, which codes closely to the MDS which is also their flow sheet. Somewhat helpful. In the event of lack of documentation, of course we do staff interviews and explain away in the RAPS.

We have daily PPS meetings where we discuss each skilled resident, then a Resident at Risk meeting follows where we discuss a Unit per day. My facility has 5. Every resident and their care/social issues are discussed at least weekly. This is also a great opportunity to continually educate the IDT about MDS coding. I do rely on the Coordinators to address any concerns they have to me if they feel one of the IDT is coding incorrectly. Then we openly discuss it the next day as to what the reasoning was for coding ...sometimes the Coordinators are wrong and the team member can back up why they coded a certain way.

I'm not sure if any of this helps, but gives you a glimpse of another facility.

Dawn

debRNo1 · Feb 5, 2003

I do understand the process but unfortunately for you and other MDS coordinators many nurses do not understand the "system" and dont care to know about it. Some nurses will document the complete opposite and this leads to big trouble with the QI's and the STATE. If the nurses are receptive maybe a little education about the "books" could help with their "pitiful" documentation???

Show them where to look for the codes and explain that if there is a change that you need to know about it !!??

Its not an easy job and the schedule alone made me never want to do it. We had care plan meetings Qwk at my facility MDS coordinator, unit manager, SW, PT/OT, and dietary would attend. On a rare occasion we would have CNA or a nurse come if an issue came about. Our problem was with short term residents who waited awhile for their meeting and I felt like it should have been done alot sooner due to their short stays.

Your restorative nurse NEEDS to talk to CNA's and begin to know the residents better to provide you with proper documentation.

My heart was bleeding for my MDS nurse when the state began to pull books.

I hope all goes well with your survey.....

good luck

FrazzledRN · Feb 7, 2003

Thank-you so much for the input..chainedchaosRN and debRNo1..I've decided to cut my DON some slack..she too has a difficult job...I just wish she would be more understanding..I mean we do help for the sake of the residents..start IV's, admissions, families, meetings,I've rounded with the surveyors when the weather was bad last year and DON had hard time making it in..I..am willing to help...we have usually 20-30 skilled, some weeks up some weeks down...and usually have anywhere from 23-35 assessments to do per week, plus updating orders and admits/readmits, submission, I do chart checks every 2 weeks or so to update and ensure 15 months worth of MDS's are there..and dates are correct (goals,etc.) Update restorative and B&B orders, casemix, PPS meeting QD, ITM meeting Q week, careplan conference Q week, updating careplans for every fall that occurs, Quality of Care meeting Q week, etc.. Plus try to help on floors and do admissions, file...I do appreciate your input and it does give me a perspective on things..I am the coordinator with 3 other full time nurses (RN's) also assisting...Myself and another nurse do help on floors as much as able ...but feel that other dept's should help out as well...staff coordinator does not ever assist with any floor work, nor the restorative RN (she does STNA classes now too at times, and goes to school 1 day per week)...then we see the DON not making much attempt to help on the floors when they are very short either (yes she has her own work also..) but when you are continually expecting the same nurses to help and do it often, without regard to what they have to do also..and don't expect the other nurses to help out or take a turn..is what starts to irritate...I know there are 4 of us....I understand that, but when I am on the floors my work is still waiting for me...I still have those assessments to do and to be ready for care conferene and be behind and questioned "why are you behind?" I don't know..it's definitely time consuming and I don't get overtime pay..I do notes and assessment schedules and whatever I can get done at home often..I easily put in 50-60 hours/week if not more...but I love the job itself! We also do the STNA ADL sheets but have many blanks or they're incorrectly filled out despite many inservices on how to do them...ours are that the STNA's insert the code # corresponding to what that resident did that day.."0,1,2,3,4,or 8" I have a hard time getting them to understand the codes and what they mean..and am working on making up a better sheet...any ideas on anywhere I might come across a better tool? Let me know... I also have skilled charting tool for the nurses so they know who is skilled and for what to try to improve charting.but it doesn't really help much..charting is very generic.."up in chair in lounge, no complaints"...we've had numerous inservices, etc..but the charting doesn't get much better....Again Thank-you for yor input and advice..I value it very greatly!!

debRNo1 · Feb 8, 2003

Originally posted by FrazzledRN
ours are that the STNA's insert the code # corresponding to what that resident did that day.."0,1,2,3,4,or 8" I have a hard time getting them to understand the codes and what they mean..and am working on making up a better sheet...any ideas on anywhere I might come across a better tool? Let me know... I also have skilled charting tool for the nurses so they know who is skilled and for what to try to improve charting.but it doesn't really help much..charting is very generic.."up in chair in lounge, no complaints

No ideas for ya .....We started to use a "new admit" sheet and one side had the #'s and codes. Well....the print didnt come out where the #'s were SUPPOSE to be and a very bright nurse began to write in the #'s and the rest just followed her cue. The problem was that she wrote 1-2-3-4-5 :eek:

left out the "0" :imbar To make matters worse another nurse comes along and begins to write "8"= did not occur. So now the entire thing is filled with 8-8 :mad: So I guess we didnt care for these residents at all ??? Feeding did not occur, transfer did not occur toileting did not occur !!

they just continue to copy what the previous nurse wrote if they fill it out at all. Now the sheets and the books CANNOT match and I just felt like we should make a noose and put it around the MDS coordinators neck !!???

rough job..........good luck :confused:

deb

FrazzledRN · Feb 8, 2003

Thanks...is at least comforting to know that ours isn't the only facility that has difficulties with this...will comfort me as I crash and burn lol!!! Am trying with the input from our MDS crew to make an attempt at creating a better sheet...that is more user friendly! Will keep trying...thanks again for yor input!

dianser · Feb 20, 2003

It is a huge undertaking and requires a loy of patience and tremendous organizational skills.

A few things to ask prior to accepting this kind of position is:

1. how often will you be pulled to the floor to work

2. how much on-call time will ou have?

3. if a larger facility, will you have an assistant?

4. will you be responsible for any other programs?

the answers to 1,2,4 should be no and you shouold get this in writing.

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You sure hit the nail on the head! I was an MDS coordinator and got pulled to the floor so much I got way behind on assessments...and guess who was reamed out for that? Certainly not managment who pulled me away from my job to do someone elses! Unfortuanately I lIKED doing MDS, but the stress of not being able to stay on top of things was just too much. :(