Passing the buck?

[Nursenan0]

At first I overlooked it...but after 2 years of this....I'm steaming mad, psychotic is how my close co-workers describe it but either way...

I'm the MDS Coordinator for our facility. I do NOT understand this building. Everytime someone slacks off on their job, it ends up being my job to do. Every time someone "doesnt have time", it ends up being my job. Examples: A resident is admitted to the facility. The nurses on the floor dont acknowledge she has a skin issue going on. They dont chart it, start a treatment, or pass it in report. Needless to say it was horrible by the time whoever found it and reported it. This had happened over and over. So the answer to fix it is.........ding ding...you guessed it, the MDS nurses will now do skin rounds with the floor nurse every monday, initiate treatments, and perform measurments. Also on that line....MDS nurse will look thru all new admission charts the morning after admission to check and see if the nurse who did the admit, followed thru with skin protocol. If not MDS will initiate it themselves.

That happened months ago, this week. I was personally invited to the administrators office, where she and the DON asked if I could do the sections on the MDS that social services and activities normally do. Well of course I can! Do I want to? Do I have time? NNOOOOOOOOOOOOOOOO!!!!! But then...they dont have time and they cant keep up. Now I find out, I'm also to do their careplans, and give them my notes to write their progress notes by. I have held my temper until today.............the activities director comes to me, with a smirk on her face I might add, and gives me some detailed worksheet she says she has to fill out with every assessment....and whats more, she says i have to use the activities I "see" the resident have.I dont see most of this. She doesnt have it all logged she says, she just uses what staff sees plus the activities on her calendar. Needless to say, my assessments and hers look nothing alike! She thinks we can adjust that if she "helps me out a little"

OK, now that I have that off my chest......Does anyone else have things like this happen? or am I the lucky one? I'm taking it to the coorporate nurse and administrator tomorrow. Arent staff members to be held accountable for their own work any more? Will I have a job when I do? Not sure I even care at this point. Interdisciplinary...what does that mean?

Nursenan

[CapeCodMermaid, RN]

lol...I don't mean to laugh, but you sound like me! Anytime someone else couldn't (or wouldn't) do their job, I was expected to do it. That's what you get for being smart,energetic,able to multi task...yeah right. People need to be held accountable for their own work. I've been the MDS/PPS coordinator before with a medicare census of 27-30. You can't keep up with the PPS assessments and do everyone else's work. Stick to your guns.

[emsboss]

CAN WE SAY??????...DELEGATE????????? ...It was delegated to you...get someone YOU can trust and ask them to do it. ALSO...You might want to let the "powers that be" that you are only human and if they expect you to do a good job to keep it within your limitations (no disrespect intended) to do.

[jkaee]

Yep, I hear you. I've been an RNAC before, and I can't see how you can possibly take on all that work plus handle your own responsibilities! When I was an admissions nurse, the floor nurses weren't doing the admit 2 step PPD's, so it was suddenly my responsibility to administer and keep track of all the new admit PPD's for a 200 plus bed facility that would get up to 7 or so admissions per day. Love admins idea of "problem solving!"

If you are to fill out Acts and SS part of the MDS, I would insist that those departments do all the work involved, and just give you the codes to enter in. You are not trained to assess those areas, and that's not how an "interdisciplinary" team works. They need to do their assessments and have all their documentation in place....that's the whole point of the MDS. As for the skin checks, I'd do it for now, just to keep the residents properly assessed and cared for, but try to arrange with the staff development RN to inservice staff about proper skin assessments and follow up care. The floor nurses need to be responsible for this....not just you. You can't be in the building 24/7....and you can't let a skin breakdown be left untreated for 16 hrs or so until you come back in the building.

Good luck and keep us posted!

[ratchit]

ARGH!

When things get hairy and people are overwhelmed with work, there are some common ways we respond. Some people work their 40 hours a week and aren't bothered by what they don't get to. Some people work themselves to death trying to do everything while saying nothing and end up miserable. And some people pass the buck.

I guess passing the buck isn't the absolute worst thing here- at least TPTB have noticed that important patient care is not getting done. But you have ended up in a role familiar to me- the competent hardworking person in the office who gets given the work other people can't or won't do.

Put your foot down. You are now killing yourself to do work that is more appropriate for other people to do. This will negatively effect your ability to do YOUR work. The right problem has to be fixed- if activities or nursing staff are understaffed or underperforming, then that is the problem that has to be fixed. And what would the state say about you documenting work done by other people, in specialties you are not trained to evaluate?

We should all pitch in and help each other- but no way should you routinely be taking on the work of other people when you have enough to do yourself.

Maybe you could "help" with the skin and PPD issues by presenting an inservice to the staff on how important THEIR role is and tracking the results- that must be less time consuming than doing all the leg work. For example, I believe nursing homes are not compensated for treating decubs that start in the facility. Telling a nurse "the facility has to pay out of pocket to treat things if they are not charted on the admission assessment or if they start here- that is X thousand dollars per year that cannot be spent on other things" might help motivate your colleagues. Especially if that money could be spent on things like raises. Maybe you could help show the people who SHOULD be doing these things how important it is to get them done- if there is more motivation to do them, there is less chance you will be the one having to do them.

Edited to add: If admissions QI is in your job description, I can see them asking you to check the paperwork after every admission. But your role should be limited to pointing it out to the charge RN and filling out the incident report. NOT initiating bedside care protocols yourself. Again- fix the right problem, not give all the problems to a few people to fix!

[CoffeeRTC, BSN, RN]

[color=red]no!

[Nursenan0]

Well I calmed down a little by the time I got into work today.....and part of my problem solved itself.....I decided I would go ahead and finish the assessments I had started...I completed the SS part without a snag....but surprise! When I went to complete the activities section.....I found no documented proof of activities, so snooping further, I found no activity progress notes for the past 2 quarters on the majority of residents...oops. Sooooo I went to a meeting I had asked for with the administrator, DON, and coorporate nurse. I told them how I felt about covering up problems and passing them on instead of fixing them ( I put a bug in the corporates ear about auditing for progress notes), and by the end of today, I was back to my own assessments only. What will happen to the others....not sure. I tried to talk to the administrator about the attitudes, when asked to complete their work on time...her reply was...."well they are always mad at you anyway, some people just cant work on a time schedule like you can" (I'm trying really hard to pretend that time schedules isnt what MDS jobs mean )