hibiscus6

Liane, I retired about 6 weeks ago (ran out of steam at 62). I do miss doing parts of my job (MDS Coordinator in a SNF), but many tasks I won’t miss at all. I remember my relief after my last on-call weekend, knowing I will never ever have to take call again. Bliss! I am struggling somewhat to find a new routine. I plan to explore some exercise classes at the local senior center, and I want to see if I can learn to play pickleball. I am hopeful that both you and I will find ways to make our retirement years joyful and meaningful.

It’s a regulation (at least in my state) in SNFs that every medication must have a diagnosis. Since that regulation doesn’t apply in hospitals or other settings, both sides can become frustrated. Hospitalists and other doctors aren’t used to being asked for diagnoses, and SNFs don’t want to get a citation for being out of compliance. My facility has a form for follow up on questions re new admissions’ orders, including a section where we list each med needing a diagnosis. We give this to the provider who is caring for them in our setting. We are now lucky enough to have an in-house NP/MD team who see every patient, but before that we would fax it to the provider (and we got to know which providers would give the diagnosis, and which expected us to write in the likely diagnosis so they could just sign it).

In my state influenza vaccination has been required for health care workers in hospitals and SNFs for several years in an effort to protect the patients through herd immunity. A consequence of exercising the right to refuse the vaccine in this state is the loss of ability to work in those settings. Consequences of exercising the right to refuse the covid vaccine include loss of opportunity for employment in certain jobs, along with increasing one’s chances of illness and the knowledge that one is helping to prolong the pandemic and endangering others.

Thanks for clarifying. Perhaps I was just in a quarrelsome mood when I read your post. Good reminder for me that part of respecting one’s colleagues is not jumping to unwarranted conclusions.

As a nurse who has worked in LTC for over 20 years, I have worked with a great many competent and qualified (and licensed) nurses who care deeply about their patients. I am sad but not surprised at your implication that LTC nurses are not quite worthy of their colleagues’ respect. I hope to see a day when we nurses respect all of our colleagues without exception.

Sorry your facility is having to deal with that. Perhaps your administrator needs to consider firing him for not fulfilling the terms of his contract (administrative on call) If you can find a replacement.

So glad for you! I too had a lot of trouble finding a job a liked and felt confident in early in my career. I have been an MDS coordinator for 20 years now and still enjoy it - always something to learn even after all this time!

I am an MDS coordinator so, I guess, part of “management.” Even so, I have been working in LTC for a long time (as a charge nurse before I got my current job). I am lucky to work for a company that is not a publicly owned outfit (no investors demanding dividends) with an owner who lives locally and seems to value his reputation. I believe that that the for-profit model of LTC is a huge impediment to quality of care. Every dollar spent on more staff is a dollar not given to a shareholder. There are currently state standards for LTC staff (at least in my state and I think in most) but they are absurdly low. My facility does not count administrative nurses in the staffing figures, but that probably varies by state. As someone else said, quality care takes time and supplies. There are no substitutes for those things. My suggestions to improve care: standards for staffing should be tightened drastically and health care companies should be non-profit in all areas (acute, LTC and ALF.) Also Medicaid really should pay more; in most states Medicaid pays less than it costs to provide care. And, from the perspective of my own job - the previous poster with 2 MDS coordinators for 240 beds - yikes! Huge workload for those 2 unfortunates.

I am an MDS coordinator in long term care. I feel that I am helping people but I do not provide direct care; I spend perhaps 5% of my time in face to face patient contact. Long term care can be a good alternative to long term care (generally non-profits are better employers or - if you are lucky, as I am - a private company that values quality care).

Yikes indeed. Sounds like a place that’s really struggling, and it doesn’t sound as if the DNS is helping any. If she “doesn’t know” why the weights can’t get done, why the *&^% doesn’t she look around on the floors and see what is going on in her building, instead of using this as a weapon to embarrass you in a meeting? You showed integrity in not leaving them in the lurch. Good luck.

They must have told her about the right to appeal when they gave her the cut letter, right? In my experience sometimes people don’t appeal but still complain. When this has happened at my place the social worker who is being complained about arranges a transfer to another social worker (I suppose they just make a trade) and they have settled down a little when the new one tells them the same as the old. Also sometimes the social workers offer (kindly) to assist them in finding a new facility, which sometimes helps people to remember why they want to be at our place. Unfortunately the nurse on an off shift has no power over any of this, and likely no knowledge of the situation. In that case they can’t do much except reiterate they are not involved in the pavement process at all and keep referring back to those who are.

Almost 25 years ago I moved from acute care (oncology, orthopedics) to long term care. I was tired of nursing and thought a change would be good, and, as an introvert, I found meeting new patients each day exhausting. It was a good move for me. I liked knowing the patients (and their families) for years, and I liked that, as the OP said, we staff would become family for patients who had none. And, I have certainly experienced the pained grimace and awkward silence that follows my telling someone where I work. Luckily, I know I work for a good company that gives nurses the tools they need to do a good job. And I take pride in the work my colleagues and I do. Thanks to the OP for standing up for us.

My company requires a BSN for leadership positions including DON. I have worked with 2 DONs who were successful in moving into their roles from ICU positions. I also worked with 2 ADONS from similar backgrounds who failed. I think some of what makes the difference is in respect for long term care as a specialty and being open to learning (versus a "how hard could it be?"approach). Sounds like you have good leadership skills , and the ability to be fair is a necessity. If it's a decent company (unfortunately not all of them are), it could be a rewarding position for you.

I am an MDS nurse at a 100 bed building; I take call 1 weekend in 5. I think a building's culture dictates whether the on-call managers are viewed as resources for the weekend staff, or as a PRN pool to cover for weekend call ins. In my place it's pretty rare that an on-call manager has to cover a shift (although it does happen once in a while). More often there are calls with questions about unusual situations. We try to work as a team.