miccay

I am also starting July 7th. I am nervous about going back to school but excited as well. Starting with one class, NR500, of course, but hope to take two classes in September.

Thanks for posting your opinions. I am about to start an online program. I chose online for two reasons - one so I continue to work full time during the day (until I get to the clinicals) and the other is because there is only one college locally that offers the program and there is a long waiting list for it. I am looking forward to being a NP and I am glad to know there are NPs who feel it was a good decision to make the sacrifices to get the credential.

Thanks for all the positive comments on this post. I have been wandering the same for myself. I am 44 yrs old and about to start a NP program. I will be close to 47 when I am finished. I have had doubts at times, thinking I am crazy for going to school now, but now I have more confidence. I appreciate words of encouragement and wisdom.

I am the DON at a 88 bed facility. Right now our census is 76. I am being told that the nurses are staying over on their shift too much and they have to clock out and leave after their 8 hrs. The census is down and we cannot have overtime. The nurses are saying they have too much documentation to do to get out on time. Of course they document on residents who are on antibiotics and any incidents for 72 hours and they have daily medicare A charting. We only have 5 medicare A residents at this time. However, we have about 10 residents receiving part B services. The DON before me implemented that the nurses have to document on the part B residents on Tues and Thurs. Where I worked before, we did not document on the residents receiving Part B. We only documented three days prior to therapy starting to establish a reason for therapy and then we documented when therapy ended. I would like to know how other facilities are documenting and how other DONs handle getting the nurses off their shifts on time.

I have been a member for three years and I am certified through AANAC. I have never regretted it.

Your MDS nurse is looking for documentation to help her code that particular resident. The MDS and care plan should paint a picture of what is going on and it can only show that if the documentation is in the chart. She is looking for behaviors such as refusing care, combativeness, wandering, delusions, hallucinations. She is looking for shortness of breath - and if it occurs - when? At rest? on exertion? Lying flat? She needs to know about continence or incontinence. Hopefully all disciplines are writing in the chart any changes or updates such as dietary, treatment nurses, social services, activities and the interviews are being completed. It is so difficult and frustrating to complete an MDS when you know what is going on with a resident and there is no documentation.

I have to code a resident's diet that is full liquid. She had an esophogeal repair and she is to have a full liquid diet now. I have never had to code this and I can't decide where it fits. It is not mechically altered in my opinion. It is just regular fluids and broth. It is not therapeutic because it does not have anything to do with nutritional content and it is not regular. Please offer some help.

MDS has changed quite a bit. To me, the new 3.0 is very time consuming. Interviews have to be conducted for each assessment - BIMS for cognition, PHQ9 for mood, pain, discharge preferences, activities preferences. In my facility, the SS worker conducts the BIMS, PHQ9, discharge, activities director conducts the activities preferences, and a nurse conducts the pain interview, but it is redundant. The old discharge tracking has been replaced with a discharge assessment, so if you work in a facility where there are a lot of unplanned or planned discharges, it takes a lot of your time. Then there are End Of Therapy OMRAs and Start of Therapy OMRAs , and starting soon there will be a Change of Therapy OMRA. Alot more work than 2.0 in my opinion. Good luck.

In the facility where I work, I have a nurse consultant that comes monthly and completes an audit on the MDS I have completed. She always comes up with one more physician order that she says I should have coded. I know what the problem is. I was taught that you do not code physician orders that are written the day of admission unless it is because of a drastic change in condition of that resident. She is wanting me to code orders from the day of admission such as when the MD changes one medication to another or wound treatment orders. These are not clarification orders ( I know they can not be counted), but they do not indicate a change in the resident's condition. I have looked in the manual for clarification and I still believe I should not be counting these orders. She states she has always counted such orders. Should I be counting them? Please advise.

I agree with the first answer. MDS is not a 9-5 job. You have to consider what other tasks come with that position. In some facilities, the MDS Coordinator has to take call. That is very hard to do. How many beds is the facility and what is their medicare census? The MDS position is no joke. Some may think it is an easy office job, but it is demanding and in some cases it will drive you crazy if you do not have the support of management. Do more investigation into the job and find out more details of other duties they will expect from you. You may have to work weekends if you can not get the work done during the week. The 3.0 has a lot of assessments that are time consuming and have to be completed and transmitted within a short period of time. Good luck.

I totally agree that this MDS needs to be revamped. We have so many unplanned discharges it is ridiculous. I try not to use dashes, but as you say, if the interview was not completed, we can not falsify the MDS! I can understand interviewing the residents annually, but with every assessment, it is ludicrous. I can only pray that CMS will wake up and revise MDS 3.0.

I agree, good for you! I understand what you went through. I work in 122 bed facility but we have what they call a transitional care unit. We have anywhere between 30-40 Medicare. Most are there 20 days. Some stay longer, but hardly never a full 100 days. They come and go - new admissions, discharges to the hospital, readmissions. It is crazy. We were lucky to have 2 full time MDS Coordinators - which I am one of - and one part time MDS Coordinator. When 3.0 hit in October, we were going crazy and I turned in my notice. I could see myself going through what you just described. Management offered to hire a fourth MDS Coordinator to complete the interviews and conduct the care plan meetings. She also does some MDS's when she can. So I retracted my resignation and stayed. The fourth person has helped us tremendously, but we still work hard every day, coding and completing MDS after MDS. I used to love being a MDS Coordinator, but I am burnt out with all the work that goes with 3.0. Good luck to you. I am sure you will find another job. Other facilities need good coordinators and some are just not as fast paced and unorganized as what you were dealing with.

First of all, I would ask myself "is this job really worth it?" You stated that you agreed to the job of MDS Coordinator because you love the facility and wanted to come back at any compacity. If you still feel that way, I suggest you make a detailed list of all your job duties and expectations and go to your D.O.N. Present it in a way that you are asking for support. Your job performance not only effects the revenue of your building but indicates the quality of care your residents are receiving. Stay positive (as positive as you can as you sit in your office with your space heater, windows sealed with garbage bags, and leaking roof) and express your desire to do a great job. Accentuate that your performance depends upon a team effort and you can not give 100% if you are constantly being delegated more tasks. It is like spreading your abilities too thin. Don't present it like a whine or complaint, but indicate how you can improve the case mix, etc. if you can concentrate more on assessments, care plans, and coding correctly. The so called "fixing" documentation does not need to fall on you. There should be inservices for the staff on what they need to document for support of the MDS. You can provide the information, but it should be up to nurse management to make sure it is done and done correctly. A good MDS needs support of the whole interdisciplinary team. Good luck.

Under section M, what type of documentation is required in the chart for a turning and repositioning program? I am confused because I thought it had to be specifically for the resident with interventions such as positioning device or pillows - documented, monitored, and reassessed to make sure this program is working for the resident. I am told the turn q 2 hrs meets the requirements if the CNAs sign off on the CNA ADL care plan that states turn q 2 hr.

I agree with all the above comments. When I first heard about 3.0 coming out, I was excited and thought they would really improve and simply the MDS. I was so disappointed when I saw it. I think most of it is a waste of time. I don't understand what they were thinking when they created it. They sure weren't thinking environmently friendly with making it so many pages. We also can not keep up with the discharge assessments at my facility. And the questions are so redundant. Some of our residents refuse to keep answering the same questions when multiple assessments are due. I hope they make some revisions in the near future, but I am not holding my breath. I have already been disappointed once with the new MDS.