kdhnursern

You will do fine. In 1995, I graduated with my BSN, passed my boards, and went to work in a LTC facility. This was also my first healthcare job so I had no previous experience. I worked a combination of LTC, skilled, and Alzheimer's (locked unit back then). You will be trained to chart on the residents and they will teach you what to chart about. It's all on computer now and mostly "fill in the blanks". Your assessment skills will be what you'll need most. In LTC, you will have more time with the resident so you are the eyes and ears of the doctor. Being a charge nurse, there will be a "team" who will give all the cares to the residents. You are going to learn a lot in LTC. Some look down their noses at nurses who work in nursing homes but I found it to be quite an education. In my years, I worked LTC, dialysis, occupational health, and management. The LTC taught me the most. Enjoy your new career. You will do fine!

Skills charting is charting towards what Medicare patients have been admitted to the facility for such as CHF, hip fracture, ... whatever the skilled nursing is for. Charting should document daily skilled care which is required for Medicare reimbursement or to establish the Case Mix Index for Medicaid. Skilled for nursing can be IV therapy, pressure ulcer or wound management, new tube feeding, or suctioning, cares that require a nurse's skills. Skilled rehab is PT/OT/ST. The facility should have examples of what they require for documentation. Our facility is totally electronic and we have skilled assessments for the charge nurses to fill out every shift.

CapeCodMermaid, this is great! I plan to present this to my DON to give to the staff at inservice. Thank you for sharing it!

I must love doing MDS's since I did them for a few years, went to doing dialysis for 5 years, went back to LTC for a couple years, and now have been doing MDS's for about 10 months again. It is interesting putting the whole puzzle together. An MDS Coordinator needs to be self-directed and have their own way of scheduling their days to make it work. Going from 2.0 to 3.0 was quite a challenge and made us reassess our scheduling but now is smoother. My facility is going from using one documentation program to a new one and also going from paper to electronic charting- everything all at once. Another challenge... but one that looks like it will give me a LOT more information to use. Just have to be open to change. And I love the challenge!!!!

Just passed my last AANAC test last night and can' wait to get my certificate. My company paid for the 3 day course, too, and I took the tests online. I think this was well worth their money. It's good to see the "whole picture".

Therapy is looking at the resident at his best for documentation. MDSs are coding them at their worst. If a resident is coded during the day as a 2/2 but on nights they are a 3/2 for 4 days during the look-back period, using the rule of three's, they would be coded as a 3/2. Therapy documentation can be used to write care plan goals. I've been working with my CNAs on ADL coding to try to get better data.

I'd just like to see all the documentation that I need to complete my MDS in the chart! Just give me what I need and I'd be happy!

I don't know about Illinois, but in Kansas, we do not have Section F on our quarterly assessments. But when I'm doing the interviews, I do Section F for all MDSs only because it lets me keep up with their preferences and it's quicker just to do it that to decide each time if I need it.

Our facility has received 2 software patches since Oct 1st. It has fixed some MAJOR glitches. But we keep finding more.

But you are still getting information only as good as the CNA. Ours do ADL sheets daily but it seems that the first person to code anything sets the stage. Everyone else just seems to copy what was put there the day before. So, if they coded it wrong the first day, it just is wrong the whole month. Wish I could fix this! If I see that the coding doesn't reflect the real way the resident is, I do a short note about what was observed during assessments and interviews. Hope it doesn't look bad since I'm the one doing the MDS's and also finding incorrect charting.

Here is a good link for wounds: http://www.woundconsultant.com/files/Wound_Documentation_Tips_6.07.pdf This is from Wound Care Education Institute - which has a great Wound Care Certification program.

I fill out the AIMS, Braden, elopement, fall risk, pain, and side rails for every quarterly and add a 3 day bowel and bladder for annuals. The nurses doing the admits do all these and I use that info for the admission, 5 day, and 14 day. I do everything but the 3 day B&B for the 30, 60, and 90 day. When you add the Section C, D, F, and J's, that's a lot of assessments to do. And in training, when they said those interviews would take about 17 minutes average......they just weren't trying them on MY residents!!! I have found that I get a lot of info from those interviews, I just don't think it's realistic to expect someone to do the full set in 17 minutes. And, BTW, I do all my own data collection and data entry. 120 bed facility and 2 MDS Coordinators have 60 residents each.

Our facility recently wrote a policy addressing it. It's one thing to talk with friends on the phone. It's another to spread your feelings worldwide. There is always that old saying "Be sure to make your words sweet, tomorrow you may have to eat them". Not sure of the specifics of what had been posted on facebook from employees, but I have seen some of the photos that have been posted. Not something I'd want a prospective employer in the future looking at!! No thought in their head that they are professionals and should try to promote that image.

Just started as MDS Coordinator again a couple weeks ago after being out of it for about 8 years. I remember the changeover to MDS 2.0 from the "Blue Bible". Guess I'll just "go with the flow" and learn again. At least the last two weeks I've felt like I kind of knew what I was doing and yesterday I felt like I had the hang of it again. Good-bye 2.0! But it sure was easier to carry the "Blue Bible" around!!!

Started in LTC, tried Occupational Health 3 years, decided to go back to LTC because I missed the real nursing I had done there. Then I worked as a dialysis nurse for 5 years and have gone back (again) to LTC where I LOVE my job. "Just a LTC nurse" proves how stupid people can be. This is a very demanding area but a very rewarding area, too. I have been lucky to work in facilities where I am given all the tools and backing I need. They have also furthered my education which actually makes me more marketable. But I am happy right where I am. I think I'll stay this time.