fulzgold

My specialty is clinical reimbursement, MDS, for long term care. I have been working as an interim, using recruiters as my marketers basically. I invoice the company directly. My contracts start out for 8-12 weeks, however, there is so much work out ...

I have a Regional consultant that is absolutely brutal. Every time she comes to my building, she spends the entire time drilling me, insulting me and embarrassing me. She tries to get me to spar with her by insulting me first. She has a rebuttal for ...

I'm a new DON in a small facility, less than 25 res.. 14 yrs of SNF experience:ADON,MDS Coordinator, staff nurse... I was not inserviced of course, given a list of tasks to sign and tossed the keys. I'm told this is the norm. Anyway, I'm a detail ...

Ok,this is makeing me crazy. What do you do when family members google a med and insist this med is the cause of some S/E. Yes, by God, they've Googled the med, read the S/E, assessed the patient and noted the S/S and want that med discontinued! Shee...

My admin wants me to try an on call rotation for the staff nurses to keep the floor covered. I have worked in several types of nursing settings that used this solution, but that was years ago. Do you use this at your facility and how has it worked ou...

A prior admin I had, told my scheduler to cut staff back to one cna and one nurse on night shift without any knowledge of resident care needs. Over 60% of the residents were a 2 person assist, 4 residents who were behavior problems were also night ow...

No, there isn't such a place, there are numerous DNS out there who all had the same ignorant (not an insult,) thoughts going into it. You'll soon discover that doctors and nurses are not consulted about patient care needs, but told, by the non medica...

This is a terrible job. You all have my admiration. I have met with so much resistance from "the powers that be". I'm fairly certain I was set up to fail. Back in April, after review of a referral, I had advised we could not meet this particular pati...

I got lucky at my facility. The Rehab was an SLP with a head for business. I showed him the case mix index and explained how the nursing care, and therapy tx effects RUGS. I gave him the list of rugs with $ amounts and a list of requirements for ach...

Wow, good ideas. Thank you so much. The prior DON had an assistant who did everything for the staff nurses for so long that they have forgotten their job tasks. They truley think it's not their job to finish an order or do their own admissions. I gav...

Jeesh! Our admin does stupid stuff like that too. One time she drove 2 hrs away to a womans apartment to assess her for placement. When she came back she was actually considering this patient. The patient was a 42 yr old female who had lived in her b...

Our is Twonumbnutsinacan. Still having all kinds of glitches. It won't validate because no matter what assessment you code for it throws old answers from prior 2.0 admits in there and fatal errors it. Can't transmit till they fix it. If they don't ge...

In August, I moved all the routine OBRA assessments due in october, up to September and spread them out through the month. That was rough, but that way we have plenty of time to focus on the PPS. We are choosing the no option. We will be doing repeat...

Too many,, and too many!

Anyone ever have a mutiny at their facility? One shift of CNAs against another? What did you do to stop it?

Ever had to or tried to discharge a patient who does not want to leave? Been lucky so far, but we have had a few who were either not sick enough to qualify with their payor source and did things like " fall.. then say .."can I stay now?" or refuse to...

[ You can't teach common sense . No, you can't. Common sense isn't all that common. It is actually a gift. I've heard these questions from staff: "Since the resident fell at the hospital and not here, do we still have to do neuro checks"? Concerning ...

We dont do those any more. We instituted a "weekly assessment". It covers everything that the MDS covers and encourages the nurses to provide a routine full assessment of residents who normally would not get one unless they are sick or it is time for...

I may be a little to picky about accuracy in coding but, I scheduled a Sig Chng on a res with End Stage Alzheimers who went hospice. She can no longer speak anything but gibberish, screams, hits, bites, kicks during care, stopped eating and drinking....

I wouldn't say "better" than. I have experienced the same ungracious comments from insecure LPNs. It's not in my character to pay them back with comments in kind. Remember, the difference between LPN and RN is simply 6 more classes and 2 more semeste...

Not really, boobs don't have the education required to understand the questions. Any of them who want to argue, just tell them the difference is 2 more years of college and 8 more classes.

Has anyone ever had the hospital fill out your paperwork for an admission? I have often considered requiring this. We normally get orders faxed early on so we can get a head start on the paperwork and hope to only have to clarify order changes after ...

Right.

There are many situations where there may be more than 3 quarterlies re: adding the OMRA and OSRA when needed. Since they have no specific OMRA/OSRA assessment, one would use a quarterly. Now when 3.0 is in effect, a lot will change.

My consultant says the quarterlies can not be any further apart than 92 days but can be closer together. So if you have a res due for a Q in a month and notice right now they had a PICC line put in for IV ATB for 10 days, then you should do a quick q...